Talk:Chiropractic

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(This section is a stub, and attempts to keep the RFC bot happy so that multiple RFCs can be listed. Please see #Request for Comment: Excluding treatment reviews below for the discussion thread.) Eubulides (talk) 23:27, 16 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."[1]

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)

A starting point for a look at the effectiveness section and introduction

I've been having an interesting discussion with User:Eubulides (thank-you!) about Chiropractic and the scientific basis of its effectiveness / efficacy (I prefer the word effectiveness for the lay reader). A number of issues strike me.

• It's not sufficient to simply link to published studies. Not all studies stand the test of time: they may be later discredited or have other problems such as methology, bias, etc etc. This issue is one of synthesis, and is outlined here WP:SYNTH. This is an issue of Wikipedia policy.
• A good starting point is the Cochrane Collaboration. In the words of Edzard Ernst:

Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion.

• Given that the Effectiveness section at present has a 'Synthesis problem' box, I'm going to try to use Cochrane to get a start on the evidence as it stands in the scientific community today.

Comments, objections etc welcome. Cheers, Macgruder (talk) 12:58, 3 September 2008 (UTC)

Both Cochrane Collaboration and Edzard Ernst is already cited in the effectiveness section and I do not have any idea what in the world you are proposing. QuackGuru 13:10, 3 September 2008 (UTC)

• I agree with Macgruder that it doesn't suffice merely to link to published studies. Chiropractic #Evidence basis attempts to follow the advice given in WP:MEDRS about reliable sources in this area; these guidelines agree with you about using up-to-date studies.
• Macgruder came to this discussion recently, so here's a bit of catch-up for his benefit. Obviously we should be avoiding synthesis. The WP:SYN tag was placed by supporters of chiropractic, who I expect would say that citing the Cochrane collection would constitute synthesis. For more on this, please see Talk:Chiropractic/Archive 24 #Syn tag, Talk:Chiropractic/Archive 24 #SYN and implicit conclusions, and Talk:Chiropractic/Archive 25 #Proposed wording for NOR/N, and Wikipedia:No original research/noticeboard #Chiropractic section on evidence basis.
• If it helps, here is a list of works in the Cochrane database that are currently cited in Chiropractic: Assendelft et al. 2004 (PMID 14973958), Hayden et al. 2005 (PMID 16034851), Gross et al. 2004 (PMID 14974063), Bronfort et al. 2004 (PMID 15266458), Glazener et al. 2005 (PMID 15846744), Proctor et al. 2006 (PMID 16855988).
• I agree with QuackGuru that it would be helpful to have specific proposals for wording changes.

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

Eubulides is grossly misrepresenting the SYN issue again. This is not a matter of chiropractic supporters versus chiropractic critics. This is a matter of editorial SYN. As I have said in the past, any study which isn't specifically about chiropractic should not be used (regardless of whether the conclusions would favorable or not if interpreted and applied to chiropractic). This is a pretty basic and real complaint about this section. No research should be used unless it is specifically commenting on chiropractic efficacy. If it is merely commenting on the effectiveness of spinal manipulation as performed by practitioners other than chiropractors, then it should not be used here in this article (but rather at Spinal manipulation. This is an article about chiropractic. Chiropractors employ a specific form of spinal manipulation wholly unique in application and technique tot he chiropractic profession. Using studies of other practitioners performing different spinal manipulation techniques creates an OR violation (regardless of whether the research is favorable to spinal manipulation or not). Essentially what we are doing now would be tantamount to describing the effectiveness of Dentistry using research studying the efficacy of dental care as performed by heart surgeons. Cochrane is a very reliable resource and should be used at this article if the researchers have something specific to say about the efficacy of chiropractic, but should not be used if they are only discussing spinal manipulation as performed by non-chiropractors. -- Levine2112 ^discuss 20:57, 3 September 2008 (UTC)

I expect that all the Cochrane reviews include some data from non-chiropractic sources, and I expect that the editors who placed that SYN tag would therefore exclude all Cochrane reviews from Chiropractic. If there are any counterexamples to this expectation, it would be good to hear about them. I don't see what is being misrepresented here; I've tried to be clear that these are merely my expectations, which of course may be incorrect. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Levine2112, you are twisting things again, just like at the NOR noticeboard, where I replied to you, and you evaded without providing evidence yet. You are creating a straw man diversion when you write above "Using studies of other practitioners performing different spinal manipulation techniques..." ^{my emphasis} We are talking about the same HVLA techniques by different names (non-DC researchers and DC researchers call them "spinal manipulations" (regardless of practitioner), and DCs call them "adjustments" and "spinal manipulations"). -- Fyslee / talk 04:47, 4 September 2008 (UTC)

Talk about strawman. You have actually been the one evading my question which remains: How do you know that they are the exact same techniques? I'm still waiting for an answer. -- Levine2112 ^discuss 05:59, 5 September 2008 (UTC)

I don't recall that question and will defer until you answer my requests for evidence backing up your unusual claim. You made the claim that they were "mechanically" different, but haven't provided any proof of such a difference without resorting to OR and personal opinion inferences. While that is interesting and I'd like to see your evidence, that isn't the discussion here. We are talking about the terminology used. Do you deny that non-DC researchers and DC researchers call them "spinal manipulations" (regardless of practitioner), and DCs call them "adjustments" and "spinal manipulations"? I really doubt that in these cases (the cited research) they are including esoteric and odd brand name chiro techniques like Activator, and comparing it to real HVLA manipulations/adjustments. -- Fyslee / talk 06:37, 5 September 2008 (UTC)

I've read all the above and rather than trying to comment individually to everyone. I'll try to give an overrall summary of my feelings:

• Wikipedia policy is very clear on the idea of original research. You do not synthesize different viewpoints combined with a knowledge of other articles (such as the placebo effect, difficulties in constructing a double-blind study) and so forth. You simply look for a respected source and summarize it. However, this has to be done carefully due to the issue of due weight, and defining what is a respected source;
• This means that you need to be careful not to simply choose to summarize a published paper, or a single paragraph from it. The paper itself may not have been studying the summary you are inferring from it (the problem with the deVocht) paper; it may have been funded by an interested group (Atkins diets also have this problem); it may later on closer inspection by experts in the field be dismissed for the way it was carried out etc. , it may not be challenged by other scientists because the assertions it makes are not the main focus of the paper. This last is an important point. A paper about the social and historical issues of Chiropractic may make assertions about the results of research but since this is not the primary focus of the paper, it will not be necessarily looked at by other researchers. etc.
• Thus the best approach is to let the experts do this work for you, and summarize that. Sometimes this can be hard to find, but it's not too difficult in this case:

Focus Altern Complement Ther 2005; 10: 87–8 http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

This is a summary by Edzard Ernst (who has impeccable credentials on the issue of evidence-based medicine ) on Chiropractic using Cochrane.

Now, you could object to this writing on the grounds of something like "it also includes spinal manipulation as performed by non-..." (this is just an example), but that is irrelevant to Wikipedia because it's original research. Your objection needs to be reliably sourced, and if it is sourced it can be included (see policy quote below). Ernst says his article is about Chiropractic thus we summarize it. Ernst article obviously corresponds with his published paper too.

Obviously, here Ernst's conclusion is something you may not agree with that but that is besides the point. If you can find a paper/writing with the other viewpoint then that can be included too, but note the Undue weight issue. Wikipedia policy says:

NPOV weights viewpoints in proportion to their prominence. However, when reputable sources contradict one another and are relatively equal in prominence, the core of the NPOV policy is to let competing approaches exist on the same page: work for balance, that is: describe the opposing viewpoints according to reputability of the sources, and give precedence to those sources that are most reliable and verifiable.

At the moment, we have in the introduction as a summary a single paper by DeVocht. ( ... 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 that is giving just an overview as part of an introduction to a paper on a different subject (i.e. not efficacy) cannot be compared to a scientifically controlled review study or a systematic review of Cochrane by Edzard Ernst. ), and it is patently WP:UNDUE to include only this paper in the introduction. At a stretch you can summarize Ernst and add a sentence alluding to this paper.

(The use of Ernst plus Cochrane works well in Acupuncture where it concludes that acupuncture may be effective for a particular subset of treatments.)

Another suggestion is to also put individual research results into their own article like http://en.wikipedia.org/wiki/Low-carbohydrate_diet .

Anyway, I'm going to take a stab at updates the introduction paragraph of the article (effectiveness area) based on the above. If you have objection to the use of Ernst and Cochrane that's fine - but to save time just link to the objection that you have found in a reputable source. (A quote in a newspaper is not sufficient - Flat Earthers are quoted in newpapers all the time :-) Obviously, an opposite summary viewpoint would be important. I'd like to see links for that. Macgruder (talk) 06:43, 5 September 2008 (UTC)

• We agree about WP:OR and WP:SYN and summaries.
• A proposal for improving the text would be welcome, but perhaps first I should mention a few problems that you might want to be aware of.
• The editorial that you cite (Ernst 2005) is obsoleted by Ernst 2008 (PMID 18280103). Ernst's 2008 paper is peer-reviewed and covers the same ground in a lot more detail than Ernst 2005, and is more up-to-date. I see no value in citing an older, less-detailed, non-peer-reviewed, duplicative source by the same author. I suggest citing Ernst 2008 instead of Ernst 2005 for any new text you'd like to propose.
• Ernst is a reliable source, but he is definitely not the only reliable source in this controversial area, and Chiropractic should not be rewritten to promote Ernst's views at the expense of other reliable sources. Other sources for the evidence basis of chiropractic that deserve attention, in addition to Ernst 2008 and to Ernst & Canter 2006 (PMID 16574972), include Villanueva-Russell 2005 (PMID 15550303), Johnston et al. 2008 (PMID 18404113), Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), Meeker et al. 2007, Vernon & Humphreys 2007 (PMID 17369783), Hurwitz et al. 2008 (PMID 18204386), and Hawk et al. 2007 (PMID 17604553). There are others, but that's enough for starters. Each of these sources are highly reliable and summarize chiropractic's evidence basis just as well as Ernst 2005 does, and in many ways better. But they don't agree with each other. (That would be too easy. :-)
• For an "opposite summary viewpoint" please read Chiropractic #Evidence basis. It cites all the papers I've mentioned above (including Ernst's of course), and cites many more to boot. It gives both the supportive-of-chiropractic side and the critical-of-chiropractic side, and for both sides it cites high-quality sources in peer-reviewed journals. This is not flat-earth or newspaper stuff.
• Getting back to the "many other medical procedures also lack rigorous proof of effectiveness" point: nothing in Ernst or any Cochrane review contradicts this comment by DeVocht. More generally, I am unaware of any reliable source disagreeing with this point by DeVocht. DeVocht's comment is a meta-comment about whether scientific evidence is required before a medical treatment can be undertaken, and as such it is highly relevant to this section. I still don't see why it should be removed. Given that we have one editor for removal of this stable text, and one editor against, I suggest keeping it in for now. (Or perhaps another editor can chime in on this subject.)

Eubulides (talk) 07:27, 5 September 2008 (UTC)

• This is good stuff. One brief point before I take a look at those links in detail: a number of the links you give me are papers from Chiropractic colleges: i.e. summaries published by people whose professions depends on the positive outcome of these trials. A problem Ernst alludes to.
• It'll take time to see whether these are 'highly reliable', but thanks for listing them.
• "nothing in Ernst or any Cochrane review contradicts this comment by DeVocht" - this doesn't mean they agree with it. More likely they don't think it's worth addressing. I don't see any evidence that DeVocht carries anything near the weight of Ernst regarding evidence-based medicine. I myself have had a scientific paper published (about another topic), but I'd be shocked if anyone in Wikipedia used it! It's a question of undue-weight. Make the point when referring to the paper but that point cannot be synthesized to the intro.
• A very pertinent issue is here. A paper published by Chiropractors themselves:

http://www.chiroandosteo.com/content/16/1/10

Macgruder (talk) 10:25, 5 September 2008 (UTC)

• I agree that Chiropractic #Evidence basis is good stuff. Some of the good stuff is written by chiropractors, and some of it is written by non-chiropractors. High-quality sources should not be excluded merely because chiropractors wrote them.
• I'm glad you agree that the Cochrane reviews and Ernst do not disagree with DeVocht's comment about other medical fields not having rigorous scientific evidence. As I understand it, your concern now is not that DeVocht's comment is incorrect, but that it's not notable. But this concern is misplaced. It is common knowledge in medical circles that many medical procedures are not supported by rigorous scientific proof. Here are two examples:

• Vincent 2004 (PMID 15302748) writes about randomized controlled trials (RCTs) in other fields of medicine and then says, "However, in intensive care medicine the situation is a little different, with RCT evidence frequently lacking....".
• Jeppsson & Thorlacius 2005 (PMID 18333189) write about RCTs and evidence-based medicine (EBM) and say, "There are several reasons for this lack of RCTs in surgery. One important reason is the reliance on RCTs as the cornerstone of EBM. The value of RCT is however limited in surgery. There are four main reasons limiting the value of RCTs in surgery.... 1. Experimentation may be unnecessary.... 2. Experimentation may be inappropriate.... 3. Experimentation may be impossible.... 4. Experimentation may be inadequate."

Many more examples of this can be cited. The point that many medical techniques are not well-supported scientifically is not controversial, is relevant to Chiropractic #Evidence basis, and is mentioned in a reliable source. I still see no reason for omitting it. Eubulides (talk) 16:26, 5 September 2008 (UTC)

MacGruder, I have no problem using reliable research which make specific conclusions about chiropractic (regardless of whether or not they are favorable to chiropractic). I do object to us using research which does not make any conclusions about chiropractic specifically (whereas the research may have studied spinal manipulations as performed by non-chiropractors and then made conclusions about spinal manipulations in general). For us to take this general non-chiropractic spinal manipulation research conclusion and apply it to make a conclusion about chiropractic at this article is - in my mind - a violation of WP:OR. Again, essentially what we are doing now would be tantamount to describing the effectiveness of Dentistry using research studying the efficacy of dental care as performed by heart surgeons. I am not speaking about DeVocht or Ernst or Cochrane specifically at this point. I am only trying to reach an agreement of generalities (i.e. At this article, we should not cite research on non-chiropractic spinal manipulation which makes no conclusion specifically about chiropractic.) Does that sound reasonable to you? -- Levine2112 ^discuss 18:21, 5 September 2008 (UTC)

• This comment on "generalities" takes a position that would exclude all use of the Cochrane reviews in question. Again, for more about this topic, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, and Chiropractic section on evidence basis.
• Going back to Macgruder's comment on "a very pertinent paper". I agree that the paper is pertinent. For more, please see #Murphy et al. 2008 below.

Eubulides (talk) 19:11, 5 September 2008 (UTC)

Why would it exclude the use of Cochrane? -- Levine2112 ^discuss 19:14, 5 September 2008 (UTC)

Please see #Cochrane reviews below for a followup. Eubulides (talk) 20:34, 5 September 2008 (UTC)

Summarize what researchers conclude

"As I understand it, your concern now is not that DeVocht's comment is incorrect, but that it's not notable. But this concern is misplaced. It is common knowledge in medical circles that many medical procedures are not supported by rigorous scientific proof. Here are two examples:"

I think you are misunderstanding the issue here. Wikipedia does NOT allow us to take any idea like '...many medical procedures are not supported by rigorous scientific proof', and synthesize it into a summary. The only place it belongs is in a summary of DeVocht's paper.

'It is common knowledge in medical circles that many medical procedures are not supported...' This is a rather bizarre comment to say the least. It may be true but that is not the point. We only summarize what researchers conclude. We do not take our knowledge drawn from other sources and use it to construct our own synthesis of the material.

Equally, the issue with whether it's chiropractic or SM. It's not for us to decide. We report the paper and its conclusions. I can absolutely agree that if the paper doesn't even mention chiropractic then we don't report it, but if for example the paper mentions both it is not up to us to decide. We report what the paper says (and if necessary look for a criticism of that paper and report that), and the reader can decide.

This is what I see is the major problem with this page: editors are attempting to do too much: taking a bunch of conflicting papers and create some kind of synthesis. We should not be trying to do A + B + C + D = summary. Wikipedia simply allows us to do A + B + C + D = A' + B' + C' + D' where X' means summary of X. Ultimately, the challenge here is one of notability, not of synthesis. To repeat Wikipedia policy:

NPOV weights viewpoints in proportion to their prominence. However, when reputable sources contradict one another and are relatively equal in prominence, the core of the NPOV policy is to let competing approaches exist on the same page: work for balance, that is: describe the opposing viewpoints according to reputability of the sources, and give precedence to those sources that are most reliable and verifiable.

This is what concerned me when I first read this article. The introduction has essentially DeVocht at 100% notability and everyone else at 0%.[Edit: rather an exageration!] An introduction should read something like this:

The evidence for the effectiveness of chiropractic is controversial. A summary of recent systematic review papers by Ernst & Canter published in the Journal of the Royal Society of Medicine concluded that Spinal manipulation as practiced by chiropractors, osteopaths, physiotherapists is a not a recommendable treatment option for any medical condition, and that this conclusion was consistent with the conclusions of 13 of the 16 most recent systematic reviews. Ernst & Canter noted that authorship by osteopaths or chiropractors and low methodological quality were associated with a positive conclusion. On the other hand... [SEE BELOW]

The above is just an example. One problem I have come across is I can't find any other summaries of review paper. Note: I don't mean individual review papers. Are there any other summaries of review papers? Are there any systematic reviews of systematic reviews that support chiropractic:

[CONTINUE] On the other hand, while no summaries of review papers concluded that chiropractic is an effective form of treatment, a review study by ... etc.

Now the above is only meant to suggest the 'way to go' as such, I'm not suggesting that such text is necessarily final. Here the challenge is one of notability and weight. The above is a factual summary of the report. It is not up to us to interpret it; Wikipedia simply reports it as it clearly meets the notability criteria. Obviously, other review studies come to other conclusions and we should report those too but keeping an eye on 'NPOV weights viewpoints in proportion to their prominence.' And this I see as the challenge. Stay away from trying to synthesize. Simply report. Macgruder (talk) 09:07, 6 September 2008 (UTC)

• I agree that it's not for us to decide, but I'm afraid I still don't understand the objection to the claim supported by DeVocht's paper.
• "Wikipedia does NOT allow us to take any idea like '...many medical procedures are not supported by rigorous scientific proof', and synthesize it into a summary. The only place it belongs is in a summary of DeVocht's paper." But the stated idea is a summary of a point in DeVocht's paper. The statement merely summarizes DeVocht; it does not come to any conclusion that DeVocht himself does not come to. So I don't follow this point. Wikipedia certainly does allow us to summarize points taken from reliable sources. And that is what was done here.
• "We should not be trying to do A + B + C + D = summary. Wikipedia simply allows us to do A + B + C + D = A' + B' + C' + D' where X' means summary of X." The latter is exactly what is occurring in Chiropractic #Evidence basis. Every statement in it is a summary of a major point in a cited source. The statement "Many controlled clinical studies of SM are available, but their results disagree" accurately summarizes a point made by Ernst & Canter 2006 (PMID 16574972). The statement "many medical procedures are not supported by rigorous scientific proof" accurately summarizes a point in DeVocht 2006 (PMID 16523145). There is no difference between those two summaries. If the summary of DeVocht were objectionable (which it is not), the the summary of Ernst & Canter would also be objectionable.

For more comments, please see #DeVocht's weight below. Eubulides (talk) 11:16, 6 September 2008 (UTC)

OK. I've edited the comment regarding DeVocht. But you are still missing the point here. You write this sentence as truth:

The statement "many medical procedures are not supported by rigorous scientific proof" accurately summarizes a point in DeVocht 2006. Yes, it does but you are not presenting it as a point by DeVocht. You are presenting it as a fact: Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. This is the point of WP:SYNTH. You are taking one point by DeVocht, putting it into the summary written in such a way that it's a fact relevant to Chiropractic. That's what I meant by the 100% issue (although I agree I overcooked it somewhat). This is my whole point. You must be presenting stuff as individual summaries and clearly stating that they are summaries (essentially quotes).

There is substantial difference between

A study by Ernst concluded that ... not a recommendable treatment option for any medical condition. On the other hand, DeVocht in 2006 questioned the reliability of studies pointing out that many medical procedures are not supported by rigorous scientific proof

and

Many medical procedures are not supported by rigorous scientific proof.

You are attempting to synthesize which we cannot do:

"A study by Ernst concluded that Spinal manipulation as practiced by chiropractors, osteopaths, physiotherapist is not a recommendable treatment option for any medical condition.' is an unarguably true statement which can be verified.

many other medical procedures also lack rigorous proof of effectiveness is not.

DeVocht states that many other medical procedures also lack rigorous proof of effectiveness is fine on the other hand.

This is the point here. Don't take points and frame then as fact. Frame them as statements made by someone. This is a very different thing. Hence my call for deciding which researchers have the weight as required by Wikipedia policy.

(Another issue is that DeVocht doesn't appear to have the weight of other researchers but that is another question).

Macgruder (talk) 12:15, 6 September 2008 (UTC)

Yes, I missed the point. It appears that this is not a WP:SYN issue at all; instead, it's a style issue, of how to present fact or opinions that are undisputed among reliable sources. As I understand it, you are taking the position that, if some Wikipedia editor disputes a fact or opinion, then it must be explicitly attributed in the text (e.g., "DeVocht says"), rather than being attributed via citation. For more, please see #Simon-says and DeVocht below. Eubulides (talk) 18:43, 6 September 2008 (UTC)

Not necessarily, 'DeVocht says' but definitely where there is dissenting opinion or doubt of veracity, clarity that this is not fact. It is a style issue but it becomes a synth issue if the two ideas are mixed together. It's better in this case to drink your orange juice then your tomato juice then try to mix them together :-)

In short, clearly separate the two dissenting opinions/sides. The question is also one of weight/prominence (i.e. the respect the writer commands) of opinion. Mixing up the dissenting opinions actually makes the fact that there is strong dissent in the scientific community hard to see, but equally there are people also making a robust defense. I find the article as it stands somewhat seems to be a water-down version of the sides Macgruder (talk) 04:21, 7 September 2008 (UTC)

• Sorry, I cannot follow the previous remark. As far as we know, among reliable sources there is no dissenting opinion for the "many other medical procedures also lack rigorous proof of effectiveness" claim; instead, there is a strong mainstream consensus. I agree that when reliable sources disagree both sides should be presented with due weight; but here, no reliable sources disagree.
• Wikipedia is supposed to be an encyclopedia, not a court-hearing transcript.
• That being said, if there are specific suggestions for improvement to this article's wording, please make them here. It is helpful to have a fresh ear and eye look over the text.

Eubulides (talk) 05:05, 7 September 2008 (UTC)

"Wikipedia is not a court-hearing transcript". Well this directly contradicts Wikipedia policy itself where when reputable sources contradict one another, then you are required to present the differing viewpoints with clarity. If this turns out to be like a 'court-hearing transcript' transcript so be it (but you are misunderstanding my use of 'he says'. We don't need to specifically do that if the context makes it clear anyway:

NPOV weights viewpoints in proportion to their prominence. However, when reputable sources contradict one another and are relatively equal in prominence, the core of the NPOV policy is to let competing approaches exist on the same page: work for balance, that is: describe the opposing viewpoints according to reputability of the sources, and give precedence to those sources that are most reliable and verifiable.

'lack of dissent' does not imply agreement. I couldn't find any lack of dissent to the assertion that the positive results came from badly-designed studies or studies done by chiropractors but I wouldn't present it as a fact because I know it's disputed whether or not I can find an explicit disagreement.

I have a suggestion. I'll write the Ernst and al viewpoint and you do the other. I can do mine first. Macgruder (talk) 05:31, 7 September 2008 (UTC)

• It is not Wikipedia policy to use a court-hearing transcript style. It is policy to present reliable sources fairly and with proper weight. But there are lots of ways to do that, and the ways that are better for an encyclopedia are almost invariably ways that do not use a court-hearing transcript style.
• No reliable source makes the claim that "the positive results came from badly-designed studies or studies designed by chiropractors". Not even Ernst makes that claim.

Eubulides (talk) 07:48, 7 September 2008 (UTC)

• "It is not Wikipedia policy to use a court-hearing transcript style" Can you show me where it states that? Anyway, this is really strawman. I'm suggesting simply clearly stating the two sides in the introduction.
• "It is policy to present reliable sources fairly." I agree. And the biggest weight at the moment would be the Ernst systematic review study of systematic review studies. At present, the article simply does not give any impression there is a 'strong' body of researchers who review chiropractic as simply ineffective.
• "No reliable source makes the claim that "the positive results came from badly-designed studies or studies designed by chiropractors". Not even Ernst makes that claim." Really? How do you interpret this comment by Ernst:

Our previous work has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion. Macgruder (talk) 15:06, 10 September 2008 (UTC)

• It is also not Wikipedia policy that every article must mention elephants, but I can't show you where it states that. My comment was in response to this exchange: '"Wikipedia is not a court-hearing transcript". Well this directly contradicts Wikipedia policy...'. In that exchange, I understood the "directly contradicts" remark to claim that Wikipedia policy requires a court-hearing transcript style. That claim sounds incorrect to me: I read Wikipedia policy but couldn't find support for it. Perhaps you can find support for the claim, in Wikipedia policy?
• I agree that Ernst's work should be given substantial weight here. It shouldn't exclude other sources, but it should be given weight. We need specific wording proposals to move forward here.
• The quote from Ernst demonstrates that authorship by chiropractors are associated with a positive conclusion, and that low methodological quality is associated with a positive conclusion. Statistical association, however, is not enought to demonstrate that "the positive results came from badly-designed studies or studies designed by chiropractors". In some cases, positive results came from well-designed studies, and from studies not designed by chiropractors.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

Sorry, I've been busy. "The quote from Ernst demonstrates..." I see your point. Wording needs to be careful. I'll work on something. But I may not be around for a week or two. We agree with the weight of Ernst I think. The 'court-style' thing is a red herring! I'm not advocating (ha!) that anyway. I'm simply saying that Wikipedia policy says, put forward differing views considering the weight. If it means that at the introduction at least, one view is presented followed by another, I think that would be good to avoid the issue of synthesis. One sentence that worries me is this: 'In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians and health plans'. It's not that I disagree with it but I think there is no context to the word 'more' or 'greater'. Essentially, chiropractic has moved from 'quack science' of 100 years ago, but the words 'more legitimacy and greater acceptance' imply that it is now broadly accepted. The most complete studies seem to imply that while no longer 'quack' it has really only received acceptance for lower-back, and even for that it appears to be better than cheaper standard methods. So yes, 'more' has too broad a meaning in my mind. Macgruder (talk) 16:13, 17 September 2008 (UTC)

Simon-says and DeVocht

• I call the proposed style the "Simon-says" style, because it alters the text so that every claim in the text has a "So-and-so says" phrase attached to it.
• The Simon-says style is not used much in Chiropractic, or in any other medical article. If it were, the article's lead paragraph would start something like this (added words italicized):

According to Nelson et al. 2005, 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. According to Chapman-Smith & Cleveland 2005, chiropractic is generally considered to be complementary and alternative medicine, a characterization many chiropractors reject in a 2008 survey published by Redwood et al. According to the Council on Chiropractic Education, chiropractic treatment emphasizes manual therapy including spinal manipulation and other joint and soft-tissue manipulation, and includes exercises and health and lifestyle counseling. According to Joseph C. Keating, Jr., 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.

• I hope you see the point. There are dozens and dozens of claims in Chiropractic. If every one of them needed a "Simon-says" qualifier, the article would become bloated, much harder to read, and (most important) much harder for readers to tell which claims were actually controversial and which were not.
• The Simon-says style is not much used in high-quality articles. For example, take Médecins Sans Frontières, a featured article on a controversial medical topic. The Simon-says style appears nowhere in the lead, and in a quick scan through the article I could find no instances of it there, either.
• It is appropriate to use the Simon-says style when the claim is controversial among reliable sources. At that point, different sources should be used, with appropriate weight, and it is apropos to use the Simon-says style, otherwise, the Wikipedia article will appear to be arguing with itself.
• However, the Simon-says style is not appropriate when discussing claims where reliable sources agree. By emphasizing that only Mr. So-and-so makes the claim, the Simon-says style implicitly casts doubt on the claim. That is not appropriate for a Wikipedia article, unless the claim is in fact doubtful.
• I should say that my opinion about the Simon-says style is not shared by all editors on this page. Although almost all uses of the Simon-says style are appropriate by the standard I suggest above: there are two counterexamples (in the following quotes, the Simon-says parts are italicized):

• "Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine."
• "Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims,..."

• In both cases, the italicized words implicitly cast doubt on the claims, which are not controversial among reliable sources. These italicized words, generally speaking, are favored by editors who are supporters of chiropractic (because they cast doubt on a critical claim). I opposed the addition of these words; please see Inserting "Keating says" and Inaccurate insertion of "Simon says" phrases. For those two cases, because some editors thought that the word "antiscientific" was too-pejorative for Wikipedia without in-text attribution, the Simon-says was inserted anyway.
• In the case here, though, there are no pejorative words that I can see. Also, the claim in question is not controversial among reliable sources. So there's no need for the Simon-says style here.
• The claim "many other medical procedures also lack rigorous proof of effectiveness" is not synthesis. It accurately summarizes what the source says. The source (DeVocht) says (p. 244):

"Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either."

• This was accurately summarized by Chiropractic #Effectiveness, which says "Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness." There is no synthesis here at all; Chiropractic is merely summarizing what the source says.
• I see now that you added the qualifier "according to at least one researcher" to the claim in question. But this qualifier gives a misleading characterization to the claim. It's not that just one, or just a few researchers make the claim. The claim is widely accepted among all reliable sources that we have available. It is not disputed by any of the sources. Adding this qualification makes the article slightly more misleading. The qualification should be removed.
• Again, I suggest proposing possibly-controversial claims like these on the talk page first, before installing them.

Eubulides (talk) 18:43, 6 September 2008 (UTC)

• I'm not really proposing a 'simon says' style as such. This is not what I mean stylistically. I'm proposing that what is claim is clearly marked as claim, and that the two dissenting sides are clearly in the intro presented in that order. Once you have made it clear one section is claim rather than fact then it's much easier to read. The intro should have the dissenting claim unwatered down followed by a counter. Like my example above.
• 'many other medical procedures also lack rigorous proof of effectiveness.' Once again you are still missing the point here. First, you claim because it's not disputed by any of the sources it can be presented as fact. ( an extreme counter example but relevant, Geologists don't feel the need to dispute flat-earthers because they believe the point to be irrelevant). This is not the case. On top of which it is clear to me that DeVocht is saying "numerous medical procedures [in the healing arts]" anyway rather than "numerous medical procedures" which is different thing.
• 'The claim is widely accepted among all reliable sources that we have available'. I strongly doubt it. I sincerely doubt that Ernst etc accepts it as relevant. That's important - is it both true and relevant. WP:NOR requires that.
• My point is also that you are giving undue weight to a overview paper at the expense of a systematic review of systematic review papers. You may believe that DeVocht's comment is widely accepted, but I disagree. Ersnt gives the viewpoint that the differing views of efficacy is due to the fact that the positive outcomes come from badly designed trials and tend to only come from chiropractors themselves - a group whose livelihoods, as other scientists point out, depend on the positive outcome of chiropractic.
• Beside arguing about this one point is not very productive. The whole intro and effectiveness section should really be rewritten. The way the sides are presented simply seem to water down both sides, and actually make it difficult to read. Wikipedia policy is very clear. Present the arguments of both sides where there is disagreement. This does not mean trying to mix the arguments into a synthesized whole. Present one, then the other. This way also means that you won't have disagreement, because you are simply presenting the viewpoints as what they are. Like this:

Effectiveness

Short sentence or two outlining fact of disagreement

1. Dissenting viewpoint summarized [Ernst etc]

2. Counter viewpoint summarized [DeVocht etc]

(This also does away with the necessity of 'He says, she says' because the organized structure implies that anyway. )

Link to separate page called 'Medical Research related to Chiropractic' which can list stuff one by one.

(This paper is also relevant to discussion. )

Just to make it clear again so there is no confusion. I'm not proposing a "He says" style for each sentence (my example was just for readability). I'm proposing separation of the viewpoints so both sides can be understood with clarity, and we don' t have the problem of WP:SYNTH as it exists now.

Macgruder (talk) 05:11, 7 September 2008 (UTC)

• Perhaps if there were a concrete wording proposal, rather than just an outline, we could avoid misunderstandings about what is being proposed. Certainly this edit, which you applied to Chiropractic without discussion, used the Simon-says style.
• When you write "This is not the case", what is the "this"? I didn't follow that comment.
• DeVocht writes "numerous medical procedures have not been rigorously proven to be effective". That's pretty clear. There is a previous clause that talks about the healing arts, but I don't see why that's relevant to this discussion.
• "I sincerely doubt that Ernst etc accepts it as relevant." No, Ernst would agree that the point is relevant. He explicitly says in his 2008 paper (PMID 18280103) that "manipulation may be as effective (or ineffective) as standard therapy", the point being that there is no rigorous scientific proof for standard therapy either. He also says "no therapy so far has been shown to make a real difference for back pain sufferers". So again, chiropractic is not alone in promoting therapies that are not rigorously proved scientifically: orthodox medicine does the same thing, for back pain. (As well as for other areas, such as surgery and emergency medicine, as already described above.) We have found no controversy about this point among reliable sources.
• "positive outcomes come from badly designed trials and tend to only come from chiropractors themselves" I am skeptical of that characterization of what Ernst says. Can you provide a direct quote from Ernst to support this claim about what Ernst says?
• More generally, you have presented no evidence to support the contention that there is serious dispute about DeVocht's claim, among reliable sources. Let's see a quote from a reliable source. I've given several supporting DeVocht's claim.
• DeVocht's paper provides a useful overview of chiropractic's view of research; it is broader in scope than Ernst & Canter. It is not reasonable to dismiss a point from a broader-scope paper simply because a narrower-scope paper doesn't address the point.
• Wikipedia policy says that when reliable sources disagree, that both sides should be presented with due weight. This does not at all require that an article must "Present one, and then the other." On the contrary, articles that are written with the "pro" arguments in one big section, and the "anti" arguments in the other, tend to be much weaker articles. All, or almost all, featured articles avoid that sort of organization. Chiropractic should avoid it too.
• Again, I disagree with a "separation of the viewpoints" approach. This should be an encyclopedic article about chiropractic; it should not be a debate. Featured articles typically do not use a debate style; Chiropractic should stick with this high-quality approach.

Eubulides (talk) 07:48, 7 September 2008 (UTC)

• OK. In this case we need to find what has the biggest weight. As far as I can see the biggest weight would be Ernst's 'systematic review study of systematic review studies'. I can find no other 'systematic review study of systematic review studies' to date (obviously there are systematic review studies). It is in this study that Ernst says: Our previous work[6] has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion.
• "manipulation may be as effective (or ineffective) as standard therapy", the point being that there is no rigorous scientific proof for standard therapy either. Yes, but you are taking this out of the context that he would intend it: "In a situation where two or more rival treatments match each other [to determine which is best] the simple determining factor is often cost which mitigates strongly against chiropractors - compare 10 sessions with a chiropractor at $100 each with regular exercise of ibuprofen. Furthermore, there are serious problems with chiropractic philosophy and practice [dealt with later:... ] physiotherapeutic exercise is a much safer option. ' (in Trick or Treatment?)
• In a sense you have answered my point for me. I wouldn't object to the sentence 'there is no rigorous scientific proof for standard therapy either' if you put it in context (because this at least is specific and clear and doesn't break wikipedia policy regarding weasel words), but the vagueness of "numerous medical procedures have not been rigorously proven to be effective" is a totally different nuance. Chiropractic is claimed to benefits dozens of medical conditions (by straights in particular). It's a very different thing for a particular treatment that is based on established medical not have been shown to work any better than placebo, and a medical system/treatement that some practitioners claim to be able to cure dozens of ailments, and yet after testing has not been shown to work any better in just one area (lower back pain) than a standard treatment that is 'cheaper, based on medical principles, and safer'.
• 'This should be an encyclopedic article about chiropractic; it should not be a debate. Featured articles typically do not use a debate style; Chiropractic should stick with this high-quality approach.' This is a kind of meaningless comment because it has no specifics. Which featured articles can you point me to in particular where there are opposing viewpoints are you referring to? Clarifying opposing viewpoints when there are opposing viewpoints is encyclopedic: http://en.wikipedia.org/wiki/Wave-particle_duality . Read through the Wikipedia guidelines and you can see that Wikipedia is not intended to work like other encyclopedias like Britannica which is generally written by an expert but is meant to present verifiable and reputable sources in a clear manner. I cannot think of a less encyclopedic sentence than "numerous medical procedures have not been rigorously proven to be effective" to be honest (whether or not it is essentially a straight quote). Macgruder (talk) 15:50, 10 September 2008 (UTC)

• The phrase 'there is no rigorous scientific proof for standard therapy either' is a bit too strong, as there is proof for a few standard therapies. How about 'there is no rigorous scientific proof for many standard therapies either instead? Also, how would you put this phrase into the existing paragraph? Exactly where? We need a specific proposal, so that other editors can comment on it.
• I recently checked Wikipedia:Featured articles #Health and medicine, and none of the 36 articles listed there had a section with the word "controversy" in its name. I inferred from that they do not use the style that you propose. But perhaps I am misunderstanding the proposal. Please take a look at that list of articles and see if there's an example there of the style you are thinking of.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

DeVocht's weight

• "The introduction has essentially DeVocht at 100% notability and everyone else at 0%". That's not accurate. The 1st paragraph of Chiropractic #Effectiveness, if we take the version before that phrase was deleted, contains 67 words.

• 52% of the words cite DeVocht. These two claims are entirely uncontroversial among reliable sources: "The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment" and "Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness."
• 18% cite Khorsan et al. 2008 (PMID 18558278). This claim is also not controversial: "and there is a wide range of ways to measure treatment outcomes"
• 16% cite Kaptchuk 2002 (PMID 12044130). This claim is also not controversial "Chiropractic care, like all medical treatment, benefits from the placebo response".
• 13% cite Leboeuf-Yde & Hestbæk 2008 (PMID 18466623). Another noncontroversial claim: "The efficacy of maintenance care in chiropractic is unknown."

• Of these claims, one claim is supportive of chiropractic ("many other medical procedures also lack rigorous proof of effectiveness"), and two are critical ("Chiropractic care, like all medical treatment, benefits from the placebo response", "The efficacy of maintenance care in chiropractic is unknown.").
• You removed the supportive claim, and justified this removal by saying that DeVocht was being given undue weight. But this removes the only comment that is supportive of chiropractic, and this raises NPOV issues.
• If the concern is primarily about the weight given to DeVocht, we should remove a different comment supported by DeVocht, namely the "The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment" comment. This comment is somewhat introductory and obvious given the rest of the section. In contrast, the "many medical procedures are not supported by rigorous scientific proof" comment is not so obvious. I made this edit to accomplish the change.

For more comments, please see #Review of draft intro para for Effectiveness below. Eubulides (talk) 11:16, 6 September 2008 (UTC)

As I've pointed out (and better to read discussion above), you are attempting to synthesize not summarize. X says 'A' and Y says 'B' does not get summarized by 'A and B' with the statement that it's balanced. It gets summarized by X says 'a' and Y says 'b' where a,b are summaries of A and B respectively.

You're misunderstanding my comment about 'weight'. I mean the weight of the research itself. i.e. A systematic review of systematic reviews carries more weight than DeVocht's paper. This is open to discussion as I have pointed out. Macgruder (talk) 12:27, 6 September 2008 (UTC)

• In Chiropractic #Evidence basis, there is no synthesis of the form that you describe.
• It is true that the systematic review (Ernst & Canter 2006, PMID 16574972) carries more weight than the opinion piece (DeVocht 2006, PMID 16523145), on topics where the two sources disagree. But the claims that cite DeVocht are not covered by the systematic review. These claims are not controversial among reliable sources. I don't see what the systematic review has to do with those claims: it doesn't talk about those claims. Suppose, for example, one source talks about insurance coverage, but Ernst & Canter do not: does this mean that Chiropractic should not mention insurance-coverage issues?

Eubulides (talk) 18:43, 6 September 2008 (UTC)

But the implied claim that the difference of 'opinion' is parallel to the fact that this is a also problem with other treatments is controversial. Ernst's conclusion from studying the statistics is that positive outcomes are related to badly designed studies and/or studies done by chiropractors themselves. Thus he would hold the above to be irrelevant in this case. This is the effectiveness section where peer review is king - so the insurance analogy doesn't really work. Macgruder (talk) 05:18, 7 September 2008 (UTC)

Again, no controversy about DeVocht's point has been shown among reliable sources. I do understand that you disagree with DeVocht on this point, but that's not enough. We need reliable sources that disagree with DeVocht on this point. As mentioned above, Ernst tends to agree with DeVocht on this point; he certainly does not disagree. Eubulides (talk) 07:48, 7 September 2008 (UTC)

"Ernst tends to agree with DeVocht". Can you find a link to this that Ernst agrees with the numerous point. Equally, I can say that it's not enough that a single sentence that is poorly written because it doesn't deal with specifics, and has not been shown to have broad agreement (lack of disagreement is not the same ). My main objection to that sentence is that it is simply appalling writing, and if it belongs in here being a general comment about evidence-based medicine I'm sure you would agree that it would belong in the evidence-based medicine section. I would attempt to put it in there myself but I'm afraid I would be laughed out of the room :-) Macgruder (talk) 16:56, 10 September 2008 (UTC)

• Ernst 2008 (PMID 18280103) says, "Many national guidelines recommend chiropractic for acute or chronic low-back pain. The reason may not be the convincingly demonstrated effectiveness of chiropractic care but the fact that no therapy so far has been shown to make a real difference for back pain sufferers."
• The sentence (and DeVocht) talks about efficacy in particular, not the evidence basis in general, so it belongs under the more-specific Chiropractic #Effectiveness, not the more-general Chiropractic #Evidence basis.
• For better wording please see the comment on your proposed wording that I just now appended to #Simon-says and DeVocht above.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

Review of draft intro para for Effectiveness

There are several problems with the proposed replacement in #Summarize what researchers conclude for the first paragraph of Chiropractic #Effectiveness.

• There is no source for the claim "The evidence for the effectiveness of chiropractic is controversial." Also, the claim doesn't make sense: it's not the evidence that is controversial, by and large; it's the opinion. It would be more accurate to write "Opinions differ as to the efficacy of chiropractic treatment".
• There is no source for the claim "no summaries of review papers concluded that chiropractic is an effective form of treatment". Furthermore, this claim is incorrect; please see the list below.
• The text "A summary of recent systematic review papers by Ernst & Canter published in the Journal of the Royal Society of Medicine" is puffery. It should just say something like "A 2006 systematic review". The details about the review can be found by reading the citation, just as with all the other reviews cited in Chiropractic.
• The text gives undue weight to Ernst & Canter 2006 (PMID 16574972), which is just one review that summarizes other reviews. There are many other such reviews, which Chiropractic #Evidence basis already cites; these include Ernst 2008 (PMID 18280103), Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), Meeker et al. 2007, Vernon & Humphreys 2007 (PMID 17369783), Hurwitz et al. 2008 (PMID 18204386), Anderson-Peacock et al. 2005, Miley et al. 2008 (PMID 17178922).
• Furthermore, many reviews have come out since Ernst & Canter 2006, or address issues outside the scope of Ernst & Canter 2006. They should not be ignored simply because Ernst & Canter's limitations. These reviews include Khorsan et al. 2008 (PMID 18558278), Fernández-de-las-Peñas et al. 2006 (PMID 16596892), Johnston et al. 2008 (PMID 18404113), Hancock et al. 2006 (PMID 16764551), Murphy et al. 2006 ( PMID 16949948), Conlin et al. 2005 (PMID 15782244), Fernández-de-las-Peñas 2006 (PMID 16514329), Biondi 2005 (PMID 15953306), McHardy et al. 2008 (PMID 1526645), Hoskins et al. 2006 (PMID 17045100), Everett et al. 2007 (PMID 17728680), Romano & Negrini 2008 (PMID 17728680), Hawk et al. 2007 (PMID 17728680), Kingston 2007 (PMID 17728680), Sarac & Gur 2006 (PMID 16454724), Vohra et al. 2007 (PMID 17178922).
• Cochrane reviews are notable in their own right: these include Assendelft et al. 2004 (PMID 14973958), Hayden et al. 2005 (PMID 16034851), Gross et al. 2004 (PMID 14974063), Bronfort et al. 2004 (PMID 15266458), Glazener et al. 2005 (PMID 17728680), Proctor et al. 2006 (PMID 16454724).

Essentially, the problem with the proposed replacement is that it is merely a summary of one review, namely Ernst & Canter 2006. Although this is a reliable source, opinions among other reliable sources differ as to the efficacy of chiropractic treatment. Wikipedia should report those differences; it should not take one side. Eubulides (talk) 11:16, 6 September 2008 (UTC)

I was very clear that opposite opinions were needed, and it was 'just something along the lines of'. Please read what I said carefully please. "It should not take one side". Exactly. As for the puffery, of course, it's just so that people could see where I was coming from. Are the above systematic reviews OF systematic reviews (to repeat systematic reviews OF systematic reviews)? Of course, I think we should have both sides. I thought I made it very clear that it was just an example of the SORT of thing we should be aiming for, and the above in no way represented a final. Macgruder (talk) 12:34, 6 September 2008 (UTC)

The sources cited above are systematic reviews, literature syntheses, and practice guidelines that cite systematic reviews, yes. Chiropractic #Evidence basis is already an example of the sort of thing we should be aiming for: it uses the very style that you propose, except that it avoids the puffery, it cites a lot more source, and it attempts to avoid giving undue weight to any one source. It is not flawless, of course: suggestions for improving it are welcome. It would be helpful to have a more-concrete suggestion than the above; admittedly this will take some work. Eubulides (talk) 18:43, 6 September 2008 (UTC)

Essentially, what I'd prefer to see is that the 'strong' opinions of each side are presented with more clarity. To me terms like 'is unknown' is not helpful when one group of scientists are saying, it potentially dangerous and subluxation is simply not science, while another group dispute that. In other words, I feel the way that it stands now simply waters down the arguments of the two sides. I do feel the effectiveness section is better; more of my objection is to the intro at the top of the article especially 'In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians'.

I like to imagine a visitor to Wikipedia trying to find information on Chiropractic. What she or he reads here may determine whether or not they decide to take that treatment. To me that reader deserves (in the intro as well) to read that their are a body of highly respected scientists that regard chiropractic as essential quackery and potentially harmful. That these opinions exist is a fact and cannot be disputed. That reader deserves to read that no(few?) public university in the U.S. offers a Chiropractic degree and opinions of university professor[s] is that "Having a chiropractic programme would seriously undermine the scientific tradition of any institution, and [it's gobbledygook and pseudoscience]" here. (That reader also deserves to be able to read that apparently there is a schism in the field itself regarding sublaxions etc ). On the other hand that reader also deserves to read that the chiropractic corner has research that suggests that the treatment is effective for certain conditions. I just feel that the article as it stands now is reducing these strong assertions to 'unknown', 'disputed', etc whereas a better way would be to present the strength of each viewpoint separately and let the reader decide. I know of no other medical treatment that has such a vocal group of highly-respected scientists and researchers having such differing viewpoints. Macgruder (talk) 06:00, 7 September 2008 (UTC)

• But it's Ernst 2007 (PMID 17606755) that is saying that the incidence of complications "is unknown". Are you disagreeing with Ernst here? He is a reliable source on this topic.
• Chiropractic #Evidence basis is not trying to water down Ernst's arguments: it is trying to summarize them as accurately as possible. If you can find places where Ernst is being watered down, let's fix them.
• The point that "subluxation is not science" is already made in Chiropractic. For example, its lead says "For most of its existence chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic."
• The claim "In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians" is supported by a reliable source (Cooper & McKie 2003, PMID 12669653). We know of no reliable source disagreeing with it. Obviously medical legitimacy is not the same as the scientific evidence basis, but the point is that chiropractic has gained the former.
• I agree with you about some points that should be raised in Chiropractic, but we need specific proposals. I have made one specific proposal about mentioning quackery, in #Fraud and abuse, and welcome your comments there. Other specific wording-change proposals are also welcome.
• If you look at reliable sources published in peer-reviewed medical journals, you'll find that they do not make the "strong assertions" that you'd like. They say "unknown" a lot. That is because the evidence basis simply isn't there, in many cases, and so "unknown" is the only scientifically justifiable thing to say. Chiropractic should follow the lead of reliable sources in this regard.

Eubulides (talk) 07:48, 7 September 2008 (UTC)

• 'But it's Ernst 2007 (PMID 17606755) that is saying that the incidence of complications "is unknown". Are you disagreeing with Ernst here? He is a reliable source on this topic.' Ernst specifically says that it's unknown to the extent that more incidents are probably unreported, and so are most likely higher. Here is what he actually says: '...has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown.' I'm going to assume good faith here, and guess that you didn't notice the Ernst used the word 'repeatedly' in the previous sentence, or that he also said ' frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death'
• If you don't think Ernst makes 'strong assertion' you might wonder why his book about alternative medicine devotes 50 pages to chiropractic concluding it doesn't work in any area it is claimed to work with the exception of lower-back pain where it works perhaps as well as traditional methods but it far more expensive and has significantly more dangers. If that is not a strong assertion I don't know what is.
• OK. Here is one specific sentence I would like added to the introduction at the beginning of the article: "The only systematic review of systematic reviews into the effectiveness of chiropractic and SM concluded that SM is associated with frequent, mild adverse effects and with serious but probably rare complications, and that spinal manipulation has not been demonstrated to be an effective treatment for any condition. Although no other systematic reviews of systematic reviews have been carried out to date, chiropractors dispute this conclusion." (Let me know if you do find another systematic review OF systematic reviews. Otherwise I can't see anything factually wrong with this.
• Part of my problems is that although these controversies are dealt with in the body, the introduction doesn't reflect them very well, particularly the very first part (I think the effectiveness section is better). Macgruder (talk) 16:28, 10 September 2008 (UTC)

• Something along those lines might be added, but that sentence itself is not supported by a reliable source. We don't have a reliable source saying that Ernst & Canter 2006 is the only systematic review of systematic reviews. Also, that sentence is way too long for the lead. Can you please propose something shorter, which summarizes Chiropractic #Evidence basis, and say exactly where this sentence will fit into the existing lead? Thanks.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

I haven't weighed in on this yet, but there is currently too much weight given to Ernst in this article. Wikipedia is not a mouthpiece for one particular view, and a huge amount of weight is already being given to Ernst. We should not be devoting more space to Ernst. I agree with Eubulides when he says the proposed sentence is not supported by a reliable source, and is too long for the lead. - DigitalC (talk) 09:57, 11 September 2008 (UTC)

It's not about 'one particular view'. Ernst is the only person to have done a systematic review of systematic reviews. He gets weight because the systematic review study is the gold standard of evidence-based medicine, and a systematic review of systematic reviews is a summary of these gold standards. Besides Ernst is one of the most respected voices in the field of 'CAM'. Wikipedia policy is to give weight to in proportion to prominence. If you can find any other systematic review of systematic reviews published in a respected journal then it will get the due weight. A major issue is that many studies are flawed and it's the job of the systematic reviewer to weed out those which have these flaws. Where systematic reviews exist we defer to them, and this Ernst goes further than that. He takes the systematic reviews themselves and notes what they conclude. Wikipedia says:

NPOV weights viewpoints in proportion to their prominence. However, when reputable sources contradict one another and are relatively equal in prominence, the core of the NPOV policy is to let competing approaches exist on the same page: work for balance, that is: describe the opposing viewpoints according to reputability of the sources, and give precedence to those sources that are most reliable and verifiable. Macgruder (talk) 13:51, 18 September 2008 (UTC)

Cochrane reviews

Following up on Levine2112's proposal in the above section to remove citations to sources "using research which does not make any conclusions about chiropractic specifically": this proposal would not exclude the use of Cochrane reviews in general, just the reviews mentioned in the above section.

Come to think of it, it would be helpful to do a sweep of Cochrane reviews that specifically mention chiropractic; I'll take a look at that. Cochrane reviews are a generally-recognized high quality source. Even if their official publish date is older, they are regularly updated and reviewed, so the are more-recent sources than their pub-date would otherwise indicate. Eubulides (talk) 20:34, 5 September 2008 (UTC)

I believe that Cochrane is a high quality source. If Cochrane makes conclusions specifically about chiropractic, then we should feel free to use it as a source (regardless of whether the conclusions are positive or negative for chiropractic). However, we should not include Cochrane reviews which are only making conclusions about spinal manipulation in general (not specifically about chiropractic). Such reviews are best suited for the Spinal manipulation article.

I am in the process of creating a detailed but clear RfC to address this matter in general, but if the editors here can generally agree to the proposal Eubulides describes here as: "to remove citations to sources 'using research which does not make any conclusions about chiropractic specifically'", then I see no need to open the RfC can of worms. -- Levine2112 ^discuss 21:10, 5 September 2008 (UTC)

• That proposal runs contrary to modern scientific practice, in which systematic reviews focus on treatments, not professions. When a treatment is so strongly identified with a profession, as spinal manipulation is with chiropractic, it is entirely proper to cite high-quality systematic reviews on that treatment. Similarly, it is entirely proper for Traditional Chinese medicine to cite studies on acupuncture and on Chinese herbal medicine.
• I searched for Cochrane reviews mentioning chiropractic, and propose to add the following words to the list at the end of Chiropractic #Effectiveness, preserving the alphabetic order that is already in that list.

asthma

carpal tunnel syndrome

pelvic and back pain during pregnancy

Each citation is to a Cochrane review that mentions chiropractic. None of the reviews found evidence of benefit. Generally speaking, what the reviews did was look for evidence supporting the use of treatments for these conditions, and included searches for treatments done by chiropractors, without finding supporting evidence.

Eubulides (talk) 21:22, 5 September 2008 (UTC)

No further comment on the proposal to add these three citations, so I added them. Eubulides (talk) 19:18, 9 September 2008 (UTC)

This article deals with the profession and not the treatment. This is precisely why the research which we provide here should discuss the efficacy of chiropractic specifically. Again, this is akin to including reflexology research in an article about podiatry or vice-versa. For the treatment which chiropractors administer consider adding research to articles such as Spinal adjustment which is badly in need of some clean up and expansion. -- Levine2112 ^discuss 22:29, 5 September 2008 (UTC)

This is an encyclopedic article about chiropractic, and it deals with all notable aspects of chiropractic, including treatment, which is a core aspect of chiropractic. Podiatry and reflexology are distinct professions with distinct Wikipedia articles, unlike chiropractic where straight and evidence-based and other are all under the same umbrella. I agree that Spinal adjustment needs a lot of work, but this thread is about Chiropractic. Eubulides (talk) 23:43, 5 September 2008 (UTC)

Just as Podiatry and Reflexology are distinct articles, Chiropractic, Osteopathy and Physical therapy are distinct. So, just as we wouldn't expect to find Reflexology research to discuss conclusions about podiatry at Podiatry, we should have Osteopathy and Physical therapy research discussing conclusion about Chiropractic here at this article. -- Levine2112 ^discuss 23:57, 5 September 2008 (UTC)

The Cochrane reviews in question (e.g., Assendelft et al. 2004, PMID 14973958) are not osteopathy research. Nor are they physical therapy research. They are reviews of treatments that are highly relevant to chiropractic. Cochrane reviews of treatments highly relevant to osteopathy can and should be cited by Osteopathy. Eubulides (talk) 01:23, 6 September 2008 (UTC)

Sure. Again, if they are about chiropractic, we have no problem adding/keeping them. If they are not about chiropractic specifically but rather about something which you say is "highly relevant", then we do have an OR problem. For instance, would we have a Cochrane review of antibiotics at Medical doctor? Some would say that studies about antibiotics are highly relevant to medical doctors as medical doctors prescribe/administer the majority of antibiotics in the world. But as you know, there is no mention of Cochrane or any research into antibiotics at Medical doctor. Of course the article Antibiotics contains much discussion about the research out there. In the same way, research about spinal manipulation in general should not be at Chiropractic, but rather at Spinal manipulation. Further, now imagine that there was research out there studying the efficacy of antibiotics as administered by non-MDs. Now imagine that an editor wanted to include such research at Medical doctor in a section discussing the efficacy of medical doctors. Ludicrous, right?! If we think about it in these terms, it makes the problems here very obvious. -- Levine2112 ^discuss 04:33, 6 September 2008 (UTC)

The analogies to reflexology/podiatrist and antibiotics/medical doctor are not quite right...too tangential. A better analogy would be bunionectomy/podiatrist. As far as I know, bunionectomies are a key function of podiatrists, much like SM is a key treatment by chiropractors. If there were reviews about the effectiveness of bunionectomies that would certainly be relevant to the podiatry Wikipedia article.--—CynRN ^(Talk) 05:22, 6 September 2008 (UTC)

Okay. But let's say there was research studying bunionectomies as performed by non-podiatrists. Would you expect this research to be cited at Podiatry under the sub-heading "Effectiveness of Podiatry"? -- Levine2112 ^discuss 00:20, 7 September 2008 (UTC)

Let's say that podiatrists do 90% of bunionectomies and that most of their patients receive a bunionectomy (Totally theoretical, as podiatrists do lots of other things and bunionectomies are not that common). If there are studies of bunionectomies, even inluding some performed by othopedic surgeons, yes, a section on "effectiveness of bunionectomies" would be appropriate in the fictional podiatrist article! The trouble with analogies is that the chiropractic profession is unique. A section on effectiveness of the key treatment of DCs is entirely appropriate. However, the section could be shorter, as I've admitted in the past.--—CynRN ^(Talk) 20:15, 7 September 2008 (UTC)

See that's the problem. You said, "effectiveness of bunionectomies" (not "effectiveness of podiatry"). A comparable section here would be "effectiveness of spinal manipulation"; that's not what we have at this article. We just have "Effectiveness". This means "effectiveness of chiropractic". So back to bunionectomies, would you say it is fair to judge the effectiveness of podiatry based on efficacy studies of bunionectomy surgery as performed by non-podiatrists? I think that's a rather obvious "No". What you could do with such a study is use it in the (currently non-existent) "Bunionectomy" article to describe its general effectiveness. Just the same, non-chiropractic spinal manipulation studies should not be used to describe the effectiveness of chiropractic; however they can and should be used at the Spinal manipulation article. -- Levine2112 ^discuss 21:04, 7 September 2008 (UTC)

Chiropractic clearly makes the distinction between SMT and the chiropractic encounter. The reader understands that "Effectiveness" refers to SMT for most of the section.--—CynRN ^(Talk) 21:54, 7 September 2008 (UTC)

So if we clearly explain the difference between chiropractic and bunionectomies, we can include bunionectomy research in this article? Apples and oranges. ;-) And if "'Effectiveness' refers to SMT for most of the section" then that begs the question: What is it doing in this article rather than the SMT article? We have created our own reason why non-chiropractic research is included in this article; hence WP:OR violation. That we are basing this reason on the "one set of researchers have done it, so we can to" logic is why more specifically we have aWP:SYN violation. -- Levine2112 ^discuss 23:04, 7 September 2008 (UTC)

Murphy et al. 2008

A new commentary paper has been published comparing chiropractic to podiatry, as professions (Murphy et al. 2008, PMID 18759966). It contains several interesting points, which deserve better attention in Chiropractic. Here are some proposed changes to Chiropractic in the light of this new paper: Eubulides (talk) 23:49, 3 September 2008 (UTC)

"How can chiropractic become a respected mainstream profession? The example of podiatry", Donald R Murphy , Michael J Schneider , David R Seaman , Stephen M Perle and Craig F Nelson, Chiropractic & Osteopathy 2008, 16:10doi:10.1186/1746-1340-16-10 -- Fyslee / talk 14:06, 4 September 2008 (UTC)

Gallup poll

The Utilization and satisfaction section does not address the common patient concern about the ethics of practitioners. To address this, insert the following text after the "Satisfaction rates are typically higher for chiropractic care" sentence.

In contrast, a 2006 Gallup Poll found that chiropractors ranked last among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; other rankings ranged from 62% for dentists to 84% for nurses.

Eubulides (talk) 23:49, 3 September 2008 (UTC)

Yeah, nurses!--—CynRN ^(Talk) 04:42, 4 September 2008 (UTC)

Nurses have consistently finished at the top of that poll for years. If memory serves, among all professions they were briefly topped by firefighters after 9/11, but then resumed being #1. Eubulides (talk) 16:18, 4 September 2008 (UTC)

I just can't help adding my vote here. My mother was a nurse, and this most caring of all professions deserves all the support and credit it deserves. -- Fyslee / talk 06:10, 5 September 2008 (UTC)

I have a suggested tweak of the wording:

• In contrast, a 2006 Gallup Poll found that chiropractors ranked lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking the honesty and ethics of chiropractors as "high" or "very high" as compared to the rankings of 62% for dentists and 84% for nurses.

I have indicated the changes in italics. The added wording, although a repetition, makes it clearer what the statistics refer to, as well as make the large contrast clearer. -- Fyslee / talk 05:05, 4 September 2008 (UTC)

More opinion polls!!! Arrgh!!! WHY OH WHY ARE YOU EDITORS SO FASCINATED WITH OPINION POLLS AND WHY DO YOU THINK OPINION POLLS ARE ENCYCLOPEDIC????. Opinion polls are ephemeral and political. They have no place in this article. --Surturz (talk) 12:47, 4 September 2008 (UTC)

Industrial Strength Oppose to the gallup poll, if you didn't work that out. --Surturz (talk) 12:49, 4 September 2008 (UTC)

Do I sense frustration with the way Wikipedia works and its all inclusive policies, as regards information? NPOV requires the inclusion of opposing and controversial POV, and if a Reliable Source has published something, it's fair game. You really don't need to shout at us. Just calm down and get used to how things work here and you'll survive, otherwise you're headed for trouble. -- Fyslee / talk 14:15, 4 September 2008 (UTC)

No, you sense my frustration that certain editors seem to want to show chiropractic as an unscientific and non-medical profession, yet use non-scientific (i.e. opinion poll) sources to do it. If you want to argue the science, then argue the science. Using opinion polls like the gallup poll or the poll of student opinions on vaccination is completely unscientific and cheapens wikipedia, and turns this article into a political battleground. Newsworthy is not the same as noteworthy. --Surturz (talk) 00:25, 5 September 2008 (UTC)

The modified proposal (mentioned below) attempts to address the "argue the science" issue somewhat by also citing the paper by Murphy et al. in Chiropractic & Osteopathy, a peer-reviewed medical journal. Of course by itself this does not establish scientifically that chiropractors are less-trusted than dentists, nurses, etc. However, the topic is clearly a notable one, and this is a reliable source published in a scientific journal, and is the best source we've found on the subject. Eubulides (talk) 02:28, 5 September 2008 (UTC)

I dispute the 'clearly notable' contention. Patient satisfaction rates could be notable, but the general public's opinion of chiropractic is hardly notable in this place. I imagine that many of the respondents hadn't ever gone to a chiropractor, or may not even know what chiropractic is. In other forums the poll would be of interest - among chiropractors, who would have an interest in improving the perception of chiros, for example - but this is not the forum website <-- talk about nitpicky! --> for such political issues. Phrasing the poll results as "chiro came last" also misrepresents reality since there would be many "health" professions not even represented in the poll. e.g. if faith healers, or water diet advocates were put in the poll, would chiros still come last? --Surturz (talk) 04:14, 5 September 2008 (UTC)

• We have a reliable source to the effect that the poll is notable.
• Patient satisfaction rates are also notable, and are also cited by reliable sources, just as the Gallup Poll is. Patient satisfaction rates are currently mentioned prominently in Chiropractic: they are mentioned in a section header, and the body of that section discusses them and cites two reliable sources.
• Chiropractic is not a "forum"; it is an encyclopedic article about chiropractic, and the topic of public opinion about chiropractic is highly relevant, just as the topic of patient satisfaction is highly relevant.

Eubulides (talk) 04:26, 5 September 2008 (UTC)

• (outdent)It may be newsworthy but it is not notable. Nowhere in the Medicine article does this sort of opinion poll rubbish appear, nor should it do so in this article. --Surturz (talk) 08:05, 5 September 2008 (UTC)

• The topic is mentioned with emphasis in a reliable source published in a peer-reviewed medical journal, indicating that it is indeed notable and not merely newsworthy. Whether Medicine includes this or other polls is not that relevant to Chiropractic; Medicine is a much broader topic, with dozens of subarticles, whereas Chiropractic has just a few, none on this particular topic. Eubulides (talk) 16:26, 5 September 2008 (UTC)

• I don't understand the comment "More opinion polls". Chiropractic currently does not cite any mass opinion polls. It does cite surveys, but that's something else.
• I agree with Fyslee; this poll is notable and is cited by a recent reliable source.
• The rewording proposed by Fyslee has some problems. Most important, it omits the point that chiropractic's number is way out of the range for other healthcare professions (the earlier text established that dentists were 2nd lowest and nurses highest; the rewording doesn't). Also, the rewording unnecessarily duplicates the phrase "honesty and ethics". How about the following wording instead? It attempts to address Fyslee's points. The new words are in italics.

In contrast, a 2006 Gallup Poll found that chiropractors ranked last lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; by the same measure other professions' rankings ranged from 62% for dentists to 84% for nurses.

Eubulides (talk) 16:18, 4 September 2008 (UTC)

Following up on my own comment; I missed that you'd changed "last" to "lowest". That change is fine of course. I updated the above rewording accordingly. Eubulides (talk) 06:16, 5 September 2008 (UTC)

I didn't leave out dentists and nurses, but made the contrast between their high position and chiropractic's low position more clear. The current use of the words "very high or high" doesn't clearly refer to anything. I tried to make it clear by repeating the words. -- Fyslee / talk 06:28, 5 September 2008 (UTC)

Your draft mentions dentists and nurses, but omits the important point that dentists finished 2nd from the bottom in the healthcare professions, and that despite finishing 2nd from the bottom, dentists still finished way above chiropractors. This point is captured in the "ranged from" wording, but it's missing in the wording you propose, where a reader might think that dentists and nurses were picked at random from the set of healthcare professions (which is not the case), and that perhaps some other profession finished nearly as lowly as chiropractic did (which is also not the case). Eubulides (talk) 07:27, 5 September 2008 (UTC)

• (outdent) I oppose the current suggested text. --Surturz (talk) 08:05, 5 September 2008 (UTC)

• Can you suggest any improvements? Eubulides (talk) 16:26, 5 September 2008 (UTC)

I agree with Surturz. Opinion polls are ephemeral and political and have no place in this article. -- Levine2112 ^discuss 19:16, 5 September 2008 (UTC)

The 2006 poll is just one year, of course, but these results are not ephemeral: Gallup did the same poll in 1999 and 2003 and got similar results. Politics very much has a place in this article: this article is encyclopedic and should not exclude a topic merely because it is political. However, as far as I can see the Gallup Poll topic is about public opinion, not politics per se. Given the "ephemeral" contention, perhaps the previous results should be mentioned as well? We could do something like the following text:

In contrast, a 2006 Gallup Poll found that chiropractors ranked lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; other professions' rankings ranged from 62% for dentists to 84% for nurses. Chiropractors received rankings of 26% in 1999 and 31% in 2003 using the same measure.

Eubulides (talk) 20:34, 5 September 2008 (UTC)

The ref is WP:RS and meets the inclusion criteria. This may be a case of I don't like it. QuackGuru 19:27, 5 September 2008 (UTC)

I can't really suggest any improvements, since I don't think the text has any place in the article. I can't support the inclusion of political text, because I feel it violates WP:NPOV. If you include the poll, it will encourage pro-chiropractic editors to refute it with other studies and I can't see how that is going to end up benefitting the article. For NPOV inclusion of the poll, you'd need to qualify the poll results with how chiropractors are less known that doctors or nurses, nurses have more contact time with patients, publicly funded professions are always going to seem more honourable than private ones etc etc --Surturz (talk) 17:35, 7 September 2008 (UTC)

Other studies from reliable sources on this topic would be welcome. I briefly searched for some, and did not find anything along the lines you suggest. Until we find other sources, we should go with the reliable sources that we have. (The last point doesn't seem correct to me, anyway: chiropractors, like nurses, get some public funding; also, many publicly funded professions have very low ratings for honesty and ethics, e.g., congressional representatives.) At any rate it does not violate WP:NPOV to summarize the reliable sources that we have on the topic. Eubulides (talk) 20:42, 7 September 2008 (UTC)

In #NPOV below, Coppertwig objected "it makes it sound as if the survey established as fact that a certain percentage of chiropractors are unethical". To fix this problem, let's apply the following change (italics are new text) "a 2006 Gallup Poll of U.S. adults found that they ranked chiropractors ranked lowest among health care professions for honesty and ethics", resulting in the following revised proposal:

In contrast, a 2006 Gallup Poll of U.S. adults found that they ranked chiropractors lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; other professions' rankings ranged from 62% for dentists to 84% for nurses. Chiropractors received rankings of 26% in 1999 and 31% in 2003 using the same measure.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

Thanks, Eubulides. That's much better; however, I don't see support in the sources for the statement that the survey participants ranked chiropractors "lowest" among health care practitioners; in fact, according to the table in USAToday, it looks to me that only one participant ranked chiropractors "very low", while three participants ranked psychiatrists "very low". (If the sources do support the statement, please tell me where exactly in the sources.) I think it would be more accurate to state that of 7 health care professions, chiropractors received the smallest percentage of survey participants ranking them as "very high" or "high" in ethics. ☺ Coppertwig (talk) 19:03, 17 September 2008 (UTC)

There is support in the cited sources. The first paragraph of Murphy et al. 2008 (PMID 18759966) summarizes the Gallup poll by saying "The profession still finds itself in a situation in which it is rated dead last amongst healthcare professions with regard to ethics and honesty". Eubulides (talk) 19:22, 17 September 2008 (UTC)

Here was the last version in the article. This is accurate and supported by the references. QuackGuru 14:18, 18 September 2008 (UTC)

Fraud and abuse

Murphy et al. write that "fraud, abuse, and quackery ... are more rampant in our profession than in other healthcare professions", citing Foreman & Stahl 2004 (PMID 15389179). This is an important point, of course; it should be mentioned somewhere. I propose appending the following text to Chiropractic #Education, licensing, and regulation:

Abuse, fraud, and quackery are more prevalent in chiropractic than in other health care professions. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).

Eubulides (talk) 23:49, 3 September 2008 (UTC)

These are the same concerns and criticisms that skeptics have and write about in skeptical writings and books, but which chiropractors often attempt to claim are based on turf wars and attempts to suppress the profession. If there is any attempt to suppress, that's why! (This was very clearly the issue in the failed attempt to get a chiropractic school established at Florida State Univ. The medical and science professors screamed "quackery and unscientific" pretty loudly, and threatened to resign.) The concerns are about rampant quackery and health fraud, and even Keating openly scolded the president of the ACA for claiming that such accusations were about a "myth". No, they were and are problems, and need coverage. -- Fyslee / talk 05:05, 4 September 2008 (UTC)

Murphy also mentions the "shrinking market share", and we haven't discussed this at all. Instead we have seemed to imply that things are looking better. There are other sources that document a shrinking market share and very slow growth. -- Fyslee / talk 05:13, 4 September 2008 (UTC)

Well, it looks like you have already found and used the good source I was thinking of! Good going. -- Fyslee / talk 05:46, 4 September 2008 (UTC)

Holism

Murphy et al. note that holism is "a drastic departure from the reductionistic subluxation-only approach, which 'reduces' the cause and care of health problems to a spinal subluxation." This important point is not made in Chiropractic's discussion of holism. To fix this, append the following to the Holism bullet in Chiropractic #Philosophy:

In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.

Eubulides (talk) 23:49, 3 September 2008 (UTC)

Analogy to podiatry

Murphy et al. have a very useful analogy on page 21, which is basically this:

podiatry : foot reflexology :: "chiropractic medicine" : straight chiropractic

where "chiropractic medicine" is their term for science-based chiropractic. Perhaps this point should be made in Chiropractic somehow? But I don't have a specific suggestion here yet. Eubulides (talk) 23:49, 3 September 2008 (UTC)

WP is not a political platform in which to attempt to divide the chiropractic profession. I see no evidence that the term 'chiropractic medicine' is in common parlance. Just because an editor might like the term does not mean it should be included. --Surturz (talk) 12:54, 4 September 2008 (UTC)

This isn't about an editor's opinion. You're missing the point the very prominent chiropractic authors are seeking to make. They are pointing out well-known existing differences and divisions already present in the profession, and Wikipedia's job is to report what the sources say. Maybe you should read it for yourself:

6. Podiatrists and Foot Reflexologists

We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof.

Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof. One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession -- call it “chiropractic medicine” as we do in this commentary -- has attempted to occupy the same scientific space as the podiatric profession. Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners and organizations. The result is continual battling with a huge waste of energy and resources, while professional growth stagnates.

"How can chiropractic become a respected mainstream profession? The example of podiatry", Donald R Murphy , Michael J Schneider , David R Seaman , Stephen M Perle and Craig F Nelson, Chiropractic & Osteopathy 2008, 16:10doi:10.1186/1746-1340-16-10 Source

Their and other's use of the term "chiropractic medicine" is another issue and should be discussed elsewhere. -- Fyslee / talk 13:51, 4 September 2008 (UTC)

• It is clear from the text you have quoted that the author is not using a common term, but is attempting to establish a new one viz. 'chiropractic medicine'. As such it should not appear in the article. --Surturz (talk) 08:11, 5 September 2008 (UTC)

• I agree that their use of "chiropractic medicine" is not that common and shouldn't be adopted uncritically in Chiropractic. Eubulides (talk) 16:26, 5 September 2008 (UTC)

Public health

Murphy et al. has a section "Public Health" that talks not only about vaccination, but about the broader issue of opposition to "many public health measures such as vaccination and water fluoridation". Perhaps Chiropractic #Vaccination should be renamed to Public health, with some treatment of other issues. A good source for ideas would be Johnson et al. 2008 (PMID 18722194). I don't have a specific proposal in this area now, though. Eubulides (talk) 23:49, 3 September 2008 (UTC)

OK, or it could be named "Public health measures" or "Chiropractors' views about conventional public health measures". ☺ Coppertwig (talk) 17:22, 14 September 2008 (UTC)

Shorter titles are better. The manual of style recommends not mentioning the title of the article in section headers, so that suggests against the longer suggestion. I don't see why Public health measures would be better than Public health. Eubulides (talk) 21:28, 14 September 2008 (UTC)

Nugent

Murphy et al. cite the work of John J. Nugent DC in improving the quality of chiropractic education. Perhaps a sentence should be added to Chiropractic #History? I don't have a specific proposal here. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Maintenance

Here's one more quote, about maintenance:

"We are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in 'selling' a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public." (page 8)

I'm not sure how this would be worked in, though. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Request for Comment, Possible OR violation at Chiropractic Effectiveness

Template:RFCsci There has been a dispute regarding the possibility of an WP:OR violation at Chiropractic#Effectiveness spanning a few months now. Essentially, this is a debate about whether or not we are able to use research not specifically about chiropractic in the article Chiropractic.

Chiropractors perform a high-percentage of spinal manipulation in the world. Other professions which perform spinal manipulations include Osteopathy and Physical therapy, among others. Chiropractic spinal manipulation (often times differentiated as spinal adjustment) differs from these other profession's version of spinal manipulation in intent, diagnosis, and technique.

There is research which studies the efficacy of chiropractic spinal manipulation. There is also research which studies non-chiropractic spinal manipulation. The latter kind of research is with what this RfC is concerned.

Some of the research currently being used at Chiropractic#Efficacy makes no mention of chiropractic at all; or only mentions chiropractic in passing but the research does not make any conclusions specifically about chiropractic spinal manipulation. This research is either about spinal manipulation in general or about spinal manipulation as performed by non-chiropractors. For instance, this study is cited twice in the "Low Back Pain" section but the conclusions in the full-text makes absolutely no mention of chiropractic specifically, only spinal manipulation (SMT) in general.

Some nominal amount researchers have used some of these non-chiropractic studies to draw conclusions about chiropractic. This RfC is not concerned with those few cases. The RfC is concerned with non-chiropractic spinal manipulation research which neither draws any conclusions about chiropractic specifically nor is there any other research out there drawing conclusions about chiropractic from these non-chiropractic studies.

Since spinal manipulation is closely related to chiropractic and since a marginal amount of researchers have drawn conclusions about chiropractic efficacy from certain non-chiropractic studies, some editors have interpreted this to mean that we have free license at Wikipedia to cite any non-chiropractic spinal manipulation study as evidence for or against chiropractic effectiveness. Further, some editors feel that it is okay to include non-chiropractic spinal manipulation research at Chiropractic#Effectiveness if we make a clear distinction in the article that we are not necessarily talking about chiropractic efficacy but rather the efficacy spinal manipulation in general.

On the other side, editors claim that this violates WP:OR in that editors are setting the reader up to draw conclusions (positive or negative) about chiropractic effectiveness by presenting non-chiropractic evidence which itself makes no conclusions about chiropractic effectiveness. Further, editors on this side of the dispute claim that this may also specifically be a WP:SYN violation as the other editors (those in favor of inclusion of non-chiropractic studies) explain that since some marginal amount of researchers have made conclusions about chiropractic from other non-chiropractic studies then that gives us at Wikipedia free license to do the same with all non-chiropractic spinal manipulation research. Editors who feel that there is an WP:OR violation are in favor of preserving the non-chiropractic information by moving it into the more apropos Spinal manipulation article (which covers spinal manipulation as performed by any kind of practitioner including chiropractors, osteopaths and physical therapists).

Please note that it is not standard practice in the scientific community to use studies about non-chiropractic spinal manipulation to make conclusions about chiropractic spinal manipulation effectiveness. In fact, the chiropractic profession has been rebuked by some members of the scientific community for using positive non-chiropractic spinal manipulation research as evidence of the effectiveness of chiropractic spinal manipulation.

Okay. That may have been a lot of information for someone outside this subject to ingest. I apologize, but I sincerely hope that I was explicit and clear in my description of the dispute. In essence, what we are looking for in terms of comments from outside editors is whether or not the current version of Chiropractic#Effectiveness violates WP:OR/WP:SYN by presenting conclusions from research not specifically about chiropractic, but rather spinal manipulation in general. Would we be better off moving the non-chiropractic spinal manipulation research to the Spinal manipulation article? 01:25, 10 September 2008 (UTC)

Comments from the uninvolved:

You say "Some of the research currently being used at Chiropractic#Efficacy makes no mention of chiropractic at all; or only mentions chiropractic in passing but the research does not make any conclusions specifically about chiropractic spinal manipulation. This research is either about spinal manipulation in general or about spinal manipulation as performed by non-chiropractors."

If this is true, then the case here is cut-and-dried. WP:OR says

Any material that is challenged or likely to be challenged must be supported by a reliable source. "Original research" is material for which no reliable source can be found. The only way you can show that your edit is not original research is to produce a reliable published source that contains that same material. Even with well-sourced material, however, if you use it out of context or to advance a position that is not directly and explicitly supported by the source used, you as an editor are engaging in original research; see below

The bolded part seems relevant here. I don't know which sources specifically don't refer to Chiro, but sources used here ought to refer to it, and in more than just in passing. FWIW, it looks like there is a SM article, and I see no reason not to just refer the reader to that. There is no call to talk about SM in the Chiro article, as that information should be covered in the SM article. Sources which explicitly compare SM in general to Chiro should be used if they are RS, but taking an article on SM in general that doesn't mention Chiro and talking about the differences is OR and SYNTH:

"If the sources cited do not explicitly reach the same conclusion, or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research."[2]

I write responses in stages, as I go along. I wrote the above before reading your paragraph starting "On the other side, editors claim that this violates WP:OR in that editors are..."

So:

"Would we be better off moving the non-chiropractic spinal manipulation research to the Spinal manipulation article?"

Yes.

I have not digested the section in question. However, if the facts are properly presented above, the conclusion is very clear. ——Martin^phi ☎ Ψ Φ—— 04:02, 10 September 2008 (UTC)

I have not been involved in this particular discussion, I even posted my comment in the wrong place (below). I think it should be moved to the spinal manipulation article. MaxPont (talk) 06:56, 13 September 2008 (UTC)

Comments:

References to past discussion threads

This topic has been going on for some time; for previous discussions, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, Chiropractic section on evidence basis, and A starting point for a look at the effectiveness section and introduction. Eubulides (talk) 05:21, 10 September 2008 (UTC)

Examples needed

The RfC gives no specific examples of WP:OR in Chiropractic #Effectiveness, and this vagueness makes the RfC difficult to follow. As far as I can see, every claim in Chiropractic #Effectiveness cites a reliable source that directly and explicitly supports the claim. If this is incorrect, then please list the specific claims that aren't directly supported by their sources. Eubulides (talk) 05:21, 10 September 2008 (UTC)

How about we start in the beginning with the first ref given in the "Low back pain" section which is used to support two statements:

1. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.
2. ...whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.

Neither of there statements say anything about chiropractic specifically but rather SMT in general. The conclusions given in this reference make no statements about chiropractic specifically: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence. I agree that this would be a nice source for the Spinal manipulation article, but is out of context and misleading at the Chiropractic article, creating an WP:OR violation. -- Levine2112 ^discuss 05:53, 10 September 2008 (UTC)

It is WP:OR without V,RS references that show the effort to deliver identical treatments. I am repeatedly seeing poor research or distant data in a general category, that is off by a factor of 10 to 100 in *several* variables, being touted as relevant to competing CAM categories. WP:OR and highly erroneous pushing a POV.--I'clast (talk) 06:56, 10 September 2008 (UTC)

• Murphy et al. 2006 (PMID 16949948) is not the first reference in Chiropractic #Effectiveness. It is the 12th reference. Are the first eleven references OK? That would be good news.
• Murphy et al. directly supports the two statements that cite it, so there is no WP:OR here. Here are quotes from Murphy et al., one for each of the two statements that you listed above. Each quote directly supports the corresponding statement:

1. "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right. ... The most surprising finding, and a factor that casts some doubt on the reliability of the recommendations made, was that the levels of evidence and/or grades of recommendation used for formulating treatment recommendations varied so significantly between countries." (page 579)
2. "The Swedish guideline, which had been updated since the earlier review by Koes et al, proposed the biggest change for the application of SMT in the treatment of LBP. The earlier version (2000) stated that SMT should be considered within the first 6 weeks (acute period) for patients who need additional help with pain relief or who are failing to return to normal activities. In contrast, the more recently updated guideline (2002) made no recommendation to use SMT as a treatment intervention for the acute phase of LBP, possibly because the guideline developers based their treatment recommendations on grade of recommendation 'A,' which represents the highest level of evidence." (page 579)

• Murphy et al. is not cited out of context. The context is the evidence basis for the effectiveness of spinal manipulative therapy for low back pain, and this context is clearly stated in Chiropractic #Effectiveness. This topic is highly relevant to chiropractic. Murphy et al. base their conclusions on their analysis of systematic reviews and randomized controlled trials that use both chiropractic and non-chiropractic data, which is standard practice in recent reviews; Chiropractic #Effectiveness characterizes their conclusions accurately; it does not claim that their conclusions are specific to chiropractic.
• Your suggestion that this material is relevant to Spinal manipulation is of course reasonable. However, putting the material there would be excluded by the overly-restrictive rule that is assumed by this RfC, because the material is not specifically about spinal manipulation; it is about spinal manipulative therapy, which is not the same thing. Of course, it would be silly to exclude this material from Spinal manipulation on WP:OR grounds, just as it would be silly to exclude this material from Chiropractic on WP:OR grounds.

Eubulides (talk) 07:02, 10 September 2008 (UTC)

• Murphy is currently the first ref given in the "Low back pain" section. Are you really disputing that? In terms of this RfC, does it really matter?
• We are not discussing whether or not Murphy accurately supports the statements it is referencing. We are discussing whether it is appropriate to cite Murphy at all given that it is not making any conclusions about chiropractic spinal manipulation specifically but rather spinal manipulation therapy in general (as performed by a mixed bag of professions).
• You say this topic is highly relevant to chiropractic. But if you look at WP:OR, you will read: ...if you use it out of context or to advance a position that is not directly and explicitly supported by the source used, you as an editor are engaging in original research... Murphy does not directly and explicitly make any conclusions about the effectiveness of chiropractic spinal manipulation specifically; however, you are using it in a section Chiropractic#Effectiveness. Regardless of how clearly you explain it to the reader, you are still engaged in original research because this text is being used to advance a position about the effectiveness of chiropractic which the source does not directly and explicitly support.

-- Levine2112 ^discuss 17:22, 10 September 2008 (UTC)

• I did not dispute that Murphy was the first ref given in some subsection. My question was whether earlier references are OK. This will help give us the rest of us the idea whether the hypothesized problem is systemic, or relatively limited to a few citations.
• WP:OR talks about using a source to support a claim that is not directly and explicitly supported by the source used. And that is what I was talking about as well. Murphy directly and explicitly supports the claim in question.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

• The earlier references are not necessarily "OK". I had access to the full-text of Murphy, it was the first one given in the Headache section, it had been discussed before, and it is a perfect example of the research in question: ones that rely on a mixed bag of professions performing spinal manipulation and one which makes no conclusions specifically about chiropractic.
• Murphy does not support that it has any correlation to any conclusions about the effectiveness of chiropractic. However, by including it in Chiropractic#Effectiveness, you are making such a correlation. Hence, the WP:OR.

-- Levine2112 ^discuss 02:34, 11 September 2008 (UTC)

• So we don't have an idea of how many references are being challenged here? And we don't know which references (other than Murphy et al. 2006, PMID 16949948) are being challenged?
• The statement "Murphy does not support that it has any correlation" doesn't seem to have anything to do with WP:OR. WP:OR says nothing about "correlation".
• Again, WP:OR talks about using a source to support a claim that is not directly and explicitly supported by the source used. The claim in question is directly and explicitly supported by Murphy et al. So there is no OR here, using WP:OR's definition.

Eubulides (talk) 08:14, 11 September 2008 (UTC)

• Any reference that doesn't specifically mention chiropractic, or the claim made is not directly relevant to chiropractic SMT is challenged. If you would like to go through them and count them, feel free. It is a fairly general concept, and we do not need to be specific about exactly which references this relates to at this point in time.
• The claim that Murphy et al's conclusions have anything to do with Chiropractic#Effectiveness is WP:OR. This has been made blatantly clear above. Is this WP:IDHT?
• If this isn't an example of IDHT, I will rephrase what Levine stated above to make it crystal clear. Murphy does not advance a position on Chiropractic effectiveness. It is being used out of context, and to advance a position "that is not directly and explicitly supported by the source..."

DigitalC (talk) 09:33, 11 September 2008 (UTC)

• We will need to be specific, if we want to make specific changes to the article. So far the only specific change requested in this thread is to not cite Murphy et al.
• I understand (and obviously disagree with) the argument that Murphy et al. has nothing to do with Chiropractic. But that argument is not an WP:OR argument. WP:OR says that claims must be directly supported by the citation. And it is not disputed that the claim in question, namely "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain" is directly supported by the citation in question (Murphy et al.).
• Clearly there is a content dispute here. But it is not an WP:OR dispute.

Eubulides (talk) 16:59, 11 September 2008 (UTC)

• We will be specific if and when it is deemed that there is a general problem with confounding non-chiropractic efficacy research with a section that is supposed to be about chiropractic efficacy. Murphy is just a prime example of such non-chiropractic research for respondents to this RfC to analyze when considering their commentary here.
• I understand (and obviously disagree with) your argument that this is not an OR dispute. This RfC will help us determine if it is or if it isn't an OR issue.
• Yes, there is a content dispute. But whether or not it is an OR dispute is something which this RfC will help us determine. Be patient. -- Levine2112 ^discuss 17:07, 11 September 2008 (UTC)

Well, we do have a spinal manipulation article. Maybe it is better to include stuff in that article instead.MaxPont (talk) 17:23, 11 September 2008 (UTC)

• remove SM material: it seems clear that a distinction is made in reliable sources between chiropractic procedures and spinal manipulation. therefore it seems obvious that you can not generalize from one to the other without violating OR. I can't even see why there's an argument about this. --Ludwigs2 17:01, 16 September 2008 (UTC)

• These more-recent comments still do not address the question of what specific changes are needed. I have followed up in #Request for Comment: Excluding treatment reviews below, to ask for some more-specific advice. Eubulides (talk) 21:39, 16 September 2008 (UTC)

• As a general rule in research articles, the terminology (spinal manipulation and spinal adjustment) is used interchangeably and synonymously by chiropractic and non-chiropractic researchers for HVLA-type manipulations/adjustments, regardless of the performer, or what the performer calls them, with all researchers using only the term "manipulation" when writing in mainstream journals to a non-chiropractic audience. Note that chiropractic researcers do that even when the bulk or all of the "manipulations" were performed by chiropractors, who in real life would likely call them "adjustments". Why? Because there is no proven physical, anatomical, or mechanical difference.

• Exceptions to the general rule will be found in ultra-straight literature. That's the only place where there is any consistency, since they make it a point of pride to identify themselves by the "purity" of their adherance to traditional chiropractic dogma. They are known as "principled" chiropractors. If your belief and point is about "who" performs it, then you will likely concede that a "manipulation", if performed by a chiropractor, is an "adjustment", and as clarified above, an "adjustment" performed by a chiropractor will be termed a "manipulation" by chiropractic authors in research designed for an audience that includes non-DCs.

• The place to make an exception is when research (it matters little who performed it) that explicitly mentions that none or only a small minority of the performers of the spinal manipulation were chiropractors (such studies exist), should be excluded. If such a statement is made in the research, then we could leave it out. -- Fyslee / talk 03:07, 17 September 2008 (UTC)

• I made a new set of comments in the section below Talk:Chiropractic#Request_for_Comment:_Excluding_treatment_reviews before I saw this. if it's true (and verifiable) that Spinal Manipulation is synonymous with Chiropractic, then I think the Ernst and Cantor review can be used (carefully, noting the following objection), but I still oppose the Cochrane review. both seems biased to me - the Cochrane particularly - mostly in how they say there's no evidence that SM is superior to conventional approaches when the evidence they have suggests that SM is roughly equivalent to conventional approaches. I can't understand why they gave chiropractic the higher bar of having to be better than conventional approaches, except that they might have been poisoning-the-well a bit. --Ludwigs2 06:25, 17 September 2008 (UTC)

• No one is saying that "Spinal Manipulation is synonymous with Chiropractic." "Chiropractic" is a profession, while SM is a technique. I'm not even saying that spinal manipulation is identical to spinal adjustment, only that in serious peer reviewed research the two terms are oftened used as synonyms since such research nearly always deals with HVLA type manipulations, not the myriad variations also included under the spinal adjustments umbrella. Since most such research includes mostly chiropractor performed "adjustments" (DCs perform about 90% of all manipulations), and those "adjustments" are termed "manipulation" in that research, even when the researchers are chiriopractors, then we are dealing with a chiropractic research POV that says they are identical enough to be termed the same thing. Serious chiropractic researchers are smart enough to avoid using esoteric straight chiropractic terminology when talking to other researchers and the public. When identical techniques, performed in an identical manner, are performed by two different persons from two different professions, there is basically no physical difference, and lots of HVLA "adjustments" are identical to HVLA "manipulations". Where any real differences show up is in the myriad "adjustment" techniques using devices, hand waving (without even touching the body), etc.. I don't recall any serious peer reviewed research (IOW not Journal of Vertebral Subluxation Research (JVSR) junk) that compares such widely different non-HVLA techniques with HVLA spinal manipulation performed by anyone in any profession. -- Fyslee / talk 14:23, 17 September 2008 (UTC)

The bottom line is that without the source stating that they were studying chiropractic or chiropractic specific spinal manipulations, then we cannot conclude that the results are applicable to chiropractic directly. As you said, spinal manipulation is not synonymous with chiropractic. Chiropractors have their own version of spinal manipulation, wholly different in diagnosis, technique and philosophy. We are not making a judgment call on whether or not the few researchers who have confounded the two are right or wrong. That is not our place a Wikipedia. If a researcher has confounded the two, then we should present their research in context. However, we should not take research which was not specifically saying anything about chiropractic but rather spinal manipulation in general (as performed by a mixed bag of practitioners) and do the confounding ourselves. That would be violating WP:NOR. And if we base our confounding of the two on the notion that "a few researchers have done it themselves with their research, so we should be able to do the same with some other research", then we are violating WP:SYN. So, in conclusion: yes, we can use research that makes conclusions specifically about chiropractic, but research which only discusses spinal manipulation in general should be saved for the Spinal manipulation article. -- Levine2112 ^discuss 17:18, 17 September 2008 (UTC)

Once again you make a claim ("Chiropractors have their own version of spinal manipulation, wholly different in diagnosis, technique and philosophy.") that ignores reality. Yes, chiropractors have all kinds of their own versions which they call "adjustments", but which are wholly different from HVLA type adjustments/manipulations, which is what we are talking about here. We aren't talking about chiropractic brandname techniques that have little to do with HVLA adjustment/manipulation. Those are not the subject of the research we are using. If you find that some of the references we are using are referring to such techniques and confounding them with HVLA adjustment/manipulation, then please help us by pointing them out. The ball is in your court. Your statement would be more true (although wholly inapplicable here) if you used more plurals: "Chiropractors have their own versions of spinal manipulation, wholly different in diagnoses, techniques and philosophy." Yes, they have myriad nonsensical and fantasiful ways of correcting their unique and fictional diagnosis, the chiropractic vertebral subluxation, sometimes using methods that can't affect spinal biomechanics at all.

To say that these brandname techniques are "their own version of spinal manipulation" is misleading, since the HVLA type adjustments have little to do with them and are already well known to and used by Osteopaths, Physical Therapists, and MDs. Many of the HVLA type techniques are not unique to chiropractic, even predating Palmer. Remember that Palmer learned from A.T. Still and bonesetters. He did develop some new variations, but those have long since become public property, are used by other professions, and are a part of what is being researched in the studies we are citing. Chiropractors have been sharing "their" techniques for years. It is only the "different diagnosis" (vertebral subluxation (VS)) and "philosophy" (VS as a cause of "dis-ease") that remains unique, very fringe, and quackery.

The HVLA techniques are the same by any name or any practitioner. There is no physical/mechanical/biomechanical/physiological difference, only a difference in intent. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Mainstream research does not consider spinal manipulation to be significantly different from spinal adjustment (the term preferred by straight chiropractors) from the point of view of effectiveness studies. We should not let WP:FRINGE theories about the distinction between "spinal adjustment" and "spinal manipulation" override mainstream views in this area. Eubulides (talk) 17:42, 17 September 2008 (UTC)

Very true. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

"Mainstream research does not consider spinal manipulation to be significantly different from spinal adjustment" - How do you know this? Remember, I have provided sources which contradict this. -- Levine2112 ^discuss 22:03, 17 September 2008 (UTC)

We haven't seen any sources that directly contradict this, without backward OR inferences related to effectiveness. No evidence has been provided that there is a physical difference between them. Even major chiropractic researchers (university presidents, professors, etc.) make no difference between the two. They are not "just anyone" who doesn't understand the issues. They are not confused or confounding anything. They know more about this than you do. You need to bow to their expertise and learn from them.

I will make some remarks about the "Futility of "effectiveness" discussions" in a new section below. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Futility of "effectiveness" discussions

What is troubling and bothersome about all of this is that misleading accusations of OR and SYNTH are being thrown around, and are functioning as straw men diversions because they are largely untrue, while another pressing issue is still unsettled. If we had settled that issue a long time ago, we would have avoided months of these discussions and have moved far ahead in our editing.

That issue is the inappropriateness of devoting so much space and energy to "effectiveness" in this article. These matters belong in the specific articles, and the only ones that relate to chiropractic are the articles related to Chiropractic treatment techniques, Spinal manipulation and Joint manipulation. Instead of devoting space to their effectiveness or lack thereof here, we should just mention them and wikilink them, for example: "The effectiveness of spinal adjustment/spinal manipulation is discussed in their own articles."

We need to get this matter settled once and for all and get on with editing other matters. An RfC would be appropriate and I will support a drastically pared down version (mostly removal to other articles) of anything related to "effectiveness", if the RfC is worded properly without the OR and SYNTH nonsense, which is unnecessary in such an RfC. If anyone revives these false accusations in that discussion, I will withdraw my support. Such accusations will only sidetrack the RfC. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Several times I have said that it'd be OK to trim Chiropractic #Evidence basis and put it into a subarticle, with a summary here. But I don't see why doing that would affect these misleading accusations.

• If we put discussion of the evidence-basis into Chiropractic treatment techniques, the exact same accusations would apply there; supporters of chiropractic would say that mainstream studies are about spinal manipulation, not chiropractic treatments, so it's WP:OR to cite those studies in Chiropractic treatment techniques.
• If we put the material into Spinal adjustment, supporters of chirorpractic would say that the mainstream studies use the term "spinal manipulation", not "spinal adjustment", so it's WP:OR to cite those studies in Spinal adjustment.
• Even Spinal manipulation wouldn't work. In #Examples needed Levine2112 gives just one example, Murphy et al. 2006 (PMID 16949948). Supporters of chiropractic would object to moving the material supported by Murphy et al. to Spinal manipulation, because Murphy et al. use the term spinal manipulative therapy, not spinal manipulation, and the two are not exactly the same thing.
• Last and not least, any summary of the evidence basis should include at least a brief mention of Ernst & Canter 2006 (PMID 16574972), the only systematic review of systematic reviews of the evidence basis, but supporters of chiropractic would object to this on the same grounds.

In short, these accusations of WP:OR are a device for removing discussion of the evidence basis from all articles about chiropractic, and for splintering the discussion in related articles so that the inexpert reader cannot follow what's going on. Eubulides (talk) 08:07, 18 September 2008 (UTC)

Did someone forget to log in?

I see now that an 59.167.72.46 is installing changes, at least one of them (namely, removing what he called the "dodgy opinion poll" was a change proposed in the past 24 hours by User:Surturz. Did someone forget to log in? Eubulides (talk) 23:48, 10 September 2008 (UTC)

It wasn't me, this is what I look like when I don't log in. It is bad faith for you and Fyslee to continue using snide comments implying that I am using sockpuppets. It seems incomprehensible to the both of you that NPOV might be between what you want the article to look like and what another editor wants to see. SurturZ --211.31.243.182 (talk) 01:13, 11 September 2008 (UTC) --Surturz (talk) 06:09, 11 September 2008 (UTC)

Hold on a minute Surturz! Who has made snide comments implying that you were using sockpuppets? Anyone can forget to log in, and such edits aren't "using sock puppets". Provide some proof. You went off earlier and falsely accused me of making such an accusation, and it's not true. Please provide proof so I can apologize, or you can just apologize and we can forget this repetition of a previous personal attack and assumption of bad faith. BTW, you should go back and sign any such edits properly. -- Fyslee / talk 05:40, 11 September 2008 (UTC)

You left a snide comment implying I was a sock here: [3]. Also, I logged out and added the comment above to defend myself against Eubilides snide remark implying that I was a sock (by demonstrating that I have an IP address in a completely different country to the comment he was referring to). To reprimand my for 'not signing' that IP comment is more bad faith. Particularly since I *did* put my user name on the comment, and you felt fit to reprimand me here rather than doing it on my talk page. (That said I have done so now, for I don't want to leave you any opening to game WP rules) --Surturz (talk) 06:09, 11 September 2008 (UTC)

That's a pretty unfair accusation considering the ancient nature of that comment and that I have since openly explained my retraction above:

• "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." [4]

and reassured you that I was not assuming you were a sock:

• "Take it easy. No one is threatening you and I'm not assuming you're a sock puppet." [5]

In spite of that you write that I have "continued"... Where have I "continued" to use "snide comments implying that [you were] using sockpuppets"? I only made a comment once a long time ago and it wasn't an accusation, only a suspicion that I have explained I dropped. I haven't continued anything, and I don't think Eubulides has either.

I believe you owe both of us an apology for making false accusations and assuming bad faith in our actions and intentions.

I am not gaming any policy. When I mention going back and signing your IP edits, I mean proper signing using four tildes that leave your username sig and time stamp, not just writing your name. I have been offering advice and warnings to help you. Why? Because I've been where you are, I needed help, and I learned from other's advice and warnings. We have all been beginners here and many of us have broken the rules and violated policies because we didn't understand how things work here. We were acting in misguided good faith. Editing here happens to be much more complicated than it would seem on the surface. The important thing is to show a positive learning curve by immediately stopping behavior that unnecessarily irritates reasonable editors, especially the type that is forbidden by policies here. Are you willing to learn from those with more experience, or are you going to continue to battle against us? We are discussing things with you and are willing to change positions if convinced by good evidence, references, and good explanations of policies. Unfortunately you are getting support from some editors who sympathize with your newby views on many of these matters, and this seems to keep you going in your current path. That's unfortunate. The editors to listen to are those who are seeking to include all available information from all POV, as long as they are well-sourced and presented in an NPOV manner. That's what NPOV demands. Those who seek to whitewash and eliminate POV they don't like will mislead you.

Where is all this aggression coming from? Ever since you came here you have treated this like a battlefield. Please calm down and assume good faith. We are here to collaborate. Maybe you should assume good faith by assuming that we know the rules here better than you do, which would be pretty much inevitable and obvious considering you are new here. Let's try to get along. We are getting tired of all your accusations, commenting on us instead of the edits, repeatedly making very controversial edits that have previously been demonstrated to be controversial, etc.. Let's try to be friends here. We don't have to agree, but at least we should be able to disagree agreeably. Just ask User:Dematt if that's possible. He's a great chiropractor and editor here. You won't find a better gentleman here. -- Fyslee / talk 07:06, 11 September 2008 (UTC)

For what its worth, I too read an implication in Eubulides post that was Surturz that made the edits, possibly do to the strange syntax in which Eubulides used "he" before using Surturz's name ("at least one of them (namely, removing what he called the "dodgy opinion poll""). Either way, we all need to relax and assume good faith. In reviewing the IP users edits, there is actually some merit to them, although it should be discussed here before the edit being made. DigitalC (talk) 09:47, 11 September 2008 (UTC)

It's possible there was a case of mistaken identity regarding which IP was used by Surturz, but my main point is that he falsely accused both myself and Eubulides of "continuing"... There was no implication of the use of sockpuppets, just that someone might have forgotten to log in. Otherwise I agree that we need to AGF. We need to get back to a pleasant editing environment. -- Fyslee / talk 13:47, 11 September 2008 (UTC)

My strange syntax was due to being hurried; did you notice the unclosed paren as well? Anyway, I wasn't accusing anybody of being a sockpuppet; I was merely asking whether someone had forgotten to log in. 59.167.72.46 has not responded to that question, so we don't yet have an answer to it, and may never get one. Eubulides (talk) 16:59, 11 September 2008 (UTC)

59.167.72.46 is again making the same edits proposed and fought for by Surturz. Has someone forgotten to log in again? If this is not Surturz, then it's a meatpuppet who should be blocked for edit warring and violating the 3RR principle, which forbids even fewer than three edits when it violates the principle. -- Fyslee / talk 06:23, 18 September 2008 (UTC)

"If this is not SurturZ"? Why do you doubt? I have already said and proved that 59.167.72.46 is not me. I'm not even in the same country as 59... Please stop trying to imply that I am logging out and editing the article with that IP. You and Eubilides have no cause to include my username in discussions about that IP address. So far you have called me a vandal, a sock puppet and speculated about my profession and friends (with the implication of POV pushing). Stop it. Just stop. --Surturz (talk) 07:05, 18 September 2008 (UTC)

That's pretty strong language, especially since it isn't true. I'm beginning to wonder if English is your second language, which is just fine, but would explain some of the misunderstandings that have been occurring. I haven't slandered you, as you wrote on my talk page, and I haven't implied anything. I only noted the similarity in edits and that it looks like you might have an unwanted "friend" who is meatpuppeting for you, likely without your knowledge. I would suggest you contact that person on their talk page and encourage them to log in properly to avoid confusion, since your IP is from Sydney, which is in the same country as Melbourne, where that IP is located. -- Fyslee / talk 14:19, 18 September 2008 (UTC)

Latest addition of Techniques section

Surturz has made a good faith attempt to improve our coverage of techniques. Unfortunately the section is located in the wrong place (we already have such a section) and we have already worked out a good solution to covering the subject, so any improvements to the existing subject should be discussed here. Maybe an improvement can be made, but the current addition needs to be moved to this talk page and worked out here. -- Fyslee / talk 14:19, 18 September 2008 (UTC)

Error in summarizing Canadian surveys

In reviewing Chiropractic #Vaccination, I see that one phrase summarized its source inaccurately. The phrase was "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". This phrase conflates two surveys. The 1st, in 2000, surveyed chiropractic students (not chiropractors) and generated the 40% figure. The 2nd, in 2002, surveyed chiropractors and generated the "over a quarter" figure. It's overkill to mention both surveys, particularly since the last sentence in this section already talks about the 1st survey, so I made this change to alter the text to mention only the 2nd survey's results; this removes the inaccuracy (and makes the text shorter by 8 words, by the way). Eubulides (talk) 06:38, 11 September 2008 (UTC)

I see now that Levine2112 reverted the change, saying "no consensus". What was wrong with the change? It corrects a clear error in the text. For convenience, here is a copy of the proposed change: replace this:

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.

with this::

a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.

and cite Russell et al. 2004 (PMID 15530683). Eubulides (talk) 07:45, 11 September 2008 (UTC)

You have made it quite clear that you don't want anything added/changed/deleted in the article without first obtaining a consensus. Please abide by this lest you be called hypocritical. Specifically, I have a problem with both of these studies as it is limited to specific geography. Further, as you know, I feel that this vaccination section is overblown and quite tangential to the subject at hand; chiefly, chiropractic. While I see the merits of including one or two sentences to the effect of "The safety and efficacy of vaccination is disputed within the chiropractic profession", I truly believe that anything more brings too much weight to a matter which would be better served in the Vaccination controversy article. We are attempting to squeeze way too much into this article (Chiropractic) as is. We need to keep this red herring, overblown, pot shots down to a minimum. So in essence, you will have a hard time gaining a consensus to add/edit any of the Vaccination material as I will be opposed to it until we first cut out this section completely and merely include a sentence or two somewhere in the body of the rest of the article. -- Levine2112 ^discuss 17:15, 11 September 2008 (UTC)

As I understand it, unless the section is removed you oppose all changes to it, even changes that make the section shorter and correct obvious errors? Eubulides (talk) 17:20, 11 September 2008 (UTC)

Shorter is better. I oppose adding for sure. Editing what's there is futile in my eyes as it should probably be cut rather than edited. If you look at the thread below you will see that I am in favor of edits that shorten, but I'd be much happier just cutting it. I am not stubborn though. I am always open to having my mind changed. But this is how I feel and having been feeling ever since this information was set apart into its own section. -- Levine2112 ^discuss 17:33, 11 September 2008 (UTC)

OK. But this edit shortens the coverage of vaccination (which you favor), and it corrects an obvious error (an action that I would think would be uncontroversial). So (acknowledging the fact that you dislike the existence of the section overall), are you still opposed to this particular edit? Eubulides (talk) 17:46, 11 September 2008 (UTC)

I am opposed to the inclusion of either of these. I would prefer the statement was removed outright. -- Levine2112 ^discuss 18:30, 11 September 2008 (UTC)

Yes, as I understand it, you are opposed to the existence of the section, prefer that it be removed with only a sentence or two remaining in some other section. But, assuming we can't gain consensus for such a drastic change, are you also opposed to a minor change that fixes an error in the section and makes the section a bit shorter? I don't see how this minor change would make the text worse from your viewpoint. A "futile" edit, I would think, is one where it wouldn't matter one way or another whether the edit was installed, so there would be no real point to opposing it. Eubulides (talk) 21:44, 11 September 2008 (UTC)

I think we are going to have to wait to hear from others. But if there is a consensus that the current text is indeed in error, I would have no problem with fixing the error. But first let's find out if others feel there is an error. -- Levine2112 ^discuss 22:59, 11 September 2008 (UTC)

Levine, please allow the correction of the text. Let's get it right for now, and continue debating whether the section belongs here in the article. I think it belongs!--—CynRN ^(Talk) 01:16, 12 September 2008 (UTC)

I am not disallowing the correction. I just want to make sure that it is indeed an error which needs correction. If it is, I am all for correcting it. To be honest though, I am surprised that Eubulides feels so strongly about the one-off survey study. He's been the one pushing to not use these kinds of studies but rather use more comprehensive reviews of literature. If this is the kinds of studies which we are going to accept, I have a whole slew of stuff for the Efficacy and Safety sections. -- Levine2112 ^discuss 01:43, 12 September 2008 (UTC)

OK, thanks, I installed this error-correcting change. We can talk about the whole slew of other changes in some other thread. Eubulides (talk) 06:20, 13 September 2008 (UTC)

Oppose this change. Eubilides, please get consensus before making changes to this section. --Surturz (talk) 16:57, 14 September 2008 (UTC)

Before you opposed the change, we had two editors in favor and one who said that he was all for correcting it if it is indeed an error. It is indeed an error, as demonstrated above; no one has disputed this. On what grounds do you oppose correcting the error? Eubulides (talk) 21:28, 14 September 2008 (UTC)

The Canadian survey error was fixed but it was reverted. I do not see any explanation for the continued reverts. QuackGuru 14:05, 18 September 2008 (UTC)

Delete "small number of authors" sentence

Levine2112 reverted this change, which had removed the sentence "A relatively small number of authors continue to disseminate antivaccination views.". Levine2112's change log said "no consensus". But the change was suggested by QuackGuru at the end of Talk:Chiropractic/Archive 26 #Vaccination draft (see "I prefer to delete it"), with no disagreement there. What is the problem with this change? Eubulides (talk) 07:45, 11 September 2008 (UTC)

I also object to the removal of this information, and believe that it should be coupled with "most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective." the way the IP editor changed it to earlier. This clearly frames that it is a minority of authors that are writing this majority of chiropractic writings on vaccination. - DigitalC (talk) 09:51, 11 September 2008 (UTC)

You do have a point "that it is a minority of authors that are writing this majority of chiropractic writings on vaccination." Please propose your new version here and let's consider it. I think you're on to something and that the coupling is important and should be written as such. -- Fyslee / talk 13:58, 11 September 2008 (UTC)

In Talk:Chiropractic/Archive 26 #Vaccination draft I proposed a change along the lines that DigitalC suggests, but QuackGuru objected to it, as he thought it was too confusing. Let me propose it again here. In Chiropractic#Vaccination, replace this:

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. A relatively small number of authors continue to disseminate antivaccination views.

with this:

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.

This subtracts six words from the text, and emphasizes the "relatively small". I don't see how it makes it more confusing (QuackGuru didn't say); perhaps someone else could explain the confusion and/or suggest a clearer rewording? Eubulides (talk) 16:59, 11 September 2008 (UTC)

The "cost effective" bit needs to go. It is taken out of context from the source to create an argument here. This is an WP:OR violation. -- Levine2112 ^discuss 17:19, 11 September 2008 (UTC)

The chiropractic source uses the phrase in an article about opposition to vaccination in the profession. The chiropractic author of the article is using it as part of his argument to make a point, and we are being true to the source. What I see here isn't an OR violation but an OB (obstructionism)^{(See the LEAD)} violation here. This stonewalling and nitpicking is getting pretty far out. -- Fyslee / talk 20:11, 11 September 2008 (UTC)

First, AGF. Lately you've seem to have forgotten this all-too-important tenet of Wikipedia. Second, please provide the full quote from the source you are speaking of above because maybe we are looking at two different things. -- Levine2112 ^discuss 21:07, 11 September 2008 (UTC)

The source is (Busse et al. 2005, PMID 15965414) is freely readable, so you can see the material in question. I'm not sure which "full quote" is being asked for here, but here's the phrase in the proposed text that cites Busse et al.:

"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 here are quotes from Busse et al. that supports the claims made in this phrase:

• "There appears to be a relatively small number of chiropractic (and chiropractic-associated) authors who continue to disseminate antivaccination views. Their arguments may appear to be valid until supporting references and data are investigated further. One common occurrence, documented above, is the use of questionable sources as the basis for antivaccination arguments."
• "The antivaccination stance of some chiropractic organizations, and the writings and other activities of certain chiropractors, have placed the profession as a whole under scrutiny.It is therefore appropriate to consider whether or not there is any justification for such a stance. Although most public health authorities would agree that vaccination constitutes one of the most cost-effective infectious disease control measures of the last century, few, if any, would argue that there are no problems associated with their use. Concerns about vaccine safety and efficacy are valid issues which continue to be addressed by public health experts in many countries. Nevertheless, in evaluating these concerns within the context of a vaccination program, it is essential that the risks and benefits be given the appropriate weight. Whether or not the curricula of most chiropractic colleges provide the necessary instruction to permit their graduates to provide this is questionable."
• "It is certainly the case that most chiropractic writings on vaccination focus almost exclusively on the negative aspects, either ignoring the huge amount of evidence supporting the benefits of vaccination or summarily dismissing this as 'bad science' or government/industrial propaganda."
• The following text from the conclusion may help place the above in context: "In the face of now overwhelming evidence to show that vaccination is an effective public health procedure, Palmer's modern followers have turned to whatever sources they can to support chiropractic's archaic anti-immunization position. However, our preliminary discussion suggests that current chiropractic anti-immunization arguments rely heavily on biased and selective misrepresentations, or omissions, of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely 'philosophical,' not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths, and false information to support this position."

Hope this helps. Eubulides (talk) 22:02, 11 September 2008 (UTC)

You will notice that the one time "cost-effective" is mentioned above, it is not in the context of making the argument which we are presenting in the article. In fact, it is in the context of saying that even though vaccination is cost-effective, most public health authorities (not just chiropractors) would agree that there are safety and efficacy problems associated with vaccination. Do you see how we have taken this out of context to create an original argument? -- Levine2112 ^discuss 23:06, 11 September 2008 (UTC)

There is no original argument in Chiropractic #Vaccination; merely the summary of an argument in the source. However, if it would be preferred to summarize that argument's context as well, here's a first cut at the wording:

"The consensus among public health authorities is that vaccination is one of the most cost-effective public health measures. Although vaccination has safety and efficacy problems, whether chiropractors are not trained to assess its risks and benefits is questionable, and arguments used by chiropractors against vaccination are full of innuendo, half-truths, and false information."

Would that be better? The idea is to summarize the source more fully and accurately (at the cost of brevity of course). Eubulides (talk) 23:49, 11 September 2008 (UTC)

• That creates another original argument because the source says that it is questionable whether or not chiropractic colleges provide the necessary instruction to evaluate the weight which should be given to the safety and efficacy problems of vaccination. Whereas what you have written states what is only questionable as a fact. That's WP:OR.
• I think all of this gives far too much weight to Busse and to the topic itself. Again, one - maybe two - sentences in total on "chiropractic and vaccine" should suffice, provided that there is a link to Vaccine controversy. -- Levine2112 ^discuss 23:59, 11 September 2008 (UTC)

OK, I altered the draft to more-closely match the source with respect to training. The goal was to use this sentence instead of something longer in Chiropractic #Vaccination, but if there's not sufficient support then let's not pursue it. Eubulides (talk) 04:51, 12 September 2008 (UTC)

Still far too much weight given to the source and the subject. The "cost-effective" part is kind of a red herring here and should be eliminated completely. No one (anti-vaccination chiropractors) seems to be arguing against that point. Perhaps the wording should be: Though the majority of public health authorities would argue that vaccination has safety and efficacy problems, it may be questionable whether chiropractors are trained to assess of such risks and benefits. Again, this still gives too much weight to Busse, a paper published JMPT, sure, but I thought we were setting the standards at the level of robust reviews of literature. This is just a(n) one-off study essay. We must be careful not to state their opinions as facts. What is amusing to me in this paper is that it condemns these anti-vaccinationists for blowing the safety problems out of proportion. That in itself isn't funny, but it kind of reminds me of how the anti-chiropractic folks blow the estimated 0.000002% chance of fatality from cervical manipulation up to be some kind of huge deal. Considering the latest Gardasil tragedies, reports from VAERS, etc., I'm quite certain that the fatality rate from vaccination is significantly higher than from chiropractic. -- Levine2112 ^discuss 06:44, 12 September 2008 (UTC)

It would be amusing if we could find reliable sources to support claims comparing the fatality rates from vaccination and chiropractic treatment. The underreporting rate for adverse effects from spinal manipulation is enormous (it's been repeatedly shown to be close to 100%; see Ernst 2007, PMID 17606755), so estimates based on these reports as to the chance of fatality due to chiropractic care are nearly meaningless. Gardasil has not been shown to cause any fatalities, so it is also amusing that the topic of Gardasil would be brought up, as this sort of misleading discussion of risk-vs-benefit ratio is exactly the kind of discussion that Busse et al. are talking about. Eubulides (talk) 21:39, 12 September 2008 (UTC)

I was thinking the same thing and was rather incredulous (but not surprised) that we would see the very misleading arguments of antivaccinationists being defended and repeated in this way, but apparently this section is seen as a pulpit to defend and repeat their dangerous ideas. Is that what is necessary to make this "balanced"? -- Fyslee / talk 01:27, 13 September 2008 (UTC)

It's amusing that you buy into that "underreporting" b.s. Just as amusing as someone who buys into VAERS faking a no-correlation analysis of 21 deaths in the two years following Gardasil's release. [6] The numbers Ernst and other highly biased researchers have provided about underreporting is outrageous. They are truly guessing that it must be underreported. They really have no firm basis to make this assumption. Their numbers would have at least one person dying daily. They just don't correspond with reality. See this report for a good schooling and some lucidity: [7]. -- Levine2112 ^discuss 22:24, 12 September 2008 (UTC)

There isn't much to "buy into". It is not "b.s.". It is not "outrageous". There is no "guessing". There is no "assumption". You are using strong words without foundation. The underreporting is an undeniable fact (it's impossible not to have underreporting) and the 100% figure is based on a real survey of "all neurologists in Britain", not on suppositions, estimates, or assumptions like the chiropractic attempts to downplay the risks by odd analyses of some statistics or testing cadaver's necks. I am beginning to realize that your opposition to this subject isn't based solely on a defense of an ancient ideology, or your avowed mission here to protect the reputation of the profession, but on not having read the studies. Try actually reading it. Maybe your views on this subject will at least get modified a bit:

• "One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an underreporting rate of 100%.4 This extreme level of underreporting obviously renders estimates nonsensical." Source

The message is clear: underreporting exists, it is great, we are looking at the tip of an iceberg of unknown size, and thus estimates (including the one you cite above) are meaningless and nonsensical attempts to defend practitioners, thus leaving injured patients to fend for themselves. For ethical practitioners this knowledge of underreporting should lead to due caution, not to more circling of the wagons. Defense of patients needs to take priority over defense of the profession or defense of neck manipulation. As you know, my position is that NO profession (including my own) should be using high cervical manipulation except in very rare and highly controlled situations where there is no other alternative, IOW practically never.

Now that we have identified a red herring and buried it, let's get back to the subject of this section on chiropractic opposition to vaccination. -- Fyslee / talk 01:27, 13 September 2008 (UTC)

CORRECTION: Although Ernst refers to downplaying "by chiropractors", I am not implying that Levine2112 is a chiropractor. It is only the "playing down" part of the shoe that fits. -- Fyslee / talk 02:58, 13 September 2008 (UTC)

Okay, let's just make sure this part is in context. We can disarm further claims of taking things out of context or of OR by simply using the provided quote from the conclusion:

• "In the face of now overwhelming evidence to show that vaccination is an effective public health procedure, Palmer's modern followers have turned to whatever sources they can to support chiropractic's archaic anti-immunization position. However, our preliminary discussion suggests that current chiropractic anti-immunization arguments rely heavily on biased and selective misrepresentations, or omissions, of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely 'philosophical,' not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths, and false information to support this position." (Busse et al. 2005, PMID 15965414) Full article

Fair use allows such usage, and we should of course attribute it to the chiropractic authors. Quoting that part makes it relevant to modern day chiropractic. Quoting the immediately preceding three sentences provides the historical background, but would make this section longer:

• "The chiropractic antivaccination position was established by DD Palmer by likening vaccines to “filthy animal poisons.”4 Palmer's views resulted not from any objective analysis of scientific data, but from a rejection of anything he perceived to be associated with the medical profession of the day.17 His anti-immunization position was a narrowly dogmatic one that did not allow for scientific advancements or the introduction of new data."

This subject is large enough and significant enough as a present day problem to justify its own full-fledged article here. If that gets written, we could then use the LEAD from that article as the sole content of this section here. Until then we have to summarize the subject, and we're doing that. -- Fyslee / talk 04:17, 12 September 2008 (UTC)

(outdent) While such quotes might be appropriate for a full-fledged article on the subject, an article that the encyclopedia could well support, they're way too long for Chiropractic. Chiropractic's coverage could already stand a bit of trimming (though not down to a sentence or two, as Levine2112 proposes; that's too far), and these quotes would head in the wrong direction. Even for a full-fledged article I'd be dubious: an encyclopedia should not use long quotes like that without a very good reason, which I don't see here. Eubulides (talk) 04:51, 12 September 2008 (UTC)

Agreed that too much quoting is not great. Agreed that the coverage could stand some trimming. Busse is really more of an essay of opinions, not really research. I think we are already given it far too much weight. -- Levine2112 ^discuss 06:57, 12 September 2008 (UTC)

Proposed revision of Vaccination's first three sentences

We are going way overboard here. There is no need to include so much more information, and as other editors have suggested, this section should be trimmed, not expanded. Levine is correct that the statement about cost-effectiveness is out of context from the source. I made this change last month, but it was subsequently deleted. It followed the source quite closely. Using that change, and with framing the information about the minority writing the majority of papers (based on the IP users change here, I propose this change:

From: There are significant disagreements about vaccination 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. A relatively small number of authors continue to disseminate antivaccination views.

To: Although vaccination is an effective public health procedure, there are significant disagreements about vaccination within the chiropractic community. A relatively small number of authors continue to disseminate antivaccination views; most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective.

A slight variation would be to shorten the second sentence to "A relatively small number of authors continue to disseminate antivaccainatio views, with most chiropractic writings on vaccination focusing on negative aspects." This would help to trim this section, reduce its weight, and not substantially alter the content.

DigitalC (talk) 09:40, 12 September 2008 (UTC)

An edit along those lines would be appropriate. I prefer the first proposal, not the variation (which removes any mention of what's in the antivaccination claims; that mention is important). However, I see two important problems with this edit. First, there's a {{Verify source}} tag that should be removed; the source does support the claim, no? Second, that proposal understates the overwhelming consensus among mainstream science and medicine about vaccination. To fix the second problem, how about adding the "overwhelming evidence" phrase from the cited source? That phrase is part of the "effective public health procedure" comment in the cited source, and helps to establish context (the source says "In the face of now overwhelming evidence to show that vaccination is an effective public health procedure ..."). Finally, though this is not crucial, I'd prefer not leading with an "Although" clause; the topic sentence should be simple and straightforward. With all this in mind, how about this proposal (strikeouts and italics are with respect to what's in Chiropractic now)?

There are significant disagreements about vaccination within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, overwhelming evidence shows that vaccination is an effective public health procedure, a relatively small number of authors continue to disseminate antivaccination views, and most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. A relatively small number of authors continue to disseminate antivaccination views.

Eubulides (talk) 21:39, 12 September 2008 (UTC)

This is missing the fact that most healthcare professionals agree that there are safety and efficacy problems with vaccination. Is there a rationale why this was left out? -- Levine2112 ^discuss 22:24, 12 September 2008 (UTC)

Good point, Levine2112. This article should not say something very positive about vaccination without also presenting the negative side: if it says "overwhelming evidence" then it also has to talk a bit more about the other side of vaccination to make it NPOV. I think DigitalC's version is OK as far as that goes; however, the word "disseminate" seems non-neutral to me; how about "express" or something instead. ☺ Coppertwig (talk) 00:23, 13 September 2008 (UTC)

The article already presents information about the negative side. It says that most chiropractic writings claim that vaccination is "hazardous or ineffective". These claims are fringe, and the mainstream side also needs to be presented with appropriate weight. The wording DigitalC proposes does not present the mainstream view with appropriate weight: it says only that vaccination is an effective public health procedure, something that might just as easily be said for antifungal soap for preventing athlete's foot, and neglecting entirely the millions of lives that vaccination has saved, along with the overwhelming evidence of its cost-effectiveness. Wikipedia requires an accurate summary of all views with due weight; it does not require equal time for all sides. In this particular case, the mainstream opinion is extremely strong and well-supported; the minority viewpoint that vaccines are hazardous and ineffective is WP:FRINGE and deserves relatively little space. Eubulides (talk) 06:08, 13 September 2008 (UTC)

Maybe the reason it was left out is that this section isn't about vaccination as such, but about the controversial position on the subject found in the profession. It is that position that is the subject. For an indepth discussion of the pros and cons of vaccination, see the Vaccination article.

We could speculate on the desire to include this bit of information, namely a desire to use this section as a pulpit for defending and repeating the arguments used by antivaccinationists. If that desire is not real, then why are we seeing these arguments? I would like to AGF, and will hopefully see it restored by a retraction of this defense of antivaccination sentiments here and in the suggested edits and/or deletions of this section. So far this defense proves these sentiments are very real, and that the referenced exposures by scientific chiropractors of the defense of ancient antiscientific dogma by straight chiropractors isn't a minor or insignificant problem that should be ignored. No, it's very real and present right here. -- Fyslee / talk 01:40, 13 September 2008 (UTC)

Maybe it's fine if it only talks about chiropractors' position about vaccination and says nothing about vaccination. However, if some information about vaccination is included, then that information must be NPOV. A small amount of moderately positive information and no other information, as in DigitalC's suggestion, seems OK to me since there is strong support for vaccination in the medical community, I believe (but as I said, a mention of "overwhelming evidence" would need to be balanced.) Actually, I think some information on vaccination itself is needed: otherwise merely stating the chiropractors' position could be taken as being non-NPOV in the anti-vaccination direction. I'm sorry, Fyslee, I don't follow much of what you're saying; I don't know what you're referring to as "this bit of information". ☺ Coppertwig (talk) 03:16, 13 September 2008 (UTC)

It's not Wikipedia policy or guideline to put in "a small amount of moderately positive information". Wikipedia is supposed to give the mainstream viewpoint appropriate weight. In this case, the weight is overwhelmingly on the mainstream side; there is no dispute among reliable sources that vaccination is one of the most cost-effective forms of preventing disease. DigitalC's proposed wording makes it sound like vaccination is merely one public health procedure among many, one that has some controversy about it (with the implication that this controversy is justifiable); this isn't an appropriately balanced summary of what reliable sources say, and the proposal needs a few extra words to bring the summary into balance. Eubulides (talk) 06:08, 13 September 2008 (UTC)

Oops! Don't worry about that part, which doesn't apply to you. The other part about "overwhelming evidence" is not an editorial comment, but a quote from the source. We are just being true to the source, hence no need for "balancing" with other POV to make it NPOV. NPOV isn't about tit for tat editing. -- Fyslee / talk 03:37, 13 September 2008 (UTC)

Mainstream sources mention "side effects" and "adverse effects" of vaccination. In my opinion, a brief, plain mention of vaccination's effectiveness such as DigitalC provided is a reasonable very short summary of the mainstream position on vaccination. However, I think I understand why you want to include "overwhelming evidence" and I agree with that reasoning: it's because the statement of some chiropractors' position could be taken as implying that there is not such evidence. I still feel, though, that if such effusive language is included, then the negative side of the mainstream position on vaccination (i.e. acknowledgement of existence of side effects) also needs some mention. However, I think any mention of side effects as part of a presentation of the mainstream position should be very brief and low-key. I suggest using this sentence from the vaccine controversy article, or something similar: "Medical opinion is that the benefits of preventing suffering and death from infectious diseases greatly outweigh the risks of adverse effects following immunization." Perhaps something about "overwhelming evidence" could be fit in there too. Here are some source, which I assume would be considered mainstream sources, which are meta-analyses on vaccination which mention "side effect" or "adverse effect" in their abstract or introduction: [8] [9] [10]

The same source which says "overwhelming evidence" also quotes the AMA as saying "Since the scientific community acknowledges that the use of vaccines is not without risk,..." A NPOV representation of this source will not select only the positive statement about vaccination without balancing it (with the negative part of the mainstream view; not with fringe views) either from within the same source or from other sources. ☺ Coppertwig (talk) 16:42, 13 September 2008 (UTC)

Please see #Bloating Vaccination below. Eubulides (talk) 18:50, 13 September 2008 (UTC)

Bloating Vaccination

I don't understanding the need for the modified change proposed by Coppertwig above. The current text talks about costs (that's the "cost" part of "cost-effective"), and the current text also mentions claims that vaccination is "harzardous or ineffective". The current text covers both the mainstream and fringe views in a compact and NPOV way. It's not clear what's being proposed here exactly, but it sounds like what's being proposed is a substantial expansion Chiropractic #Vaccination, one that imports significant chunks of text from Vaccination controversy, an article that itself (because of its subject) goes out of its way to cover the fringe theories at length. I don't think that bloating Chiropractic here would be advisable, on WP:WEIGHT grounds; but even if we decide to bloat it, we would have to continue the current approach of emphasizing the mainstream view that the benefits of vaccination greatly outweigh the risks, and that the evidence for this is overwhelming. It would not conform to WP:WEIGHT to "balance" the discussion by mentioning pro and con sides with equal weight, which is what seems to be proposed here. Such an approach would give undue weight to the fringe views espoused by many chiropractors, views that inflate the risks and minimize the benefits of vaccination. Eubulides (talk) 18:50, 13 September 2008 (UTC)

My concern is, and has always been, that the section carries undue weight. My main concern is that we should not give the impression that the whole profession is anti-vaccination, when it clearly is not. The section should talk about the minority of chiropractors that oppose, rather than seeking to 'spin' the topic using all-encompassing phrases such as 'vaccination is controversial within the chiropractic community', etc. I'm not happy with the survey of students at the end of the paragraph either, since 1) students are not chiropractors 2) it is an opinion poll and unscientific. --Surturz (talk) 16:46, 14 September 2008 (UTC)

• None of the versions under dispute say that the whole profession is anti-vaccination. The profession is split, with a minority favoring vaccination, and a minority opposing, with the rest in the middle. The lead should give an accurate impression of the situation: it should not say merely that a significant minority is opposed to vaccination, without also noting that a significant minority favors vaccination.
• I agree with removing last sentence, which talks about the survey of students, as I think that the issue is relatively minor for Chiropractic and can be covered in Vaccination controversy instead. However, when I raised this issue earlier my suggestion did not reach consensus. Perhaps we can revisit the issue now? I suggest starting a new thread for that, so that people can clearly see it.
• I see that you just installed a single edit that reverted several changes saying "Please gain consensus first". One of the changes restored older wording (which you have consistently opposed, and have consistently tried to insert wording that you prefer, without consensus). One of the changes shrinks a URL, which no editor has opposed. One of the changes corrects an error, which (before you showed up) two editors favored and one editor said was OK if the change corrected an error; you did not explain your opposition to correcting an error. Combining all these edits into one is misleading, and it's certainly not consensus to install the disputed topic sentence. Since there is still an outstanding dispute about correcting the error in question, I restored the old (erroneous) text, and the old introduction; I assume the shorter URL is not in dispute so I installed that as well. Eubulides (talk) 21:28, 14 September 2008 (UTC)

Eubulides (talk) 21:28, 14 September 2008 (UTC)

In my comment above, I'm not proposing any modification to the current text (or to the other version in the current sequence of reverts). I'm saying that if the words "overwhelming evidence" are added in a statement about vaccination, then the words "side effect", "adverse effect" or "risk" should also be added (in a very brief, low-key way) in a statement about vaccination (not just in a statement about chiropractors' views about vaccination), in order to present a NPOV view of vaccination (i.e. the mainstream view). I'm not talking about vaccine controversy or a fringe position; I'm talking about the mainstream position that there are some risks and side effects to vaccination. If you wish to avoid bloat, I'm OK with not adding the words "overwhelming evidence"; just stating as a fact that vaccines are effective seems sufficient to me, although I understand the reason for wanting to include this phrase and I don't oppose it provided it's properly balanced as I suggest.

These two adjacent sentences in the article seem to contradict each other: "...most chiropractic writings on vaccination focus on its negative aspects,[10] claiming that it is hazardous or ineffective.[117] A relatively small number of authors continue to disseminate antivaccination views..." and the first one is taken out of context: the source continues on to say "...Such an approach, however, is akin to describing the airline industry entirely on the basis of flight delays, lost luggage, and air crashes." which I think is a good point and joins in with the point Surtuz is trying to make. Incidentally, it also ties in with something about Wikipedia editing: two editors might have similar, but just slightly different, ideas of what a NPOV article should look like, but each might get the impression that the other is trying to "push" the article very far towards a fringe view in one direction or the other, because they're constantly pushing in opposite directions. If they see that a certain view already seems adequately represented in their opinion, they may say nothing about it, and others may jump to the conclusion that they think nothing ought to be said about that view: this applies both to Chiropractors writing about vaccination, and to Wikipedian editors editing on any topic.

Eubulides, could you describe if you haven't already what was the error you were trying to correct in the article? Does it have to do with whether the survey participants were chiropractors or students (graduates)? ☺ Coppertwig (talk) 17:16, 14 September 2008 (UTC)

• The two sentences are not contradictory, of course. Most chiropractic writings on vaccination are critical of vaccination, and these writings are generated by a relatively small number of authors.
• I'm afraid that you misread the point of Busse et al. 2005 (PMID 15965414). Their sentence "Such an approach, however, is akin to describing the airline industry entirely on the basis of flight delays, lost luggage, and air crashes." is in a paragraph describing chiropractic antivaccination writings. That sentence clearly refers to the approach taken by chiropractic writings, which describe vaccination entirely on the basis of its risks and adverse effects. That is, Busse et al. in that sentence are writing about chiropractic critics of vaccination, not about critics of chiropractic.
• This misreading underscores your point that multiple editors are needed here, to keep all sides on their toes, and to summarize reliable sources as accurately as possible.
• Merely saying that "vaccines are effective" understates their enormous impact on public health; going on to talk about criticism (which is what the proposed text would then do) is POV, because it makes it sound like the criticism is justified and that there is serious dispute among reliable sources whether vaccination is a good idea. There is no such dispute, and Wikipedia should not make it appear that there is such a dispute.
• The current wording does not say "overwhelming evidence", so I take it you're OK with the current wording? It would be OK to talk about the mainstream position that there are some risks and side effects only if these risks and side effects are placed within context, namely, that the benefits of vaccination greatly outweigh its risks and side effects.
• The error in the current version (now that Surturz has reverted the correction) is discussed in #Error in summarizing Canadian surveys above. The error is partly that "40%" came from students (not graduates, and not chiropractors). But it's also that the 40% is an average over a student body that became more anti-vaccination with time; it's more accurate to use a survey of chiropractors themselves.

Eubulides (talk) 21:28, 14 September 2008 (UTC)

We could try something like this:

• In spite of the overwhelming evidence of great efficacy and cost effectiveness for millions of people, mostly children, the relatively small number of advocates of antivaccination viewpoints produce most of the chiropractic writings on this subject and they choose to focus on the known risks and side effects in rare instances for single individuals."

That needs tweaking, but I've tried to get all contrasting aspects in there and remove what might seem like a contradiction. -- Fyslee / talk 18:19, 14 September 2008 (UTC)

Something along those lines would be reasonable, yes. I'd prefer adding something about what vaccines do (prevent infectious disease, avoid deaths, that sort of thing). The phrases "they choose to" and "for single individuals" are redundant and can be omitted. "Efficacy" should be "effectiveness". We'd need sources, of course. Eubulides (talk) 21:28, 14 September 2008 (UTC)

Improvements were made to the vaccination section but it was reverted. QuackGuru 14:00, 18 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. [11] [12] [13]
9. "Wellness" care (treatment of asymptomatic individuals for a lifetime).
10. Anti-medical propaganda [14] [15]
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)

Request for Comment: Excluding treatment reviews

Should a Cochrane review on spinal manipulation be excluded from Chiropractic on WP:OR grounds? Similarly, should other reviews of treatments used by chiropractors be excluded from Chiropractic?

• Example of what's in the article now. Chiropractic #Effectiveness's coverage of chiropractic treatments talks about spinal manipulation (SM), and says "a 2004 Cochrane review () stated that SM or mobilization is no more or less effective than other standard interventions for back pain." This passage cites the current Cochrane review on SM therapy for low back pain, along with a systematic review of systematic reviews of SM. Chiropractic #Effectiveness also cites several other reviews of treatments used by chiropractors, e.g., Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), and Gross et al. 2004 (PMID 14974063).

• Some background on the dispute. Some Wikipedia editors are objecting to citing mainstream reviews such as these, arguing that only sources specifically devoted to chiropractic should be cited by Chiropractic. This dispute has gone on for months; for previous discussions, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, Chiropractic section on evidence basis, and A starting point for a look at the effectiveness section and introduction. A previous RfC on this issue (see Request for Comment, Possible OR violation at Chiropractic Effectiveness) does not specifically ask whether the abovementioned reviews should be excluded. This followup asks for clear advice on the core of the dispute.

Statements by editors previously involved in dispute

• Mainstream reviews of treatments commonly used by chiropractors should not be excluded from Chiropractic on WP:OR grounds. Such exclusion would be contrary to WP:WEIGHT, a fundamental Wikipedia principle. Eubulides (talk) 21:39, 16 September 2008 (UTC)

Comments

View by Ludwigs2

• Remove Cochrane Review. reading the review (as provided here), the review really says little, much less anything useful about chiropractic, and what it does say it says in a mildly biased fashion. summarizing the results, the review uses the following categories: 'sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful'. SHAM appears to be a placebo control, but chiropractic is not mentioned in the list, and it is not obviously clear where it would fall. even if we assume that chiropractic is considered to be a form of spinal manipulation, the review concludes that "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which is simply a well poisoning way of saying that spinal manipulation is roughly equal in effectiveness to conventional treatments. since we don't know the relationship between Ch and SM, and SM is roughly equivalent to conventional treatments, this review tells us absolutely nothing about Ch. --Ludwigs2 00:53, 17 September 2008 (UTC)

The abstract says that SM comparably effective to some other standard treatments. I'm not sure why you think that is negative. Your point about chiropractic is relevant, though. Do we have any sources discussing the relationship between SM and chiropractic? Chou's review states that heat is moderately effective, and I know some chiropractors use heat. II | (t - c) 07:02, 17 September 2008 (UTC)

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "We agree that many of the randomized trials we described were on spinal manipulation rather than specifically on chiropractic manipulation itself, but we believe that this is not a significant point. Chiropractors use all forms of manipulation. In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." The course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.
• Ludwigs2's comment seems to be primarily about WP:NPOV, not WP:OR. NPOV is of course an important issue, but the RfC is about WP:OR, not WP:NPOV.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

• Include SM reviews.I find it strange that you didn't mention that Ernst raised the exact point we have at issue here, saying that these SM studies are not relevant to chiropractic necessarily. And we have separate articles with the two -- and my attempt to connect the two was reverted. Until this relationship has been clarified more extensively, it's hard to say whether general SM research is really completely relevant to chiropractic. Are the providers who are being tested in the RCTs chiropractors? Anyway, I still want to keep the SM research summarized in the article, and I think its relationship to chiropractic is decently presented. However, Ernst's point that general SM research may not apply to chiropractic SM should be noted. II | (t - c) 07:42, 18 September 2008 (UTC)

• It would be appropriate to note that point and cite Ernst. Could you refresh our memories with a cited quote from Ernst about this? I don't recall his writing about it. Thanks. Eubulides (talk) 08:07, 18 September 2008 (UTC)

• Remove Ernst and Cantor review. (subject to consideration). this review shares the same problems as the above review - it does not clearly speak to chiropractic, and its conclusion is oddly biased. if it can be demonstrated that SM and Ch are equivalent terms, this review would be useful for for pointing out the number of conditions that SM doesn't seem to work on; however, its general conclusions do not follow from its conclusions about back pain (e.g., they assert that SM is better than sham but not better than conventional treatments for back pain, but then they assert that "these data do not demonstrate that spinal manipulation is an effective intervention for any condition", which is patently false given their earlier statement. why use a source that can't be consistent over the space of three lines? --Ludwigs2 01:03, 17 September 2008 (UTC)

Would appreciate you linking these reviews as you kindly did the other one. II | (t - c)

sorry - I just took them from the links given above. but here you go. --Ludwigs2 07:45, 17 September 2008 (UTC)

• Here, Ludwigs2's comment seems to be primarily about WP:RS, not WP:OR. That is, Ludwigs2 seems to be primarily arguing that Ernst & Canter are contradictory and are not reliable.
• The results from Ernst & Canter 2006 (PMID 16574972) are consistent. They say that some reviews (e.g., Assendelft et al., Bronfort) say that SM is superior to sham for back pain, and that some reviews (e.g., Gross et al., Ferreira) say it's not. Their remark "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition" says that the overall evidence is contradictory and that SM overall has not been demonstrated to be effective. This is a consistent position.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

Keep the reviews. It's not us to decide whether or not they apply to SM, chiropractic, or both. If the authors state that they apply, we do not as editors contradict that. Ernst & Canter have clearly stated that in the reports themselves and in other writings ( a whole chapter in Ernst & Singh's book Trick or Treatment ) that these reviews apply to the effectiveness of chiropractic. We defer to the experts. Macgruder (talk) 14:28, 18 September 2008 (UTC)

Outside view by WhatamIdoing

The Cochrane reviews should be included. Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. The ongoing assertion at this page that Wikipedia should exclude normal scientific information from highly reputable sources simply because a given paper wasn't written by a chiropractor is absurd. WP:WEIGHT prevents the exclusion of mainstream sources. However, if you want to follow up on that theme, it might be interesting to include a point published by Ernst: whether or not a given clinical study determines that chiropractic care is effective depends significantly on whether there's a DC writing the paper (not just doing the spinal manipulation).

The Ernst and Cantor review should be included. Editors with an opposing POV may want to make a case for including this editorial about it, although I found several of the complaints to be particularly weak. They will also want to carefully consider their position: if you accept this critical commentary, then you must also accept the fact that the Ernst and Cantor review is considered, by relevant experts in chiropractic itself, to have direct connections to chiropractic.

About the difference between "same effectiveness" (for one condition) and "not effective" in general: Increasingly, the standard for effectiveness is "better than what we've already got". However, the general reader isn't going to know that, and thus the conclusions should be presented in somewhat more detail: "no more or less effective than other standard interventions for back pain." In other words, exactly like it's currently in the article. I also don't understand why this is seen as disparaging information.

In short, the inclusion of these reviews does not violate WP:OR and they do provide necessary balance under WP:WEIGHT. WhatamIdoing (talk) 22:50, 17 September 2008 (UTC)

Your argument for inclusion hinges on this statement: Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. How do you know this? Plus, is this about what chiropractors accept or what the mainstream scientific community accepts? For instance, there was a case where chiropractors were using positive conclusions from a general spinal manipulation study to state things such as "Chiropractic works!" However, the researchers involved with the study were very critical of chiropractors doing so because their research was about spinal manipulation and not about chiropractic. Dr. Paul Shekelle of RAND released this statement:

"...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic... Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."

-- Levine2112 ^discuss 23:51, 17 September 2008 (UTC)

You are again confounding "spinal manipulation" (a technique) with "chiropractic" (the profession), which is the same error made by the original chiropractors mentioned above, and scolded by Shekelle for doing so. They were trying to claim that spinal manipulation research that was positive was a green card for claiming that everything the profession did "works", which is far from the truth. Much in chiropractic is rejected as fringe, unscientific quackery, and Shekelle wasn't about to allow such misuse of the RAND study. The conclusions of the study only had relevance to the major technique performed by the profession, and upon which the profession is based. Chiropractic is not equal to spinal adjustment/manipulation (SM), but "no SM, no chiropractic". Chiropractic without SM would be like a nail without a hammer. They belong together.

We aren't discussing the RAND conflict here. We are discussing whether the subject of "spinal manipulation" is relevant to the chiropractic profession, and it is very relevant, as noted by their strong objections in the commentary mentioned above. If it were irrelevant, they would have been silent. BUT keep in mind, it is only relevant as regards the effectiveness of manipulation/adjustments, which are performed by chiropractors and thus such research is very relevant to them, even when it is about SM performed solely by non-DCs (a few such studies exist), or including a few non-DCs (usually the case). -- Fyslee / talk 04:50, 18 September 2008 (UTC)

The fact that notable chiropractors and researchers consider general research about spinal manipulation relevant for the profession is explained quite clearly by Meeker and Haldeman, as noted above by Eubulides:

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "We agree that many of the randomized trials we described were on spinal manipulation rather than specifically on chiropractic manipulation itself, but we believe that this is not a significant point. Chiropractors use all forms of manipulation. In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." The course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.

Neither Eubulides nor myself know of any dissenting voices in reliable sources, and I think we should follow the sources, rather than Levine2112's (or other's) personal opinion. This is not a case of OR or SYNTH. -- Fyslee / talk 06:09, 18 September 2008 (UTC)

Your explanation illustrates the WP:SYN violation beautifully. You are wanting to use Meeker's explanation to justify the inclusion of research which Meeker didn't specifically analyze. Thus you are justifying Source A by using an explanation in Source B to create an Original Statement C (that the conclusions of non-chiropractic Source A is directly applicable to chiropractic). Please note that I have no problem including Meeker or the non-chiropractic research which they analyzed and directly applied to chiropractic. This issue here is with the other non-chiropractic research which has not been directly applied to chiropractic by any researchers. Merely following the lead of Meeker here with these other non-chiropractic studies creates original research and we cannot have that. -- Levine2112 ^discuss 07:58, 18 September 2008 (UTC)

There is no "original statement C" in Chiropractic #Evidence basis, so there is no WP:OR there. As you note, there are original statements on this talk page; but that's OK. A talk page is allowed to contain original research, and talk pages routinely contain OR; it's only the article itself that should not contain OR. Eubulides (talk) 08:07, 18 September 2008 (UTC)

NPOV

Welcome back, QuackGuru. However, I disagree with all or almost all of the changes in this edit. Per NPOV, Wikipedia articles must not state opinions as if they are facts. This is a core policy and is more important than whether the text flows smoothly etc. Please get consensus on the talk page before making this sort of change which significantly changes the meaning and causes the article to make bold assertions. Re the survey: as you've worded it here, it makes it sound as if the survey established as fact that a certain percentage of chiropractors are unethical, when all it did was establish that a certain percentage of people believe that chiropractors are unethical. Please get agreement on the talk page on the wording about the survery before inserting it into the article. ☺ Coppertwig (talk) 13:28, 17 September 2008 (UTC)

Agreed. It's troubling that QuackGuru's first action back after 100 hour disciplinary ban is to make broad reverts without trying to gain consensus. Many of his edits (such as removing the SYN banner from the Effectiveness section) flies in the face of the ongoing RfCs. -- Levine2112 ^discuss 17:21, 17 September 2008 (UTC)

Coppertwig, thanks for catching the wording problem about the survey. To fix the problem I just now proposed new text in #Gallup poll above. I agree with Levine2112 that it's premature to remove the SYN tag. I disagree with Coppertwig about the Simon-says text; that's something I'd like to take up in a later thread. Eubulides (talk) 17:42, 17 September 2008 (UTC)

I reverted QG's defiant edits twice now. He tried removing the SYN tag (for which there is agreement that it should remain) and tried to add in premature Gallup text which is currently being discussed. Would requesting a topic ban of QuackGuru be unfounded? -- Levine2112 ^discuss 18:38, 17 September 2008 (UTC)

I do not support a topic ban for QuackGuru. The specific Gallup text was not disputed until after he added it, and it's not clear that he knows of Coppertwig's later remarks about it. The SYN tag is arguable, and it's not unreasonable to remove it, though I myself think it should stay for now. Eubulides (talk) 19:22, 17 September 2008 (UTC)

Oppose topic ban. I don't see any good reason for the SYN tag now that we've already put this question to NOR/N: a tag should be related to a process with some hope of resolution. I'm not aware of agreement that the tag remain after the NOR/N discussion.^{(23:20, 17 September 2008 (UTC))} Boldly adding proposed text for which some support has been expressed is not unreasonable. ☺ Coppertwig (talk) 21:02, 17 September 2008 (UTC)

With respect to the SYN tag, I want to make sure that Coppertwig is aware of the two directly related RfCs taking place on this page. Both of them are calling into question whether or not there is a SYN/OR violation in the section. At this time, all of the outside editors responding believe that there is an OR violation. Further, please note that the NOR/N (still open) has received input from other editors and currently there are more editors agreeing that there is an SYN/OR problem with the Effectiveness section. Given this, do you still feel that the SYN tag is unwarranted/unnecessary? -- Levine2112 ^discuss 22:02, 17 September 2008 (UTC)

Oh, sorry. I wasn't aware of all that. I saw the RfC but forgot about it when commenting above, sorry. I did a partial revert and didn't restore the tag; that was because I was taking a neutral position on the tag, not from any intention to remove it.☺ Coppertwig (talk) 23:20, 17 September 2008 (UTC)

I appreciate your neutrality. I am going to add an OR tag to the section rather than the more specific SYN tag. -- Levine2112 ^discuss 23:26, 17 September 2008 (UTC)

(outdent) Levine2112's summary of the NOR/N discussion is misleading.

• Only one previously-uninvolved editor responded to the NOR/N, namely User:Calamitybrook. That editor firmly stated that there was no OR here (see, for example [16]).
• The other editors who posted in that thread (Dematt, DigitalC, Fyslee, Levine2112, QuackGuru, TheDoctorIsIn, Soyuz113, Surturz, and myself) were all veterans of the discussion here first, and largely just repeated that discussion there.
• The NOR/N discussion suffers from two other procedural issues:

• Levine2112 wrote Surturz, recruiting Surturz to NOR/N, after Surturz had jumped in at Chiropractic by tagging Chiropractic#Vaccination with {{POV-section}}, and making several comments here strongly criticizing the section on WP:POV grounds.[17][18][19].
• User:Soyuz113 has since been blocked indefinitely as a sockpuppet of User:CorticoSpinal/User:EBDCM/etc. Chiropractic has had significant problems with sockpuppet and abusive accounts, unfortunately, and it appears that this affected the discussion noted above.

In short, the NOR/N discussion supported removing the SYN tag. Levine2112 disagreed with that removal, and initiated an RfC here to reverse it. Eubulides (talk) 08:07, 18 September 2008 (UTC)

Levine2112 previously agreed with Dematt against having a RFC and the outside opinion at the NOR noticeboard is that there was no OR. There was consensus at the noticeboard for removing the tag. There was a RFC for adding a lot of this specific information to the article. The outside view was to include the information. It was for the better. QuackGuru 13:54, 18 September 2008 (UTC)

Assert facts

NPOV states "Assert facts, including facts about opinions—but do not assert the opinions themselves" (emphasis in the original). Therefore the following points:

I oppose removing the word "considered" from this sentence: "For most of its existence chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic." Removing the word "considered" has the effect of making the Wikipedia article state as if it's fact that the idea of subluxation is a significant barrier to scientific progress. This is merely an opinion, not a widely-accepted fact.

I oppose deleting "what are characterized as" from "Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine", because to do so transforms the sentence into one which asserts that the ideas are antiscientific and pseudoscientific, which again is opinion. This has been discussed previously.

Similarly, I oppose deleting "what is considered by many chiropractic researchers to be" before "antiscientific reasoning".

I oppose changing "have been called ethically suspect" to "are ethically suspect". Again, do not assert opinions.

I added a sidebox to previous discussion. There, Eubulides makes the points that "antiscientific" is the most common term used in the sources for this; carries its usual meaning; and describes a position critical of science and the scientific method. While these are good points, I still contend that it would be surprising to find chiropractors describing themselves as "antiscientific" and that this term therefore does not have a neutral tone. If it's established as fact that chiropractors are critical of science and the scientific method, then that can be stated in those words. I can imagine a chiropractor (at one end of the spectrum) stating that they reject the scientific method and do not consider that they require proof for their assertions; I cannot imagine them saying of themselves that they are "antiscientific" and using "unsubstantiated claims". If something is asserted as fact by the Wikipedia article it must be done with words with an "impartial tone" per NPOV. Eubulides also argues that "ethically suspect" is part of the mainstream consensus. I argue that a statement of ethics must necessarily be a statement of opinion, not fact, and therefore requires attribution. ☺ Coppertwig (talk) 21:36, 17 September 2008 (UTC)

Agreed. -- Levine2112 ^discuss 23:45, 17 September 2008 (UTC)

Agreed. Attribution is proper here. We can't state as fact what is an (accurate) opinion. It happens to be the opinion of mainstream science and of many notable progressive chiropractors who are not mired in the mud of ancient "straight" biotheological dogma, and it should be attributed to them, not stated as fact. The only ones who question it is large numbers of old-fashioned chiropractors who are concerned with preserving the fringe, independent, antiscientific identity of the profession as what it is. Both POV should be presented and this part presents the mainstream POV and should be attributed accordingly. We have plenty of chiropractic sources which express such POV, which makes the case against a conspiracy against chiropractic even stronger. Chiropractors themselves are protesting hanging onto ancient dogma. As Carter, former Canadian Chiropractic Association President stated:

• "Subluxation, though a vital part of our history has been described as the Achilles Heel of our profession. When you review the available literature and combine it with knowledge of our history, it quickly shows where the subluxation model has failed. This model has cost us years of positive growth."

Keep in mind that Vertebral subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach.

-- Fyslee / talk 05:24, 18 September 2008 (UTC)

WP:NPOV does not require the Simon-says style being proposed here. When WP:NPOV says "Assert facts, including facts about opinions—but do not assert the opinions themselves." it immediately goes on to define "fact" to mean "a piece of information about which there is no serious dispute" and "opinion" to mean "a matter which is subject to dispute", and by "dispute" they clearly mean "serious dispute". There is no serious dispute among reliable sources about the items being being discussed in this section. (There is dispute by some Wikipedia editors, but we editors do not count as reliable sources.) Therefore, by WP:NPOV's own definition, these items are "facts" and not "opinions". (PS. Earlier I was confused about this, because I was using a different definition of "opinion" and "fact", not the definitions that WP:NPOV uses.) Eubulides (talk) 08:07, 18 September 2008 (UTC)

There is no serious disagreement or dispute among reliable sources. Per NPOV, there is not a requirement to add the unnecessary Simon says attribution. QuackGuru 13:34, 18 September 2008 (UTC)

Two Techniques sections?

This edit added a new section Chiropractic #Techniques. But there already is a section Chiropractic #Treatment techniques on the same subject, and the latter section is a brief summary of Chiropractic treatment techniques, using the Wikipedia summary style. The newly-added material should be moved to Chiropractic treatment techniques, no? At best a very brief summary would belong in Chiropractic #Treatment techniques. (Also, it's better to propose extensive or possibly-controversial changes like these on the talk page first, to avoid problems like this.) Eubulides (talk) 08:30, 18 September 2008 (UTC)

Having two sections is like having two articles. Is there anything worth merging into the original Techniques section. If not, then we should delete the second section. QuackGuru 13:37, 18 September 2008 (UTC)

References

Please keep this section at the bottom. TO ADD A NEW SECTION, just click the EDIT link at the right and add the new section ABOVE this one. Then copy the heading into the edit summary box.

(The following resolve otherwise-dangling references: )