Talk:Chiropractic/Archive 32

The word frequently is sourced using a systematic review
The word frequently is sourced and no doubt NPOV.

The conclusion of the 2007 "Adverse effects of spinal manipulation: a systematic review" stated: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation. It is not appropriate to delete sourced text from a recent systematic review. The deletion diluted the meaning of the sentence. QuackGuru (talk) 18:44, 25 September 2010 (UTC)


 * "Frequently" is a conclusion of the study. Putting it in the voice of WP endorses the study, which would not be impartial/NPOV. To use "frequently", the sentence should say "according to a 2007 study...". Additionally, "frequently" is a relative term and does not convey clear information. --JimWae (talk) 19:06, 25 September 2010 (UTC)


 * You have not shown a serious dispute to attribute it with "According to..." per Wikipedia's WP:ASF. The word "frequently" is a precise term that conveys that the adverse effects are frequent following SM. QuackGuru (talk) 19:13, 25 September 2010 (UTC)


 * "Frequently" is indeed a conclusion of the study. Using the words chosen in a reliable source's conclusion in the article is accurate reporting, not endorsing, and the only NPOV violation is the deliberate omission of part of a source's conclusion to distort it. WP:ATTRIBUTEPOV is a subsection of Neutrality disputes and handling, and there is "no serious dispute among reliable sources". We attribute disputed statements (which are treated as opinions); undisputed statements of a reliable source are facts, and it is pushing a POV to treat facts as if they were only opinions. Show the reliable secondary sources that demonstrate a dispute about "Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects." The word "frequently" is a relative term, but it does convey information, and it was the word chosen by the author of a MEDRS-compliant review. Are you seriously suggesting that we should prefer your formulation to that of a reliable source, or do you have a reliable secondary source that says adverse affects are infrequent? --RexxS (talk) 22:12, 25 September 2010 (UTC)


 * From what I see ONE source says frequently, another says the number is unknown. WP cannot decide on the relative frequency if the sources cannot - even if ONE source has decided, & "frequently" appears to be nothing more than a subjective call--JimWae (talk) 08:45, 26 September 2010 (UTC)
 * Look harder. We have a reliable source Ernst 2007 that says "frequently". The current text in the article is also sourced to Anderson-Peacock 2005 that gives numbers ("40 of 100" on page 175), and another cited source Gouveia 2009 reporting "The frequency of adverse events varied between 33% and 60.9%". There's PLENTY there for WP to make up its mind with, and there's nothing "subjective" about using the same phraseology already used a reliable secondary source. "Accurately report your sources" is the relevant guidance here. What is this mysterious unnamed other source of yours that says "the number is unknown"? --RexxS (talk) 11:33, 26 September 2010 (UTC)


 * Text that is in Safety: "They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours;[146]"
 * The word "frequently" appears more than once in the article and it has a very specific meaning as to the adverse events. QuackGuru (talk) 03:32, 27 September 2010 (UTC)

Possible compromise
Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[21][22] The word "However" can be removed while restoring the word "frequently". I think this can work as a possible compromise. QuackGuru (talk) 06:06, 5 October 2010 (UTC)

I made this change to the text as a compromise. QuackGuru (talk) 18:57, 5 October 2010 (UTC)


 * Follows from the sources - looks good to me. - 2/0 (cont.) 18:29, 6 October 2010 (UTC)

Risk-Benefit
The last sentence of the risk benefit section is flawed: "A 2010 systematic review determined that there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition and thus concluded, "the risks of chiropractic neck manipulations by far outweigh their benefits."[23]

The "review" by Ernst does not address the issue of efficacy of cervical manipulation, it only lists case-reports of death that occur sometime after manipulation. As such, it is incorrect to state that this paper "determined" that there is no evidence to support neck manipulation as an effective treatment.173.206.208.56 (talk) 03:03, 3 October 2010 (UTC)


 * You seem to be familiar with editing on Wikipedia. Do you have an established account? Is this page on your watchlist. QuackGuru (talk) 05:00, 3 October 2010 (UTC)


 * The text is sourced. I don't understand why you deleted sourced text and replaced it with original research and irrelevant information to risk-benefit. I think you have read the source. Have you read the full text source. If you have read it then why are you deleting sourced text. In case you missed it I have pasted text from the source that shows the text is source per V policy. See Talk:Chiropractic. QuackGuru (talk) 05:00, 3 October 2010 (UTC)
 * Sorry, I dont have a watchlist. Also, I just copy and pasted references from the evidence section to support the claim that "There is conflicting evidence to support the use of cervical manipulation as a therapeutic modality" as this is the conclusion in that section. As such, I made the edit because there is an entire section on the effectiveness of manipulation for whiplash, headache, etc., via cervical manipulation, which concludes that there is still insufficient evidence to make a statement of efficacy or lack of efficacy. There are a list of reviews and systematic reviews used to support this conclusion in these sections. Then, when reaching the risk-benefit section, every study referenced is by the same critic (Ernst) and his studies also only reference other of his studies to support his biased point. This makes the risk-benefit section entirely one-sided and biased. He is the only author of any of the references that examine efficacy to state that there is no benefit from cervical manipulation. His 2010 "review" deals (poorly) with the risk only, not the possible benefits, he has simply referenced another of his biased studies to claim "there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition", whereas the list of references that I copied and pasted form the evidence section all claim that there is insufficient evidence to say one way or the other. Why should Ernst get the whole say? 173.206.208.56 (talk) 14:05, 3 October 2010 (UTC)


 * You wrote: Sorry, I dont have a watchlist. But you also wrote ... he has simply referenced another of his biased studies to claim "there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition", ... that is a similar comment made by a logged in account called Sir Anon. Both 173.206.208.56 and Sir Anon say Ernst is referenced by another Ernst study.


 * [Cut and paste of logged in editor.]Here is a copy-paste quote from the Ernst paper: "Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition (32) Thus, the risk-beneﬁt balance for chiropractic neck manipulation fails to be positive." [32 points to another "study" by... you guessed it, Ernst]. I don't quite understand your and Arthur's objection to Ocaasi's summary of this. Do you have an alternative way of phrasing this in a few words?--Anon 10:23, 13 September 2010 (UTC)


 * "There is conflicting evidence to support the use of cervical manipulation as a therapeutic modality" is not relevant to risk-benefit. The risk-benefit section is specifically about the risk-benefit story. The sources that get the whole say are the sources that say stuff about risk-benefit balance and adhere to MEDRS. QuackGuru (talk) 17:56, 3 October 2010 (UTC)
 * Are you asking if I am sir anon? I am not, although I have also posted under another IP address in the recent past (that of my school computer). My intent was not to stick around long enough to require an account...but the blatant bias and one-sided approach to this article's safety and risk-benefit sections forces me to keep coming back. Are you Ernst under the alias of CG? It would not surprise me as you upsell Ernst' articles with such passion, despite their many limitations, plus you use the same strategy in the risk-benefit section as he does in his weak and biased studies... reference only his own papers to support his own point of view and not give "voice" to any contradictory views. Dont bother to answer, it is irrelevent.
 * What is relevent is that the risk-benefit section represents the biased opinion of only one author (Ernst), and is contradictory to previous sections in the same wikipedia article. There are multiple references by multiple authors in the evidence section that indicate "insufficient evidence is available to conclude whether or not cervical manipulation is efficacious", yet quoted text from one of Ernst' studies, that is really just a quote of another of his studies and not a finding in the study (quoting a quote of a quote?), is the only perspective considered in the risk benefit section.
 * Please explain why all other reviews of safety but Ernst's are excluded from the risk benefit section. Kindly dont spew the same BS that "only papers dealing with risk-benefit are used", as far more authors than Ernst have studies this issue, yet Ernst is the only author used here (hmmm...). Further Ernst 2010 review itself is not designed to measure risk-benefit, it is not even designed to measure risk, it is only designed to find and list case reports.173.206.208.56 (talk) 21:31, 3 October 2010 (UTC)
 * The explanation is that we have a guideline called WP:MEDRS which helps us to use only the best quality sources. A review is called a "secondary source" and when published in a quality journal (like IJCP), carries the weight of the editors and peer-reviewers of the journal, as well as that of the author. As such it represents the highest level of sourcing that we have; because reviews, by their very nature, examine the previous literature in the field and base their conclusions upon them. Please feel free to supply us with all these other reviews of risk-benefit that you are aware of, but do try to find ones that are published in a reliable source. The same goes for Safety, although that's a different section of the article. As for your opinions on Ernst and his work, you'd do better to express them to the editors of IJCP, as they are people endorsing them. We only report what we find in reliable sources, and have a mechanism for deciding what those sources are; amateur analysis of reliable secondary sources carries very little weight here. --RexxS (talk) 22:29, 3 October 2010 (UTC)
 * 173.XXX.XXX.XX, you want to replace relevant text with irrelevant text that is not specifically about risk-benefit. We should not repeat past mistakes like other logged in accounts have made. Other reviews of safety are not relevant to risk-benefit and don't discuss risk-benefit. Don't tell me we must include information that does not measure or address risk-benefit. QuackGuru (talk) 18:18, 4 October 2010 (UTC)
 * Except Ernst 2010 review does not measure risk-benefit, nor is his 2010 review designed to address this issue, and yet gets the final say in the risk-benefit section. 209.183.26.162 (talk) 18:41, 4 October 2010 (UTC)


 * The text and sources added by 173.XXX.XXX.XX does not measure or address risk-benefit but the statement "The risks of chiropractic neck manipulations by far outweigh their benefits." specifically addresses risk-benefit. QuackGuru (talk) 18:48, 4 October 2010 (UTC)


 * Does it mean nothing that the review was not designed to measure risk-benefit? and the statement "The risks of chiropractic neck manipulations by far outweigh their benefits" was not an actual finding in the review, but rather an editorialized comment by the author? If this does not restrict its use in this wikipedia article, or at least warrant mentioning this fact, then I will have to start digging for opposing points of view mentioned by authors in other reviews, regardless of what the review was actually designed to measure. I can understand that if the statement made by Ernst was an actual finding, that it would be un-arguable, but as it is only a statement of opinion found in the discussion of his "review" and not an actual finding of his study, it doesnt seem to hold enough "weight" to be the conclusing statement in at least 2 different sections of the wikipedia article (introduction and risk-benefit sections).173.206.208.56 (talk) 22:03, 4 October 2010 (UTC)


 * The article does say "Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree,[110] and they are typically of low methodological quality.[111]" So the article does explain the methodology is not up to par for spinal manipulation studies.
 * PubMed abstract: CONCLUSION: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.
 * PDF file direct from Ernst himsself: In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly.
 * This is indeed the finding of the systematic review, because it is part of the conclusion. If you have other MEDRS quality sources specifically about risk-benefit I want to see them otherwise this conversation should be over.
 * Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[21][22]
 * A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits.[23]
 * These two sentences balance each over in the lead. The word However can be removed while restoring the word frequently. QuackGuru (talk) 05:55, 5 October 2010 (UTC)

Controversial change to risk-benefit
This controversial edit deleted sourced text and replaced it with original research editorialising and irrelevant material to the risk-benefit section.

The text "There is conflicting evidence to support the use of cervical manipulation as a therapeutic modality" is irrelevant to risk-benefit. The section is about references that specifically address risk-benefit balance.

The text "A 2010 systematic review has used this fact to support its claim that" is OR and editorialising. We don't conduct our own Wikipedia review of the source presented.

"This systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death (1,2,26,30). Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g. 30,31). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition (32). Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive."

"In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly."

"A 2010 systematic review determined that there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition and thus concluded, "the risks of chiropractic neck manipulations by far outweigh their benefits."[23]

The claim is sourced in accordance with MEDRS using a recent systematic review. Article Note: The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished. QuackGuru (talk) 05:00, 3 October 2010 (UTC)


 * The clause has used this fact to claim that is obviously never going to fly, and I have reverted. Omitting the two duplicated refs, below are the sources listed by 173.xxx in support of the misplaced There is conflicting ... sentence. Some of these are already used in the article, and some might be useful to source e.g. the first sentence of #Effectiveness. - 2/0 (cont.) 07:23, 3 October 2010 (UTC)




 * We are not going to misuse sources that don't say anything about risk-benfit balance in a section about risk-benefit. Using irrelevant text in risk-benefit is improper synthesis to advance a position. If there are other sources that say something about risk-benefit then we can include those sources if they meet MEDRS. QuackGuru (talk) 17:56, 3 October 2010 (UTC)

ASSERT
There has been a lot of discussion about on how to present the text here. I thought it was important to clarify ASSERT based on discussion at chiropractic talk. QuackGuru (talk) 21:03, 8 October 2010 (UTC)


 * That would make the conclusions of a survey that has just come out & nobody has published a response to yet a fact. Not every conclusion within a single survey is an established fact, corroboration is needed.--JimWae (talk) 21:28, 8 October 2010 (UTC)


 * @JimWae: Where is the consensus for that? What policy are you relying on for that assertion? WP:ASF is clear: A "fact" is a statement about which there is no serious dispute among reliable sources. Corroboration is only a bonus, since otherwise we would then be requiring an agreement by at least two reliable sources, and I see no consensus for mandatory double-sourcing anywhere in Wikipedia. For example, it would mean that we could not use a statement from the most recent Cochrane review without waiting for another secondary source to make the same statement – we already have the guidelines in WP:MEDRS for dealing with novel conclusions in primary sources, but that was never intended as a tool to suppress the conclusions of secondary sources. Frankly, your suggestion denigrates the value we place on reliable secondary sources such as reviews as the best judges of current literature, and replacing it with an artificial hurdle to sourcing. So, yes, the findings of a reliable review of a topic are facts, and remain so until they are seriously disputed within the mainstream literature. Making up our own rules for sourcing is a recipe for edit-warring and POV-pushing.
 * @QG, I've restored the previous definition of "fact" in WP:ASF, since your version would allow any dispute (such as an editor saying "I dispute that") to disqualify a fact. --RexxS (talk) 23:36, 8 October 2010 (UTC)
 * I removed the duplication. The consensus on how to present the text is to intentionally avoid attribution in the text when there is no serious dispute. For example, see Chiropractic. QuackGuru (talk) 03:54, 9 October 2010 (UTC)

Note: The survey example was replaced with "For instance, the published finding of a reliable literature review is a fact, when it is not disputed by another secondary source." Of course here at Wikiland an editor may disagree with the overall improvements but without any specific explanation on the talk page. I think the dispute tag should be removed. QuackGuru (talk) 18:10, 12 October 2010 (UTC)

Note: Editors want to drastically change policy again. See. QuackGuru (talk) 09:32, 15 October 2010 (UTC)

Vaccination Edits
This sentence was totally out of place in the paragraph it was in (at least how it was written there)

Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.

Please explain what this is suppose to mean, it is very unclear considering it was between two sentences about vacination. In addition some edits were made to this section to emphasize that the opposition to vaccination is held by a minority of chiropractors. Most modern chiropractors work in tandem with modern medicine, and the references in the article did not support the strong language used in the sentences in this section. Remember we are suppose to have a neutral point of view here. --MATThematical (talk) 07:25, 10 October 2010 (UTC)


 * I have pasted text from two sources. I don't understand how the changes you made improved the page. The text is clearly supported by the sources presented. You deleted sourced text and your rewrite was OR.
 * "The chiropractic profession should openly embrace, and become actively involved in, established public health initiatives. The APHA is by far the largest and most influential public health organization in the United States. It wields tremendous influence on policy and procedure in our healthcare system. In 1983 a few chiropractic pioneers began what eventually became the Chiropractic Section of APHA [16]. This section is made up of dedicated individuals who care about promoting and taking part in APHA activities. Some examples of these activities are provided in Table 1. However, these dedicated individuals did this with very little support from the profession as a whole. Even now, very few chiropractic physicians are members of the APHA."


 * "It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization [15] and public water fluoridation, cease such unfounded activity. In fact, because of the traditional chiropractic opposition of these well-accepted public health practices, there was major concern regarding whether chiropractic would even be accepted within the APHA [16]. In addition, the profession must take an honest public health-oriented approach to clinical practice and wellness care by becoming more involved in teaching patients how to stay healthy without frequent, endless visits to chiropractic offices. 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 [2]."


 * The text supports the claim "Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment. " but the sourced text was deleted. I think we can expand the text to make it even more clear.


 * "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.17 Such an approach, however, is akin to describing the airline industry entirely on the basis of flight delays, lost luggage, and air crashes."


 * The claim "Historically" and "have focused" is not supported by the reference. I can verify the text "Most chiropractic writings on vaccination focus on its negative aspects..." but I was unable to verify the rewrite. QuackGuru (talk) 17:25, 10 October 2010 (UTC)


 * After looking over my edit, I agree that the first sentence did not need modification (even though it was supported by the references on this page, i.e. well over half of chiropractors support or take no position on vaccination). However, I think the rest of the edit is necessary in making the text factually accurate
 * The "historically" part is what is supported by the reference attributed to that sentence. The reference is 5 years old and hence is talking about historical writings. The reference does not provide information on what percentage of writings are currently anti-vaccination. If you can find a reference that supports that the majority of writings in the last couple of years have been anti-vaccination by all means delete the word "historically". However, the reference that is currently up does not support such a deletion.
 * I think you misinterpreted the part of the edit where I deleted the sentence (at the beginning of this section on the discussion page). I never said it was not supported, I said it was out of place and did not fit with the paragraph it was in. The deletion of sentence was meant for discussion, and then replacement where it is more appropriate. It is not even clear what the sentence was trying to say when taken in the context of its location. The entire paragraph is talking very specifically about vaccination and fluoride and this sentence is talking very vaguely about the perception of chiropractors by other people (and as it is written does not seem connected to fluoride or vaccination). I agree that expansion of this idea is important and should be developed, but it should be a separate paragraph.
 * Lastly the accusation that the edits were original research is completely unfounded, they were solely based on the references on the page. None of the edits were original research, although the first modification was not useful, as you point out, (and probably should have said majority "take no stance or support"), it was definitely supported by the references in the article. please WP:AGF.MATThematical (talk) 23:07, 10 October 2010 (UTC)


 * It is important to realise that sources used in articles such as these are subject to WP:MEDRS, which demands the use of the highest quality sources. In most cases, these will be secondary sources and often reviews. It is acknowledged that in many disciplines the review cycle is of the order of five years or more. This means that the highest quality sources that we need are often necessarily several years old. That is essentially as up to date as we can get, and it has to be accepted that until new reviews are published, the most recent review represents the current mainstream opinion, as best we can determine. For that reason it would be nonsensical to qualify the findings of every five-year old review as "historical" – and where would we draw the line? The reader should not be confused by any such lack of qualification, since each reference will have its publication date visible for those who are interested. I agree that when a later reliable secondary source reaches a newer conclusion, then the findings of the earlier review (if used at all) would be appropriately marked as "historical", and in fact would probably only be usable in giving a historical overview of the development of the issue. I'm afraid that the burden of proof must lie with the editor who wishes to declare a source "historical" to produce a newer reliable source that updates the first source's findings. --RexxS (talk) 23:43, 10 October 2010 (UTC)


 * I did not see one statistical measure (or reference to one) in that review which suggested that the majority of the writings (even around 2005) were anti-vaccine. The review article looked at a sample of anti-vaccine writings, so duh they are all going to be anti vaccine. Whether pro vaccine writings exist or not, the article does not mention anything about this. I think that the article irrefutably suggests that "many" anti-vaccine writings exist, so I think the best edit would be to replace "Historically, most" with "Many". If you can show me where it compares the number of pro vaccine articles to anti vaccine articles (of course given that it actually sites a source with sound methodology) I would be happy with the version of the sentence before my edit. MATThematical (talk) 03:11, 11 October 2010 (UTC)


 * "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.17 Such an approach, however, is akin to describing the airline industry entirely on the basis of flight delays, lost luggage, and air crashes."
 * I have shown where the word "most" is sourced per V. Sorry if I did not make it clear enough in my previous post. The word "many" is not closer to the source than "most". If things have changed there will be newer sources on the topic in the future. But for now we can stick to the source and possibly add more information.
 * Thanks for showing the "most" quote. I would contend that because this is not sourced in the review, and that no explanation or evidence is provided there may be a problem stating this in this article. Now I think that since this is considered a secondary source perhaps we are suppose to just take the authors word for it eventhough the sentence has no further support in the article (its just stated with a position of authority, using the word "clearly", if it were clear they would not have to use the word clearly). "Many" is definitely supported by the reference as there are several (at least >20) pieces mentioned in the article with proper citations. I don't think that is original research. MATThematical (talk) 21:10, 11 October 2010 (UTC)


 * "Many" is not supported by the reference because the reference uses the word "most" not many. You have read the "most" quote but where is the quote for the word "many"? QuackGuru (talk) 21:22, 11 October 2010 (UTC)


 * "Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.[1]" Is there any reason why this sentence should remain deleted. If it is not clear for the reader you can read the source and expand it to make it clearer. QuackGuru (talk) 18:42, 11 October 2010 (UTC)


 * As I pointed out above, this sentence should not be in this paragraph, it should be in a separate paragraph (even if that paragraph only contains this sentence). Again based on the reference there is no strong connection between this sentence and the paragraph on vaccination. It should certainly remain outside of that paragraph unless there can be a sentence that connects it to the topic in that paragraph. My second problem that I have is that all sentences in a wikipedia article should at least be intelligable on their own, without reading the source. The source can serve for methodology, deeper understanding, etc. but not to understand the basics of what the sentence is trying to say. Personally I think this sentence needs some explanation as to how it compromises the chiroprators standing, but at the very least it should not be in the vaccine paragraph. --MATThematical (talk) 21:10, 11 October 2010 (UTC)


 * You agree that sentence can be restored. Feel free to expand the sentence to make it more clear. QuackGuru (talk) 21:22, 11 October 2010 (UTC)
 * Yes and I just restored it, in a seperate paragraph. I am not going to attempt to expand it because I am not sure I understand it well enough to do that. Hopefully someone who is more well versed in this literature can explain the how part of this sentence. --MATThematical (talk) 22:28, 11 October 2010 (UTC)


 * The part "have focused" is past tense. I think this may be OR. This suggests that most chiropractic wrings on vaccination no longer focus exclusively on its negative aspects. QuackGuru (talk) 20:04, 11 October 2010 (UTC)
 * I think that the past tense can be changed (I actually meant to change it with the many edit). However, I would like to point out that the claimed implication by the past tense is not implied at all. For example if I say I ran 10 days ago would you say this implies I did not run today. The past tense implies nothing about the current position chiropractors take. --MATThematical (talk) 21:10, 11 October 2010 (UTC)


 * According to your previous edit, you wrote in part that the reference does not support that this is the common current position in the chiropractic literature, add a diff reference if you want to change back. You seem to believe, according to your edit summary, that the past tense implies that this is not the current position chiropractors take. Did you intentially change the tense to suggest that the reference was wrong and your right. Wikipedia is about verifiable, not truth. See WP:V. QuackGuru (talk) 21:37, 11 October 2010 (UTC)
 * No I was refering to it not being supported by that reference, which as you pointed above (by your quote) was incorrect, and I agreed with you. Any other conclusions you have come to about "what I seem to believe" is through faulty logic. My edit summary suggested that the reference did not support the sentence. The summary did not say anything about historically implying that this is not the current position. Historically implies that it may or may not be the current position, your claim about my intentions is blatantly wrong. Please do not make unfounded assumptions about what people believe, its quite mean. I intentionally changed the tense because I thought the word historically was better supported by that reference (again I was wrong). Implying that I am POV pushing is rediculous and offensive, please see WP:AGF. I am a respected editor who has no opinion about chiropractors. Why would you think I have some sort of hidden agenda here, is there some past history to this section that I am unaware of? --MATThematical (talk) 22:10, 11 October 2010 (UTC)
 * Please accept my apologies, Matthew, if I've made any untoward assumptions about your contributions. This page is a very contentious area, and often appears to be a battleground between editors who feel that chiropractic is a topic on the fringes of conventional medicine with little to offer, and those who have a strong belief in it and don't wish to see it belittled – although that's a much starker picture than what actually happens. QuackGuru has worked hard for a considerable time on this page to balance what the mainstream view is against the tendency for statements to be made that are not actually verified by reliable sources. Have a read of the archives of this talk page, and I hope you will understand how easy it is for us to sometimes fall below the standards that AGF encourages. --RexxS (talk) 22:55, 11 October 2010 (UTC)

I made this change. I included a new sentence to bring more balance to the section. "The extent to which anti-vaccination views are sustained by the current chiropractic profession is uncertain." I hope this resolves this dispute. QuackGuru (talk) 04:34, 12 October 2010 (UTC) I made this change to the new sentence to make it more readable. QuackGuru (talk) 05:11, 12 October 2010 (UTC)

MATThematical, I never accused you of POV pushing. I pointed out what was OR and eventually added a new sentence to bring balance the section because you correctly pointed out there was a problem. QuackGuru (talk) 03:36, 13 October 2010 (UTC)

Slight rewrite
The slight rewrite was "The extent to which anti-vaccination views sustain the current chiropractic profession is uncertain." QuackGuru (talk) 17:06, 12 October 2010 (UTC)
 * Did I correctly assume that it was meant to say:

"The extent to which anti-vaccination views are sustained by the current chiropractic profession is uncertain." 173.206.208.56 (talk) 20:44, 12 October 2010 (UTC)
 * QuackGuru meant to write it like this:
 * "The extent to which anti-vaccination views sustain the current chiropractic profession is uncertain." QuackGuru (talk) 03:36, 13 October 2010 (UTC)

This was my intention. QuackGuru (talk) 05:19, 18 October 2010 (UTC)

Attribution in the text violation
This controversial change added even more attribution in the text when there is no serious dispute. QuackGuru (talk) 17:44, 10 October 2010 (UTC)
 * The description "systematic review of case studies" is an accurate description, a challenge of the use of this description can only be based on a desire to give more weight to the review then is warranted. The description of the outcome of the review has not been changed.173.206.208.56 (talk) 18:19, 10 October 2010 (UTC)
 * From the review's abstract: "Design:  This study is a systematic review of case reports." Thus, the changes make the text in the wikipedia article more closely resemble the actual source.173.206.208.56 (talk) 18:37, 10 October 2010 (UTC)
 * The findings of the review have not been seriously disputed in any reliable sources and stand as facts per WP:ASSERT. The wording should actually remove all attribution and the findings simply asserted. Therefore the unhelpful qualification to the present attribution only serves to further cast unwarranted doubt on a reliable undisputed secondary source. The reference is plainly given, and anyone who is interested in the detail of the review only has to follow the link. I've reverted to the previous wording while this is being discussed. --RexxS (talk) 22:24, 10 October 2010 (UTC)
 * Going by this logic you should also delete "systematic review". In my opinion "Systematic review" adds no information, where as "review of case studies" is actually just factually describing the methodology. Either we should just assert the statement as fact (no qualifier at all, which is my preference), or use systematic review of case studies. The original wording is confusing, "systematic review" could mean just about anything, its a meaningless phrase.MATThematical (talk) 04:57, 11 October 2010 (UTC)
 * Indeed, I would much prefer to see most of the "A 200X review found that ..." disappear from the article, and the findings simply asserted, whenever those findings are not seriously disputed by reliable sources. It would tighten up the prose and be much more encyclopedic, in my humble opinion. Nevertheless, this article is in a contentious area – as you can see from viewing the archives – and so these sort of changes need considerable discussion. A further complication is that the sentence we're discussing actually quotes the review, so it would need to be reworded if we were to eliminate the attribution. Let's see if QG will offer any suggestions. By the way "systematic review" does have a fairly precise definition in the field of evidential medicine, and we have an article, Systematic review, that could be wikilinked if you felt that it should be explained more carefully. --RexxS (talk) 14:47, 11 October 2010 (UTC)
 * Yes, I think the link is a good idea, at least in the meantime. I am going to go ahead and do that right now. It would clear up any potential confusion, as a systematic review has different meanings in different fields.--MATThematical (talk) 15:38, 11 October 2010 (UTC)
 * I actually decided not to immediately make this edit as systematic review is already linked on the page. I think it should be linked more often due to the highly contentious nature of this piece. Maybe it should be linked the first time it is used in each section? Linking it everytime would be a bit overkill in my opinion, but its a long enough article that multiple links should not be a problem.--MATThematical (talk) 15:43, 11 October 2010 (UTC)
 * You've figured it out correctly. See WP:REPEATLINK and the subsections above it for further guidance. --RexxS (talk) 15:58, 11 October 2010 (UTC)
 * Can anyone tell me why this article is being considered a secondary source at all? Despite my reading through MEDRS, I cannot find a clear reason why this article is given so much "weight" in the "debate". It certainly is not listed as a systematic review in the journals table of contents . Note that the table of contents has a section for "meta-analysis" and for "reviews", but the Ernst article is not found under either of these headings. In fact, it is listed as a "short communication" by the journal. As such, why is wikipedia overinflating its value? The descriptor " A systematic review..." is poached from the abstract, leaving behind the articles own qualifier "...of case-reports"? 173.206.208.56 (talk) 18:39, 11 October 2010 (UTC)
 *  What’s new 
 * "The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished."
 * This is text directly from the PDF file. There was a compromise to add the the part "A systematic review...". Adding extra attribution where there is no dispute is not appropriate. I can't think of another suggestion that would replace systematic review. The wording "systematic review" adds very detailed information to the sentence. QuackGuru (talk) 19:00, 11 October 2010 (UTC)

Low level details
This controversial edit was reverted becuase [http://en.wikipedia.org/w/index.php?title=Chiropractic&action=historysubmit&diff=391378470&oldid=391292305 the part "even though" was WP:OR and "only" was WP:OR. We don't conduct our own original analysis of the source, and "twenty six fatalities were..." is low level details to summarise in the WP:LEAD]. The quote implies there is a dispute where there is none and it does not have an encyclopedic feel to use quotes when an editor can rewrite the text and comply with Wikipedia's WP:V policy. This controversial edit deleted sentences and a reference from a systematic review that meets WP:MEDRS when editors previously explained they want to keep the review for obvious reasons. This controversial edit marked as minor and without an edit summary restored the quotes and low level details to the lead. I believe the low level details are unnecessary for the lead. For now I rewrote the text from a neutral point of view without the quotation marks. To comply with WP:V policy I read the text from the systematic review that stated "The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished." The claim there was only twenty six fatalities is misleading and obviously not neutral. QuackGuru (talk) 18:29, 19 October 2010 (UTC)

Even more low level details
This controverisal edit added too much details from the body. To add "since 1934" is really unnecessary. QuackGuru (talk) 03:37, 20 October 2010 (UTC)
 * The time period over which those deaths were found is as important as the number of deaths themselves, and this is right out of the "review", not OR or editorializing. Try to maintain NPOV as you so commonly ask of everyone else.173.206.208.56 (talk) 05:14, 20 October 2010 (UTC)


 * The date since 1934 over which those deaths occured is in the body. As for the lead, it should remain concise. QuackGuru (talk) 05:31, 20 October 2010 (UTC)
 * If the topic were not so controversial, and if there were not alot of research in existence that might indicate those findings are flawed then I would agree. However, the finding is controversial, the methodology is controversial, and it is biased to assume that this is the end of the debate. Thus, putting the finding in context right away is the only way to maintain NPOV.173.206.208.56 (talk) 14:23, 20 October 2010 (UTC)
 * The reason you added the date was because you disagree with the systematic review while not adhering to having a WP:LEAD concise? The specific date is not at all significant to chiropractic. You are giving too much WEIGHT (detail) to one source. QuackGuru (talk) 18:26, 20 October 2010 (UTC)
 * The date is required to put the finding in context. The solid finding of the review is that there have been 26 deaths since 1934, the rest of the reviews text is the authors interpretation of the finding.173.206.208.56 (talk) 22:00, 20 October 2010 (UTC)
 * You are unable to explain why the date is significant to chiropractic and why the lead should not be concise. QuackGuru (talk) 22:15, 20 October 2010 (UTC)
 * It is 3 words added to the remainder of the sentence, which itself is an excellent synopsis of the review taken straight from its abstract, and is necessary to put the reviews findings in context. I would love to hear what another editor has to say, as your resaoning is purely based on the opposite bias you accuse me of. My view is to addd details from the study that provide context for the study, your view is to leave out any detail that might cause one to question the outcome, Who's approach is more biased?173.206.208.56 (talk) 23:34, 21 October 2010 (UTC)
 * To be fair, I think all the extra details don't belong in the lead. The previous sentence was concise but now it is like two sentences. The reviews findings in context with the date is done in the body. I am the editor who originally added the date to the body. QuackGuru (talk) 16:43, 22 October 2010 (UTC)
 * "The published medical literature contains reports of 26 deaths since 1934 following chiropractic manipulations and many more seem to remain unpublished." This adjusted sentence is now in its entirety in the body without putting the text in unnecessary quotes. I think this can work as a compromise while keeping the lead concise per WP:LEAD. QuackGuru (talk) 18:09, 22 October 2010 (UTC)
 * The problem is that clarity should take precedence over concision. Omitting the date actually gives a stronger impression of the number of deaths than including the date, which appropriately puts them in context.  Thus, in the interest of NPOV, an exception to LEAD is reasonable here. Ocaasi (talk) 07:46, 23 October 2010 (UTC)
 * The number of deaths is not included in the lead because it would be an obvious LEAD violation. I agree the date is relevant to the number of deaths but this additional level of detail in the lead would be giving too much weight to one reference. We summarise the body but not summarise each individual refernce. To maintain NPOV and comply with lead both the number of deaths and the date are kept together in the body in the same sentence. QuackGuru (talk) 20:20, 23 October 2010 (UTC)

Sourced text replaced with original research editorialising
This controversial edit deleted sourced text and replaced it with WP:OR.

To comply with WP:V policy I read the text from the systematic review that stated "Twenty-six deaths are on record and many more seem to have remained unpublished."

This controversial edit is also OR. The source did not say that was the reason being. This is a case of WP:SYNTHESIS editorialising. We don't conduct our own original interpretation of the source. QuackGuru (talk) 03:29, 20 October 2010 (UTC)
 * I like the modified text"controversial" edit because it accurately states the findings of the "review" and puts it in perspective in a NPOV way using facts straight out of the review (eg: time, number, limitations of conclusions, etc.). It is important to put the findings of this review in context for the reader as this is a controversial topic (safety of C-manip) and there has not been time for a conflicting point of view to be published, which will certainly happen in time, considering the history of this topic and the extensive literature that has opposing outcomes. Until the other side of this controversial topic can be represented by a quality source, the most recent review, which is heavily biased to one side of the debate, must be put in context for the reader.173.206.208.56 (talk) 05:05, 20 October 2010 (UTC)


 * I'm confused you think the text meets NPOV. Can you show how WP:OR is accurate or sourced per WP:NPOV. QuackGuru (talk) 05:31, 20 October 2010 (UTC)
 * Sure, although I am confused how you dont think it meets the standard? WP:OR says "Rewriting source material in your own original language, substantially retaining the meaning of the references, is not considered to be original research." In this case, the text from the review has been rewritten so that a single sentence can very accurately detail both the findings as well as how the review made its findings. That is, 26 deaths were reported since 1934, and thus the review concludes that the risks outweigh the benefits. This is 100% accurate as per the review. Further, the wiki sentence accurately states "may more may have been unpublished". Ernst's abstract says "many more might have remained unpublished", if you would prefer to change "may" to "might" then I am sure that you would have no arguement, but it seems like a needless edit.173.206.208.56 (talk) 14:19, 20 October 2010 (UTC)


 * The part "the reasoning being" is original research editorialising.
 * You seem to suggest the word "may" is OR which changed the whole meaning of the sentence.
 * The full PDF file text makes a stronger point and goes into much more detail: "Twenty-six deaths are on record and many more seem to have remained unpublished."
 * QuackGuru (talk) 18:19, 20 October 2010 (UTC)
 * I think that if you want to quote the text rather than use a rewrite then you should quote the abstract text rather than the discussion, as it is more representative of the lack of certainty to the claim (he cant know if many were unpublished or not, it is an assumption). "Twenty six fatalities were published in the medical literature and many more might have remained unpublished". Either way, the timeline should be included to add perspective (ie: since 1938). 173.206.208.56 (talk) 21:58, 20 October 2010 (UTC)
 * You want to weaken the text because you think "it is more representative of the lack of certainty to the claim". You are putting your own perspective above the sourced details from the PDF file. QuackGuru (talk) 22:19, 20 October 2010 (UTC)
 * Please note that the abstract of ernsts review states: "Twenty six fatalities were published in the medical literature and many more might have remained unpublished.....Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit." The current version in the wiki article says "A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits; the reasoning being that twenty six fatalities have been recorded since 1934 in the medical literature and many more may have been unpublished." There is no bias here, the current version very accurately summarizes the study using details straight out of the abstract, with the added detail of the date range the review covers. Adding details from the study itself is not a biased approach, however, your consistent desire to leave out details that might reveal any limitations of the review clearly reveals your bias. Obviously another editor is going to be required to reach concensus on this, as you like to twist the concept of NPOV to suit your own POV.173.206.208.56 (talk) 23:28, 21 October 2010 (UTC)
 * You are weakening the text becuase as I previously explained the PDF file goes into more explicit detail even showing evidence of unpublished deaths after manipulation. QuackGuru (talk) 16:39, 22 October 2010 (UTC)
 * "Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, Lewis, Fawcett, Parisien, Standt. Long also states that ‘many others [are] unknown hidden behind legal agreements of silence’ (28). A website names further North American fatalities: Linda Epping (California), G. Fowden (Utah), Ronald Grainger (Alberta), John Hoffman (Maryland), Renate Dora Labonte (Ontario), Jose Lopez (California), Donald Pereyra (Connecticut), Elizabeth A. Roth (Ontario) and Kimberly Lee Strohecker (Pennsylvania) (29)."
 * Here is a bit of information direct from the PDF file to verify the claim per WP:V policy for the part "and many more seem to remain unpublished.". QuackGuru (talk) 18:52, 22 October 2010 (UTC)
 * The PDF file also says "This systematic review demonstrates that numerous deaths have been associated with chiropractic." QuackGuru (talk) 21:09, 23 October 2010 (UTC)

Sourced sentence per V deleted
This controversial edit deleted a sourced sentence. The word found can be replaced with another word such as stated or determined. QuackGuru (talk) 03:33, 20 October 2010 (UTC)


 * Although this is a redundant sentence (the exact same text is repeated in 2 other locations) the sentence can be re-inserted if it is that meaningful to you. However, the source referenced should be the study that made the original "finding", not a more recent review that simply quotes the earlier work. A quote of a quote is unnecessary when the appropriate earlier reference is available. I believe Ernst just cited another of his "reviews" to make this "conclusion", thus his earlier work should be cited (Ernst, 2008; I believe), not the later work that quoted it.173.206.208.56 (talk) 04:56, 20 October 2010 (UTC)


 * The previous reference is older but the way articles are written on Wikipedia is to cite reviews per MEDRS. Intentially using an older reference when we have a newer reference reviewing an older reference is against MEDRS. If I violated MEDRS then anyone could say we can use older references instead of a newer reference that reviewed older references. QuackGuru (talk) 05:31, 20 October 2010 (UTC)
 * The older (2008) reference itself meets MEDRS and is a systematic review. Further, the newer review never set out to measure effectiveness, thus it is inappropriate to credit the finding to the newer review. It would be just as silly to find a review on effectiveness of manipulation for neck pain and reference it to support a claim of safety of manipulation because a sentence is put somewhere in the review to that regard. Ernst 2008 review examined effectiveness, so use that review to support statements regarding effectiveness, the 2010 review examined deaths, so use the 2010 review to support statements regarding safety.173.206.208.56 (talk) 14:07, 20 October 2010 (UTC)


 * On Wikipedia we don't substitute a newer reference with an older reference. The 2010 review reviews the older reference not the other way around. The 2010 review is specific to neck manipulation. The older reference is more about chiropractic manipulation in general. QuackGuru (talk) 18:09, 20 October 2010 (UTC)
 * I disagree, the newer review does not review the subject of efficacy, it reviews the issue of safety and then simply quotes a single earlier review that did in fact deal with efficacy. To use the 2010 review to support a statement of efficacy is incorrect when the actual review that made the finding regarding efficacy is available.173.206.208.56 (talk) 22:03, 20 October 2010 (UTC)
 * The newer source does discuss the subject of efficacy. There is even text in the chiropractic page from the newer reference on the subject of efficacy. To use the older reference for the sentence which does not make the exact claim would violate MEDRS and V. QuackGuru (talk) 22:14, 20 October 2010 (UTC)
 * Please quote the section of the methods that details how the review will address the issue of efficacy. I think that you are confusing a brief discussion of a single previous work on efficacy with an actual review of efficacy. Please note that the title of the review has nothing to do with efficacy, nor does the methods, nor the conclusion. A brief mention of efficacy in the discussion, with reference to a single study by the same author does not constitute a review of efficacy.173.206.208.56 (talk) 23:19, 21 October 2010 (UTC)
 * I will give you quotes but from MEDRS.
 * See the last part of WP:MEDASSESS: ""Assessing evidence quality" means that editors should determine the quality of the type of study. Editors should not perform a detailed academic peer review. Do not reject a high-quality type of study because you personally disagree with the study's inclusion criteria, references, funding sources, or conclusions."
 * MEDRS is a nutshell at the top of the page: "Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies."
 * It is routine to use sysematic reviews instead of previous work or a primary study. I can't violate MEDRS for you or otherwise editors could use previous work or older studies intead of recent sysematic reviews. QuackGuru (talk) 16:57, 22 October 2010 (UTC)

The improper WP:SYNTHESIS added to the lead "the reasoning being" was original research. But I did find sourced text that seems to suggest the reasons. "A 2010 systematic review stated that there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition, and suggested a precautionary principle in healthcare for chiropractic intervention even if a causality with vertebral artery dissection after neck manipulation were merely a remote possibility.[25]" This expanded sentence explains it better than including extra details in the lead or original research. QuackGuru (talk) 18:16, 22 October 2010 (UTC)

Past tense is original research
Keating writes of subluxation: "Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession."

We are not dealing with truth here. We are repeating what is written in the source per WP:V. Changing the tense would say it is no longer ridiculed by maintream health care. The reference does show the text is sourced per WP:V policy. This controversial edit to intentially change the tense to past tense is original research. The source does not make the claim that it formerly brought ridicule. QuackGuru (talk) 03:58, 20 October 2010 (UTC)

Recently added sentence is unsourced
This controversial edit added an unsourced sentence. QuackGuru (talk) 04:01, 20 October 2010 (UTC)
 * Agree with QG, not only is the sentence unsourced, but I have never seen any research that supports vitalism in any way such as to provide a source for this sentence.173.206.208.56 (talk) 05:08, 20 October 2010 (UTC)

Massive MEDRS violation
This controversial change conflicts with WP:MEDRS because the sources are dated. QuackGuru (talk) 04:06, 20 October 2010 (UTC)

Council on Chiropractic Education Australasia
Accrediting bodies CCEA is a red link in the chiropractic info box. QuackGuru (talk) 22:25, 23 October 2010 (UTC)

Edits to improve current coverage
User:Frolicin's edits were not up to sourcing standards, but they did shed some light on areas where this article might be lacking in coverage:


 * The role of chiropractors in professional athletics and physical training/therapy
 * The increasing legitimacy of some chiropractic universities
 * Standards of chiropractic education--at least in the U.S.-- and how they compare to medical school
 * D.C. recognition (in U.S.)
 * The role of Chiropractors in their personal businesses (or other arrangements where they work)
 * The rise of research at chiropractic colleges in an attempt to substantiate practices

Some of these are partially included, but I agree with Frolicin's underlying claim, that Chiropractic has a more prevalent role in a variety of fields, and a steadily improving position in terms of accreditation and legitimacy, at least within certain medical/academic circles. There's a good deal of general acceptance of Chiropractic that we could flesh out, which has nothing to do with evidence-based efficacy and is simply related to its prevalence and perceived social standing. Of course, RSs are needed, but I think the recent edits were a worthwhile pointer at something that could be improved. Ocaasi (talk) 20:33, 27 October 2010 (UTC)

Survey of UK chiropractors
"A 2010 questionnaire presented to UK chiropractors indicated only 45% of chiropractors disclosed with patients the serious risk associated with manipulation of the cervical spine as a direct consequence of the fear that the patient would refuse treatment despite knowing the moral responsibility." The text in quotes is a specific proposal for obviously this page. QuackGuru (talk) 06:01, 29 October 2010 (UTC)

Out of date evidence
This recent change added an older reference from 1995. This is too dated for recent evidence. See MEDRS. QuackGuru (talk) 15:42, 30 October 2010 (UTC)
 * If there is no more recent study that asks or answers this question then this is still considered "current" research. MEDRS only requires one to use the most current evidence, as this study is the most current study to examine the issue (NSAIDS vs Manipulation) it is valid to use in wikipedia.173.206.208.56 (talk) 18:23, 30 October 2010 (UTC)


 * "Prefer recent reviews to older primary sources on the same topic. If recent reviews don't mention an older primary source, the older source is dubious. Conversely, an older primary source that is seminal, replicated, and often-cited in reviews is notable in its own right and can be mentioned in the main text in a context established by reviews. For example, Genetics might mention Darwin's 1859 book On the Origin of Species as part of a discussion supported by recent reviews." It is not valid to use such an old reference. See MEDRS. QuackGuru (talk) 02:19, 31 October 2010 (UTC)
 * http://scholar.google.com/scholar?hl=en&sciodt=800000000000&q=&cites=16094428407290618252&as_sdt=800000000005&as_ylo=2005&as_vis=0 --Ocaasi (talk) 11:42, 31 October 2010 (UTC)


 * "If recent reviews don't mention an older primary source, the older source is dubious." Where does it mention in the text the older source. We can use a newer reference rather than extremely old references. I explained this before about dated references. QuackGuru (talk) 18:26, 31 October 2010 (UTC)


 * What does it mean that 27 papers have cited this article since 2005, including: European Neurology, 2008; International Journal of Osteopathic Medicine, 2006; Journal of the American Osteopathic Association, 2005; Pediatrics, 2007; Clinical Evidence (Surgery), 2008; The Spine Journal, 2005; Southern Medical Journal, 2007; Evidence-Based Chronic Pain Management, 2010; Spine, 2005. I think if you still disagree we should post it at WP:RSN for clarification. Ocaasi (talk) 05:41, 1 November 2010 (UTC)


 * MEDRS does not use the term cited. Lots of old sources are cited by newer sourced but don't specifically mention the old source. So what does it mean then. According to MEDRS, it is dubious because newer sources do not mention it. Again, "If recent reviews don't mention an older primary source, the older source is dubious." Please show where newer sources mention it. Cited and mention are very different. I think you misunderstand what is meant by MEDRS. I could not find even one newer source that discussed the older source from 1995. QuackGuru (talk) 06:00, 1 November 2010 (UTC)
 * I won't stick on this point, QG, but I'd like to get some uninvolved opinions for clarification. e.g. how old is too old, cited vs mentioned, when a study becomes 'old' precedent...Ocaasi (talk) 06:28, 1 November 2010 (UTC)


 * See MEDRS: * Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews examined should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies.
 * cited vs mentioned: I did explain MEDRS does not mention the word cited. MEDRS seems clear to me. QuackGuru (talk) 06:42, 1 November 2010 (UTC)
 * Hey QG, I wanted to get someone else's opinion, since we have a small disagreement about this--or at least I would prefer clarification from someone less involved. I think you're generally correct about policy, but you also have some very strict interpretations of them which may, intentionally or not, suit you general outlook on alternative medicine.  So, I hope you don't think i'm WP:IDHT to your response...


 * I am wondering if there are 'exceptions' to your explanation, when a result is particularly specific, for example, in a direct comparison of Chiropractic vs. NSAID medications. There have been general reviews of safety, but few (or none) with that level of specificity.  I understand the semantic difference between mentioned and cited, but I'm not clear that MEDRS sets the bar as high as only mentioned rather than mentioned or recently cited in reliable research.  As for the 5 year issues, that is why I limited the cites to 2005 and later.  I realize that's not quite what you meant, but it's a similar indication of recent relevance.  Ocaasi (talk) 07:42, 1 November 2010 (UTC)


 * It is clear MEDRS sets the bar as only mentioned rather than also mentioned or cited in recent reliable research because MEDRS did not mention there is a second option such as WP:IAR if MEDRS stops you from improving a Wikipedia page. This is a routine interpretation of MEDRS. This is not confusing or vague like what was done to ASF. QuackGuru (talk) 16:25, 1 November 2010 (UTC)

Medication survey
"A 2010 survey found 72% of Switzerland chiropractors judged the current allowance to prescribing nonprescription medication as an advantage for chiropractic treatment." We might be able to use this study. QuackGuru (talk) 02:19, 31 October 2010 (UTC)
 * Go for it, as long as it's not mixed in with commentary that Chiropractors are overstepping boundaries, or somesuch--in other words, not immediately followed by criticism where that criticism would fit better elsewhere. Ocaasi (talk) 05:44, 1 November 2010 (UTC)

Taken out of context
Please note that the review states: "Twenty-six deaths are on record and many more seem to have remained unpublished." "Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, Lewis, Fawcett, Parisien, Standt. Long also states that ‘many others [are] unknown hidden behind legal agreements of silence’ (28). A website names further North American fatalities: Linda Epping (California), G. Fowden (Utah), Ronald Grainger (Alberta), John Hoffman (Maryland), Renate Dora Labonte (Ontario), Jose Lopez (California), Donald Pereyra (Connecticut), Elizabeth A. Roth (Ontario) and Kimberly Lee Strohecker (Pennsylvania) (29)."

It was misleading to claim even though only "twenty six fatalities were published in the medical literature." because there were numerous deaths that remain unpublished. The edit was quoting the source out of context because many more seem to remain unpublished according to the same source. Quoting the source out of context was like putting words in the cited source's mouth. The lead should also remain concise. These details without quoting the source out of context remain in the body under the safety section. There was a previous discussion regarding a very similar controversial change. See. QuackGuru (talk) 18:32, 31 October 2010 (UTC)
 * Agree that the edits were misleading, but let's keep clear the difference between "were unpublished" and "seem to have remained unpublished". Ocaasi (talk) 05:46, 1 November 2010 (UTC)
 * The text in the article seems clear with the qualifier "seem". QuackGuru (talk) 06:15, 1 November 2010 (UTC)
 * Yes, I meant in your description above, where it appeared to change midway.


 * I also think that it's a bit awkward for Wiki's voice to assert that "more seem", since that is implying it seems that way to Wikipedia. I think it would be better to use a more passive construction such as, 'more unpublished cases are suspected' or 'more are suspected of having remained unpublished'.  Or something like that.  This is not an (asf) issue, but an grammar one, since 'seem' always implies subjectivity--which is fine when we know that it's Ernst or someone specific to whom it 'seems' that way--but we're trying to assert this generally.  Know what I am getting at? Ocaasi (talk) 06:25, 1 November 2010 (UTC)


 * You want to add weasel words which would imply a serious dispute. It seems that this is another ASF dispute despite the unilateral elimination of ASF against broad community consensus. QuackGuru (talk) 06:33, 1 November 2010 (UTC)
 * Your accusation does not appear to be based on an accurate reading. Please identify the weasel word in the following phrase:  'More unpublished deaths are suspected'. Ocaasi (talk) 07:53, 1 November 2010 (UTC)
 * The part 'more unpublished cases are suspected' is too vague and the word 'cases' is not very accurate (weasel). Or, 'more unpublished deaths are suspected' seems like a misinterpretation of the source and is confusing. You suggestion also weakens the claim made by the review. Again, "Twenty-six deaths are on record and many more seem to have remained unpublished." is what the source says. QuackGuru (talk) 16:33, 1 November 2010 (UTC)
 * Hey QG, you didn't respond to my question. Where is the weasel word in 'More unpublished deaths are suspected'?  If you find fault in every attempt to paraphrase anything then it begins to look like your objections are baseless.  Can you explain specifically how 'More unpublished deaths are suspected' is any less clear than 'many more seem to have remained unpublished'.  Do you think it's ok to accurately paraphrase?  Ocaasi (talk) 16:38, 1 November 2010 (UTC)
 * The part 'more unpublished cases are suspected' is too vague and the word 'cases' is not very accurate (weasel). How is the wording 'more unpublished deaths are suspected' more accurate than explaining 'many more seem to remain unpublished'. The wording 'suspected' is weaker and more confusing than 'many more seem to remain unpublished'. The part 'more unpublished deaths' is a misinterpretation of the source because 'many more' seem to remain unpublished. The wording 'suspected' (weasel) is a much weaker claim than the source intended because many more seem to remain unpublished rather than only suspecting there was more unpublished deaths. QuackGuru (talk) 16:56, 1 November 2010 (UTC)
 * I don't mind 'many more unpublished deaths are suspected'. I think you're wrong that 'seem' is stronger than 'suspected'.  Seem is a very weak word, and suspected is no weaker.  Sometimes the changes other editors suggest are not designed to weaken but to improve phrasing; always opposing them shows a bit of a bit of a presumption on your part.  Ocaasi (talk) 17:26, 1 November 2010 (UTC)
 * That wording weakens the claim and does not improve the phrasing. QuackGuru (talk) 17:29, 1 November 2010 (UTC)
 * Can you explain how it weakens the claim. I am beginning to tire of assertions without evidence.  You wouldn't accept that for articles; why do it on the talk page?  Ocaasi (talk) 17:40, 1 November 2010 (UTC)
 * "Twenty-six deaths are on record and many more seem to have remained unpublished."
 * The current wording is closer to what the source says. QuackGuru (talk) 18:22, 1 November 2010 (UTC)
 * So it's not weaker, it's just not as close to the exact phrasing? Should all research results be quoted then?  You seem to find paraphrasing to be inherently problematic, but  WP:NOR makes it pretty clear that accurate paraphrasing is a fundamental part of encyclopedic writing.  Moreover, if your standard is verbatim fidelity, then you need to use quotation marks. Ocaasi (talk) 18:29, 1 November 2010 (UTC)
 * I do not understand where you got the wording for your proposal that is too vague (weaker) when the current text is very accurate paraphrasing. I did write text that is clear and faithful to the source without violating the copyright. I don't need to use quotation marks when it is not a direct quote because the text was rewritten. Quoting the source implies a serious dispute, anyhow. I can't use quoted text against the consensus version of ASF when no serious dispute has been presented. QuackGuru (talk) 05:38, 2 November 2010 (UTC)

A simple formulation
Assert facts, including facts about opinions—but do not assert the opinions themselves. A "fact", for this policy, is a statement about which there is no serious dispute between reliable sources. For instance, the published finding of a reliable literature review is a fact, when it is not disputed by another secondary source. That there is a planet called Mars is a fact. That Plato was a philosopher is a fact. No reliable source seriously disputes any of these statements, so Wikipedia articles can simply assert them. Facts can be asserted in Wikipedia's voice (e.g. "Mars is a planet.") and without an inline qualifier (e.g. "According to...", "John Doe believes...", "The book Manual of Cardiovascular Medicine stated...", "A systematic review...").

An "opinion", on the other hand, is a statement which expresses a value judgement, or a statement construed as factual that is a matter subject to dispute. There are many propositions that very clearly express values or opinions. That stealing or killing animals is wrong is a value or opinion. That The Beatles were the greatest band in history is an opinion. That the United States is the only country in the world that has used a nuclear weapon during wartime is a fact, but that the United States was right or wrong to drop the atomic bomb is a value or opinion.

Values or opinions must not be written as if they were in Wikipedia's voice. Factually attribute the opinion in the text to a person, organization, group of persons, or percentage of persons, and state as fact that they have this opinion, citing a reliable source. For instance, rather than asserting, "The Beatles were the greatest band ever", locate a source such as Rolling Stone magazine and write: "Rolling Stone said that the Beatles were the greatest band ever", including a reference to the issue in which that statement was made. Likewise, the statement "Most people from Liverpool consider the Beatles the greatest band ever", can be made if it can be supported per Wikipedia's verifiability to a particular survey or reliable source. Attribution in the text must accurately reflect the source presented. Do not use terms like "most people" unless a source can be found to substantiate such a claim (See WP:SYN and WP:WEASEL).

There are bound to be borderline cases where careful editorial judgment needs to be exercised – either because a statement is part way between a fact and an opinion, or because it is not clear whether there is a serious dispute – editorial consideration of undue weight will determine whether a particular disagreement between sources is significant enough to be acknowledged.

A careful selection of reliable sources is also critical for producing articles with a neutral point of view. When a matter is subject to dispute there are competing, contradictory views between reliable sources. When discussing the facts on which a point of view is based, it is important to also include the facts on which competing opinions are based since this helps a reader evaluate the credibility of the competing viewpoints. This should be done without implying that any one of the opinions is correct. It is also important to make it clear who holds these opinions. It is often best to cite a prominent representative of the view.

This is the broad consensus version of ASF. QuackGuru (talk) 06:55, 1 November 2010 (UTC)


 * That issue has to be resolved at WP:NPOV or at WP:NPOVN in the meantime, while policy is settled. So far it has been over a week with no significant objections to the NPOV changes, aside from your fully noted criticism.  As I mentioned in my post, I intended to address the grammatical issue not the policy issue, preferring 'more unpublished deaths are suspected' to 'more deaths seem to have been unpublished'.  The meaning of those statements is nearly identical, but the former uses passive voice rather than an inherently subjective verb, 'seem', where no subject is implied.  'Seem' just isn't an encyclopedic phrasing, IMO although, I don't dispute the underlying statement.


 * I refactored your post, since I believe a link to the policy suffices. Ocaasi (talk) 07:50, 1 November 2010 (UTC)


 * I have restored my post you deleted because a link to a policy does not link to the consensus version of ASF. You should not delete my post for the massive consensus for ASF. You did not link to the massive consensus version of ASF. You put a link to a version that was vague and confusing. There has been significant objections to the unilateral NPOV changes. QuackGuru (talk) 16:18, 1 November 2010 (UTC)
 * I didn't realize the link was to the new version of policy. I intended to link to ASF as you pasted it.  Can you do that, as  I still think posting the entire policy here is unwarranted.  Ocaasi (talk) 16:46, 1 November 2010 (UTC)
 * Also, would you show me a few diffs of users besides yourself who objected to the changes? I haven't seen them on the NPOV talk page. Ocaasi (talk) 16:48, 1 November 2010 (UTC)


 * There are a lot of diffs on your talk page and you have not shown there is consensus for the mass deletion of ASF. I won't ask you to show where is the consensus for the changes because I already know you can't show there ever was consensus. I think it is warranted to show the full text of ASF policy when editors continue to try to imply a serious dispute where there is none. QuackGuru (talk) 17:00, 1 November 2010 (UTC)
 * The diffs on my talk page are all from you, though. I asked for opposition aside from your 'fully noted criticism', from someone else.  There's always a risk of WP:CONLIMITED decisions on policy talk pages, but myself, Ludwigs, Kotniski, and BlueBoar didn't seem to have any problems with it.  Kenosis didn't seem to object.  Neither did Tryptophish.  There aren't too many people who regularly comment on the talk page, so, I'm curious on what you're basing your analysis, except for your personal dislike of the changes.  As for not showing evidence of consensus, thanks for trying to save me the work, but assuming your conclusions does not an argument make.  Ocaasi (talk) 17:13, 1 November 2010 (UTC)


 * You haved not shown how the mass changes improved ASF. There is opposition on the talk page from someone else. It seems you want to leave room in policy for editors to decide how to write articles with less explicit instructions. Do you think an editor who disapproves of the intent of ASF policy should be allowed to continue to edit Wikipedia without restriction. QuackGuru (talk) 17:30, 1 November 2010 (UTC)
 * The changes improved NPOV by making it simpler, and slightly opened up room for editors to use discretion, as well as made room for a more nuanced discussion of attribution. ASF is not the purpose of NPOV, rather NPOV is the core policy and ASF was just an aspect of it which helped to explain how Wikipedia should not state opinions in Wikipedia's voice.  I think your emphasis on asserting as a plain fact anything not contested in a reliable source whenever possible is not how the policy was intended.
 * It doesn't seem to have ever occurred to you that attribution could be useful, provide information to readers, avoid overly strong statements that though nominally uncontested still do not have significant confirmation or support, or are in a gray area between fact and opinion that is not best served by treating as a plain fact, etc. Also, I'm not convinced you prefer ASF because it's longstanding and good policy or just because it allows you to fend off a particular type of editor who wants to balance articles away from SPOV towards NPOV.


 * If you want to discuss any of those issues, I think there's plenty to address. If you just want to preach ASF as holy and anything not ASF as heretical, then I think the conversation is pretty much stalled.   Describing criticism of your particular interpretation of ASF as IAR is a pretty weak tack, and I think you'll have to be a little more explicit.


 * In answer to your question, I think editors who disagree with your particular application of ASF should indeed be allowed to edit without restriction, especially now that ASF has been refactored into NPOV. I know this won't make sense to you, but you would have to consider that there's a chance you could be wrong in order to consider that editors who disagree with you are not mere infidels and idiots.  That's something I can only suggest but not compel. Ocaasi (talk) 17:49, 1 November 2010 (UTC)


 * The changes did not improve NPOV by making it vague. I think ASF is supposed to be a little more explicit unless editors prefer very little or no instructions. QuackGuru (talk) 18:25, 1 November 2010 (UTC)

Template with instructions
There is often new editors who are unfamiliar with how to write Wikipedia articles. I could try to add guidelines on how to edit this page in the form of a collapsed template at the top of the page. QuackGuru (talk) 06:01, 29 October 2010 (UTC)
 * I like that idea very much, but what would be the justification for having it here rather than on every article. Is it because it's a controversial subject?


 * One place I have seen that kind of thing is at Talk:Intelligent_design's article-editing notes. I like the beginning.  We could also work on a draft of specific points, though I doubt they'd be easy to come up with until some of the controversies are more thoroughly settled. Ocaasi (talk) 07:06, 29 October 2010 (UTC)


 * It is not because of the subject. It is because of the controversial edits to this article. A little assistance can't hurt. I can add a new template to the top of the chiropractic article. Adding a template to the talk page will not get read by most potential editors. I don't want to work on a draft on the talk page because it will slow me down. Things will move a lot faster if I edit the article. If you have any suggestions you can make them now or work on the template after it is in the article. We can start with the color of the template and the shape. QuackGuru (talk) 15:42, 30 October 2010 (UTC)

What should the first sentence of the template say to encourage new editors to follow the instructions. QuackGuru (talk) 19:04, 31 October 2010 (UTC)
 * There is already a template announcing that substantial changes should be discussed on talk first and backed up with sources.  I don't know if this is an easy one to just solve with more text.  I'd really only be comfortable emphasizing using the talk page and following V, NOR, NPOV, and MEDRS where appropriate.  Linking to those policies would be a start, but I'm interested in educating editors, not telling them ahead of time not to try and improve the article.  We should encourage criticism of the article but caution against editing without discussion. Ocaasi (talk) 15:11, 4 November 2010 (UTC)
 * I'm also interested in educating editors. I won't put a warning to not to try to edit. The template can educate on how to improve the article. I want to create a template with instructions on how to edit. Most editors don't want to bother with reading so many policies. A single page with a summary of policies and guidelines may help editors. Editors have discussed for a number of years to have one page with all policies and guidelines. I think a template can create a single unified page with simple instructions. The 'instructions template'won't be specific for this article. It would be for any Wikipedia article. QuackGuru (talk) 03:21, 5 November 2010 (UTC)
 * Ok, sounds good. I'd like the template to mention BOLD, IAR, and CIVIL, as well as V, NPOV, NOR, RS, and COPYRIGHT.  If you think MEDRS is appropriate for a general editing template, I'd consider it, too. Ocaasi (talk) 14:14, 8 November 2010 (UTC)
 * After you considered it let me know if you will approve of it, including beyond a mention. I am referring to sentences and paragraphs with instructions. This won't be a mention of policies. This would be an explanantion of policies including ASF. This will take me a long time to work on this. If you are against this then this thread can be archived. Either I am going to create a good template or I won't bother with a meaningless template. I won't create a template with only links and possibly a brief explanation. It must be a lot of paragraphs with instructions or it won't helpful. QuackGuru (talk) 18:09, 8 November 2010 (UTC)
 * QG, I don't want to discourage this effort, because policy clarification is important. I have a long list of issues related to ASF and attribution that I have been accumulating in the interest of someday trying to create a guidance page or essay, as well.  I think that the path for either of us is to start with a userspace essay and then bring it to NPOV for comment/integration.  I think that going through the edit template avoids the necessary policy discussion, and instead just presents it to the reader without it having broader approval or consensus.  Again, I'd like to see what you come up with, and I'm sure you can make a persuasive argument for ASF being strictly applied, at least to this article, but I think there's a somewhat broader conversation going on that needs to be clarified first.  So, it's up to you.  Go for it if you think it will help advance your view of how to apply ASF, but I can't promise not to address my general criticisms of your reading of it.  Maybe we should trade notes to see if there are some issues that can be resolved before you get into a major draft... Ocaasi (talk) 18:44, 8 November 2010 (UTC)
 * It must be a summary of the consensus version of ASF. I don't think there is a need for clarification. Either you support ASF or not. Editors were against making ASF simpler because ASF was deleted and replaced with vague and incoherent sentences against consensus. QuackGuru (talk) 20:08, 8 November 2010 (UTC)

The first line is not supported by its citation
It is in fact refuted by the citation. The first sentence is defining chiropractic, and the citation says "More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent."

That is the current state of the definition of chiropractic, according to this article. This same article does attempt to create a new definition for chiropractic, but that doesn't mean it is the accepted definition. In fact, it is the opposite, a completely unaccepted definition. Please provide a definition that is supported by a citation. TheThomas (talk) 11:50, 13 November 2010 (UTC)


 * This same article puts the ACC forward as the leading consensus makers in the Chiropractic field:

Part II: The Failed Identities of Chiropractic

The "ACC Paradigm" document developed by the Association of Chiropractic Colleges in 1996 currently represents the closest thing to an official consensus of chiropractic identity [13]. This paradigm was formed by consensus among the 16 presidents of the member ACC institutions – a group generally believed to hold divergent beliefs and interests.

From the same link that is given by said article I found this definition of Chiropractic. "Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery." http://www.webcitation.org/query.php?url=http://www.chirocolleges.org/paradigm_scopet.html&refdoi=10.1186/1746-1340-13-9

Since this article was already used to define Chiropractic, I know we can trust it. Since it says the ACC represents the closest thing to consensus among Chiropractors, I will trust what they have to say. So, I am inserting their definition in place of the self-stated "new definition." —Preceding unsigned comment added by TheThomas (talk • contribs) 11:58, 13 November 2010 (UTC)


 * These sections exist to discuss the changes I made, if you disagree with the changes, discuss it. Otherwise accept my change as consensus.TheThomas (talk) 07:53, 15 November 2010 (UTC)


 * I do disagree, and no change you can ever make unilaterally can ever be considered a consensus here. That's not the way it works, so I suggest you refactor your comment (as well as the identical comment in the next sections.) They smack of ownership. There are hundreds of editors who have this article on their watchlists, and they may well chime in if necessary. A consensus can only be formed when one considers input from those editors, and that's what would be necessary to make any radical changes. If necessary an RfC can be started, but we're far too early in the discussion process for such a large undertaking. It would be quite disruptive. So....let's work on this.


 * The first sentence in the lead (which in this case serves as Wikipedia's "definition") is:


 * Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. 


 * I have tried to track down how we came up with that wording and why the Nelson reference is even there, since the lead doesn't necessarily have to contain any references (but often does), since it is based on content in the body of the article which is referenced. That wording was created a long time ago (since Sept. 7, 2008), so it has existed for over two years, representing the results of a very stable consensus, which is a miracle on this article. It was arrived at after years of editwarring between myriad editors of all persuasions, many of them chiropractors. According to these comments in the archives, that reference covers the last few words in the first sentence, the part about "hypothesis". You will find the content in the Nelson article under the subheading "What is the Chiropractic Hypothesis?"


 * There are obviously numerous "definitions" floating around in the literature, but they usually suffer from being written from one POV among the many competing POV in the profession. Thus using any single one of them would violate NPOV. What we have here is based on all the available literature and is a condensation of various POV.


 * Now what do you find problematic about the first sentence in our lead? Do you feel it misrepresents the chiropractic profession? Is it inaccurate? -- Brangifer (talk) 02:33, 16 November 2010 (UTC)
 * My major problem with the first sentence is that it is unsupported by its citation, in an article that is so contentious that everything needs to be supported by citation. Other problems include, Chiropractic doesn't fit the definition of Health Care given in that internal link: "Health care or healthcare is the treatment and prevention of illness. Health care is delivered by professionals in medicine, dentistry, nursing, pharmacy and allied health(which is 'medicine, dentistry, and nursing')." Chiropractic, as a CAM, cannot treat or prevent illness; only "strengthen the immune system" and other meaningless utterances. Depending on the location, there are laws against CAMs saying the treat or prevent illness. It also cannot/does not "treat mechanical disorders". —Preceding unsigned comment added by TheThomas (talk • contribs) 09:43, 18 November 2010 (UTC)


 * Simply false. Allied health is "clinical health care professions distinct from medicine, dentistry, and nursing". Chiropractic, as a health care profession, CAN treat and prevent illness - for example, treating arthritis through prescription of exercise, or with therapeutic ultrasound. It certainly DOES treat mechanical disorders, such as mechanical low back pain, rotator cuff strains, patellar tendonopathy, etc. DigitalC (talk) 20:58, 18 November 2010 (UTC)


 * DigitalC is correct. -- Brangifer (talk) 21:04, 18 November 2010 (UTC)

Health Care Discipline
Since NCAM modalities are not legally allowed to say they prevent or treat illnesses, it may be illegal to say they are health care providers. Though their website says it, so I don't think wikipedia would be held responsible —Preceding unsigned comment added by TheThomas (talk • contribs) 12:10, 13 November 2010 (UTC)


 * Not sure what you're getting at. Chiropractors definitely treat diseases (eg: carpal tunnel syndrome, lateral epicondylitis, etc.), and it certainly is not illegal to say they are health care providers. They are primary contact health care providers. DigitalC (talk) 20:44, 18 November 2010 (UTC)


 * Correct. -- Brangifer (talk) 21:04, 18 November 2010 (UTC)

Tried to clean up the opening section
By bringing similar ideas together in one paragraph. Eliminating redundancies, extraneous details. Hope I didn't step on anyone's toes. The material is all well-sourced, which is good. WIkipedia was telling me the introduction was too long. SO I tried to trim the fat. —Preceding unsigned comment added by TheThomas (talk • contribs) 13:18, 13 November 2010 (UTC)
 * These sections exist to discuss the changes I made, if you disagree with the changes, discuss it. Otherwise accept my change as consensus.TheThomas (talk) 07:51, 15 November 2010 (UTC)
 * If there is nobody claiming there was problems with my edits, I'll just go ahead and put them back in. —Preceding unsigned comment added by TheThomas (talk • contribs) 09:47, 18 November 2010 (UTC)

This section is too vague to really deal with. -- Brangifer (talk) 21:07, 18 November 2010 (UTC)

Removed sentence that didn't fit anywhere in the introduction
Among chiropractors there are significant disagreements over vaccination.

True, maybe worthwhile to know. But uninformative as an introduction to chiropractic isn't it? —Preceding unsigned comment added by TheThomas (talk • contribs) 13:34, 13 November 2010 (UTC)
 * These sections exist to discuss the changes I made, if you disagree with the changes, discuss it. Otherwise accept my change as consensus.TheThomas (talk) 07:51, 15 November 2010 (UTC)
 * If there is nobody claiming there was problems with my edits, I'll just go ahead and put them back in. —Preceding unsigned comment added by TheThomas (talk • contribs) 09:48, 18 November 2010 (UTC)

Definite disagreement. -- Brangifer (talk) 21:36, 18 November 2010 (UTC)

The second and third sentences read like a debate, not an encyclopedia
And the third line has what point exactly? Defining the difference between primary care and dentistry? Relevance? —Preceding unsigned comment added by TheThomas (talk • contribs) 12:14, 13 November 2010 (UTC)


 * These sections exist to discuss the changes I made, if you disagree with the changes, discuss it. Otherwise accept my change as consensus.TheThomas (talk) 07:51, 15 November 2010 (UTC)


 * Look at the sources. There is debate in the profession and we follow and include what the sources say. So if you get the feel of "debate", then we've succeeded in giving that impression to the reader, since that's the case. -- Brangifer (talk) 02:37, 16 November 2010 (UTC)


 * But, that's not a good style for an encyclopedia article is it?TheThomas (talk) 09:44, 18 November 2010 (UTC)


 * Actually it's excellent editing. It's hard to reproduce the sense of debate in the real world in an article without taking sides, but it can be done and we're supposed to do it. -- Brangifer (talk) 21:06, 18 November 2010 (UTC)


 * We're supposed to make a lead look like a debate if the subject is often under debate? That's not something I have ever heard. Where are you getting that from? —Preceding unsigned comment added by TheThomas (talk • contribs) 13:13, 19 November 2010 (UTC)


 * If RS document a debate, then the article should document that debate. It's really a very simple concept. If we slur that fact, then we are inserting editorial control in a manner considered original research and/or whitewashing. We aren't supposed to do that. We're supposed to document the sum total of human knowledge as shown in RS. -- Brangifer (talk) 20:55, 19 November 2010 (UTC)


 * I think there is another way to present debated subjects which involves starting with the 'in-universe' definition of the field, as it sees itself, and then expanding outward to describe controversies, criticisms, and external views of the field towards the end of the lead. Otherwise there is a bit of a back and forth quality which can be seen as the article debating itself. Perhaps that is what the 'un-encyclopedic' reference was to. Talk:Intelligent design has been working on this type of issue. Ocaasi (talk) 03:24, 25 November 2010 (UTC)

Eleven undiscussed changes to LEAD reverted
I have reverted 11 undiscussed changes of the LEAD, some of them rather radical. It's good that they were mentioned on this page, but now, per WP:BRD, they will need to be discussed and a consensus formed before restoring them. I suggest our inexperienced editor (which is okay, since we all have been there!) read the rules for WP:LEAD. The LEAD reflects prior changes to the body of the article and sums up the article. It isn't a "definition".

This article has always been a hotspot and any potentially controversial changes need to be discussed first. Changing the LEAD without first getting a consensus for any changes to the body of the article is often a bad idea. (1) Start with suggesting small changes to the body of the article. (2) Get a consensus for each one of those changes. (3) Then see if those changes justify tweaking the LEAD. That's the proper order of things. -- Brangifer (talk) 17:08, 13 November 2010 (UTC)


 * Thanks for the suggestion, but I prefer to use wikipedia the way it was meant to be used. See a problem, fix a problem. My revisions were to make sense out of the mess you call an introduction. A paragraph is usually used as a tool for encompassing an idea, not just four sentences which are attached to each other. The whole introduction needs to be reworked into sections reflecting the material in the article, which is what I did. All of the paragraphs are mish-mashes of ideas. Many sentences fit nowhere, and are not of primary importance, thus shouldn't be in the introduction. My version was simply better, simpler to read, and more logical in form than the current version. 72.187.199.192 07:48, November 15, 2010 (UTC)


 * You should read that section on the lead you linked. It reflects exactly what I did.I'm not sure why you linked it to me as if writing me a ticket for loitering on our article. TheThomas 07:58, November 15, 2010 (UTC)


 * If there is nobody claiming there was problems with my edits, I'll just go ahead and put them back in.TheThomas (talk) 09:48, 18 November 2010 (UTC)


 * There are many problems. See section below. -- Brangifer (talk) 21:37, 18 November 2010 (UTC)

After five days I reverted to my previous reverted edit
I noted exceptions and left those sections unchanged. The rest, which nobody noted any exceptions for, are back in. According to WP:CON I assume consensus b/c nobody took exception to my edits after five days on the discussion page. There was one notable "exception" in the '11 changes to lead' section. Simply, that my edit was different, and I edited a lot. Neither of which is an actual exception to what I did. Just, a formality in highly contentious pages. Don't revert due to "no consensus" TheThomas 12:20, November 18, 2010 (UTC)
 * The Thomas, I support your efforts to make this introduction clearer, more coherent, and more encyclopedic, but your approach to consensus is confusing me, and I typically find myself on your side of a given debate. You might want to check out WP:CONLIMITED and WP:SILENCE, as well as any guidance on WP:CONTROVERSIAL articles.  It's great that you leave comments after your edits, but in this article, given its extensive and contentious history, you can 'almost' expect to require support rather than the mere absence of disagreement.  That might not be a de facto reading, but in practice I think it will bear out more closely with how this article changes.  Ocaasi (talk) 03:33, 25 November 2010 (UTC)
 * After looking VERY carefully through your changes, some of which you had to self-revert, I have restored the previous version as I saw no significant improvement, and several significant problems that were created. This restored mention of the Public Health section (vaccination), which must be mentioned in the lead. It also fixed your split of the Redwood ref which happened when you removed the reference name. You also removed sourced content. Get consensus before making such changes. Keep discussing. Please don't make anymore changes to the lead until a consensus has formed. -- Brangifer (talk) 21:35, 18 November 2010 (UTC)


 * I can agree with a mention of vaccination, though you gave no reason for it, but that isn't a reason to revert. I can also agree with you fixing references--which isn't a reason to revert. I don't agree with you citing removing sourced content as a problem, because everything that is in the lead is in the article. Do you have any reasons for the revert?


 * Whether you saw significant improvement is not a basis for reversion. Your opinion of improvement isn't really significant. Most importantly, don't tell me what to do. I don't need consensus before making changes. I don't need you to tell me to acquire consensus before making changes. I had consensus before making changes. I don't need to discuss before making changes. I don't need you to tell me to discuss before making changes. I had been the only person discussing for three out of the five days before I made the changes. Your commands are ridiculous in multiple ways, please keep them to yourself. This is not a talk page for how you feel I should act. TheThomas 13:25, November 19, 2010 (UTC)


 * You may not like it, but new editors need education and advice. If they don't accept it and don't show a positive learning curve, they end up in trouble. I notice that you often include unsourced, editorializing, content. That violates our policies. Please be more careful. Your userpage also shows you have a confrontational approach toward other editors. That doesn't bode well for your future here. You need to collaborate with other editors, especially those who hold opposing POV. It's not easy, but it ends up a very rewarding experience and the articles benefit from such collaboration. That's how it works here. Solo editing doesn't work very well on controversial articles. It only starts edit wars. AGF and you'll do well. I'm actually trying to help you. I've been here for five years and have over 28,000 edits under my belt. I have some experience and I like to help newbies. I'm not your enemy. BTW, please remember to sign all your talk page posts. I'm getting tired of fixing them for you. -- Brangifer (talk) 21:13, 19 November 2010 (UTC)
 * Bull, these are important comments, but maybe better placed on the editor's userpage. Ocaasi (talk) 03:35, 25 November 2010 (UTC)

Addition: Technique Validity Criticisms
Technique Validity Needs to be Added

I propose adding this section:

Chiropractic Technique Criticisms

The biomechanical validity of chiropractic techniques is unsupported by research. Intervertebral ranges of motion as determined by motion and static palpation is highly subjective and prone to false positives due to postural deviations which are not considered in the analysis. Chiropractic vertebral listing systems have been shown to be inaccurate due to the failure to account for translations which account for 50% of all vertebral motions, failure to consider x-ray distortion effects and the use of skin torquing motions which can't influence underlying vertebral structures. In the 1990s Donald Harrison PhD DC introduced modern biomechanical listing systems into chiropractic through his Chiropractic Biomechanics of Posture technique but his system is limited in that it does not include intersegmental listings. Also problematic is the fact that the prohibition against injections in most states in the chiropractic scope of practice prohibits effective treatment of ligament laxity-a common biomechanical problem which is treated by osteopathy using prolotherapy. These problems invalidate chiropractic claims of biomechanical efficacy and lead to ineffective treatment promoting patient dependency.

Moreover, it needs to be mentioned that chiropractic techniques based on x-ray analysis have been shown to have no effect on position and that manipulations have no long term effects on palpation findings-both indicating a lack of biomechanical efficacy. Panjabi's neutral zone theory explains the false positives see in motion palpation technique and this is correlated clinically in a research study by Cagne that found that there is a 60.9% adverse effect rate for chiropractic techniques.
 * Two hundred and eighty three patients (60.9%) reported at least one post-manipulative reaction. The most common were headache (19.8%), stiffness (19.5%), local discomfort (15.2%), radiating discomfort (12.1%) and fatigue (12.1%). Most of these reactions began within 4 h and generally disappeared within the next 24 h.

Much of this is due to jamming the facets from the false positives.

The current technique section omits any suspicion that these techniques are ineffective and is very inaccurate. Abotnick (talk) 16:09, 30 November 2010 (UTC)


 * Please propose wording that is neutral, without any editorializing, and provide the sources that you'll use. Do that below in its own section. -- Brangifer (talk) 20:48, 30 November 2010 (UTC)


 * Done. See below.Abotnick (talk) 14:26, 1 December 2010 (UTC)

New Section: Causes of Adverse Effects from Chiropractic Techniques
Causes of Adverse Effects from Chiropractic Techniques

Adverse effects are a common occurrence with chiropractic techniques. In a 1997 study Senstad reported that 53% of subjects receiving manipulative therapy experienced local discomfort. One explanation for the local discomfort is mild joint sprain injury arising from biomechanically flawed techniques which lead to jamming at the vertebral facet joints. . Several chiropractic authors have criticized chiropractic listing systems as being invalid but their criticisms have never led to significant change. In 1980 chiropractic radiologist Roy Hildebrandt’s textbook Chiropractic Spinography criticizes the Gonstead and Diversified technique's pelvic listing systems as being inaccurate for choosing an impossible axis of motion at the hip rather than the true axis at the pubic symphysis. Despite the criticism, the listing systems were never modified. In 1996 Harrison published a review revealing that the biomechanical positional listing systems use by chiropractors to describe vertebrae were inaccurate. Harrison’s criticisms of traditional listings (Gonstead, Diversified and Upper Cervical) include:
 * They fail to describe translations so 50% of all possible positions are ignored.
 * Because posture determines the neutral position of vertebra (termed the neutral zone) and traditional chiropractic techniques ignore posture, they are prone to false positives.
 * Likewise, failure to factor in posture leads to unaccounted for x-ray distortions and treatment errors.
 * Many rotational listings, known as “torque”, are impossible to achieve due to the lack of friction between skin and bone.

Harrison tried to correct the problems by replacing the invalid intervertebral listings with multi-segmental biomechanical listings but his techniques are used by only a minority of the profession and like Hildebrand, have not caused any modification of intersegmental listing systems despite their errors. Abotnick (talk) 13:52, 1 December 2010 (UTC)


 * Far too much detail about a limited problem for this article. Can you pare that down to 2-3 sentences? -- Brangifer (talk) 17:09, 1 December 2010 (UTC)


 * It's going to take time to do that. Moreover, it has to be reconciled with the outdated information in the techniques section that it is updating.  Give me a few days.Abotnick (talk) 01:52, 2 December 2010 (UTC)


 * Okay. Just start a section below and work on it here on the talk page. -- Brangifer (talk) 02:53, 2 December 2010 (UTC)


 * Brang, actually chiropractic controversy is a major element. These issues are central to the reason for chiropractic's lack of acceptance.  If its treatments were valid they it would get better results and acceptance would be much higher (currently it's no better than manipulation by any other provider-PTs etc).  People need to understand why this is and this text provides that explanation so to limit the subject to three sentences is too short.  However, the other treatment information needs to be reconciled with this new material.Abotnick (talk) 11:08, 2 December 2010 (UTC)


 * Abotnick, I made this change based on your suggestions. Is there anything missing from the article. QuackGuru (talk) 08:50, 5 December 2010 (UTC)
 * The 2009 study is an epidemological survey from one chiropractic college about injuries received by chiropractic students. Several problems here: it's a primary study; it's based on self-reporting; it only looked at one school; it looked at injuries to students who were presumably being worked on by other students in a higher-risk learning environment; it's still relatively recent from 2009.  Also, it has to do with safety not treatment techniques, so it doesn't belong in this section even if it didn't have those problems.  I'm going to remove that section but leave the 2010 study, which is relevant. Ocaasi (talk) 09:10, 5 December 2010 (UTC)


 * This is the best source available. It has to do with safety of specific treatment techniques. It's still relatively recent from 2009 is not a problem. If it was dated then it would be a problem. QuackGuru (talk) 21:38, 5 December 2010 (UTC)


 * The date's the least of its issues. Just because it's the best study available doesn't mean it's good enough to use and certainly doesn't mean we give it its own paragraph in a section where it's barely relevant.  You speak very highly of MEDRS but you don't seem to want to apply it in this case.  Do you want similar quality studies which are less critical of Chiropractic to be included as well? Ocaasi (talk) 02:21, 6 December 2010 (UTC)

People have also been found to "frequently" have mild adverse effects (local pain) from flu shots and other immunizations, sometimes considerable (moderate) local pain such as temporary loss of mobility, and in rare cases, death. Would a systemic study that concluded (in agreement with some chiropractors & homeopaths) that inoculations are not worth the risk also be put in the voice of wikipedia? --JimWae (talk) 19:57, 2 December 2010 (UTC) I see the "not worth the risk" is no longer in the voice of wikipedia - but the "frequently" (a term elaborated on in the study - but not in the lede) is still in wp's voice.--JimWae (talk) 20:03, 2 December 2010 (UTC)
 * Since this discussion is now appearing on multiple noticeboards, I will chime in here. I would appreciate being notified if the discussion keeps spreading. We certainly do not need a paragraph on one epidemiological survey-based study. We have had a previous consensus here to try to stick to high quality secondary sources where possible, especially on topics that involve safety and efficacy (scientific aspects). There were over 2000 hits for a google scholar search for "chiropract*" limited to sources published since 2010, and we do not have the space on this article to cover every primary study to do with chiropractic. Wait and see what the secondary sources see relevant to discuss and lets go from there, otherwise we run into WP:WEIGHT issues. DigitalC (talk) 17:16, 15 December 2010 (UTC)

Why are we still using a 1997 study in 2010? We have previously decided to keep our references recent, within the last 5 years, not 13 year old data. DigitalC (talk) 22:53, 5 December 2010 (UTC) Realistically we should only be using the Cagne study, the others are WAY too old. If no one else has been talking about this stuff for the last 13-30 years, it isn't important enough for wikipedia to discuss. DigitalC (talk) 22:56, 5 December 2010 (UTC)
 * For more on this, please see WP:MEDRS DigitalC (talk) 23:08, 5 December 2010 (UTC)


 * Please see V. MEDRS was rejected from V for no valid reason. Now editors don't have to use recent studies according to V? QuackGuru (talk) 23:12, 5 December 2010 (UTC)
 * Please keep your other disputes where they belong. WP:MEDRS is a content guideline, WP:V is policy. I don't know how what you posted could be relevant to improving this article. DigitalC (talk) 01:26, 6 December 2010 (UTC)

Please provide a quote from the WebMD article that you think verifies this statement: "One explanation for the local discomfort is mild joint sprain injury arising from biomechanically flawed techniques which lead to jamming at the vertebral facet joints". DigitalC (talk) 23:04, 5 December 2010 (UTC)

After re-reading this section, I think that a well-sourced (hopefully with a recent source?) sentence about the validity/reliability of listings might be a good addition to the article. However, the proposed content provides much more detail than necessary, while still being outdated. The majority of the content does not seem to be related to the topic heading. Some of the content is duplicating content already in the article, except the article is using much more recent sources. If sources exist, some discussion of whether chiropractors all use listings or if many still use listings and a contrast of the term joint restriction might be relevant to discussing listins as well? DigitalC (talk) 01:44, 6 December 2010 (UTC)


 * I agree that a source on listings would help to explain a technical aspect of Chiropractic. Perhaps a Chiropractic source such as a textbook or instructional review would be useful.  Trying to explain the inner workings of a field using only risk-focused studies is not going to give us a comprehensive treatment. Ocaasi (talk) 02:24, 6 December 2010 (UTC)


 * I would actually be suprised if current textbooks still discussed listings, other than for the fact(?) that chiropractic board exams in the USA test knowledge of listings as far as I know. Then again, I'm sure there are implications with the straight/mixer/evidence-based points of view when it comes to listings. DigitalC (talk) 02:59, 6 December 2010 (UTC)


 * I think it's still relevant and interesting even if it's not current. IMO we're getting too much into a medical guideline mentality and forgetting to just describe the full status and history of the field. Listings are or were a part of Chiropractic, and either way, they should be described for their role and the change that has happened there.  If current research addresses them, great, but that doesn't make them not notable otherwise.  It just means we will be using a different kind of source to address historical and descriptive aspects rather than medical claims. Ocaasi (talk) 03:51, 6 December 2010 (UTC)


 * Very well put! -- Brangifer (talk) 03:59, 6 December 2010 (UTC)

Everyone,

I found some more quotes that pertain to the biomechanical problems with Diversified and Gonstead chiropractic listings which are the official listing systems taught and used by the profession. Regarding DigitalC's request for a reference for why joints are jammed when they are forced beyond their anatomical boundaries, this is the very definition of a joint sprain and doesn't need a citation because it is self evident. The source on sprains covers it. Quote: CONCLUSIONS: Thoracic cage x-axis translations compared to a fixed pelvis are significant, between 35 and 70 mm. The z-axis lumbar coupled rotation was largest at L2-L3, L3-L4 and L4-L5 and to the same side of the main motion translation in L1-L5, but opposite the main motion direction for T12. All other movements were small, averaging less than 1 degrees or 1 mm.

RELEVANCE: The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature. Normal values for lumbar segmental coupling on anterior-posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less. -Harrison, DE. Lumbar coupling during lateral translations of the thoracic cage relative to a fixed pelvis. Clin Biomech (Bristol, Avon). 1999 Dec;14(10):704-9.

Quote: Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. Therefore, the validity of any chiropractic technique procedure, listing, motion analysis or adjusting style based on the two-dimensional radiograph and coupling studies must be questioned. We have identified four types of spinal subluxations (displacements) in the biomechanical literature: (a) posture main motion and associated segmental coupling, (b) Euler buckling viewed in the anteroposterior view, (c) snap through viewed in the lateral view and (d) segmental instability.

CONCLUSIONS: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Previous chiropractic letter listings (e.g., PRI, PLS, etc.) of spinal displacements are inadequate and invalid. Only one of the four types of biomechanical displacements, segmental instability, is consistent with the traditional chiropractic theory of segmental spinal displacements; in general, this does not respond well to care. In general, vertebrae displacement must be viewed in the context of equilibrium configurations and one vertebra can not be displaced as an individual misalignment. Validity questions arise for any technique methods that use letter listings of displacement taken from motion palpation or two-dimensional radiographic analysis. -Harrison, DE. J Manipulative Physiol Ther. 1998 Mar-Apr;21(3):177-86. Three-dimensional spinal coupling mechanics: Part II. Implications for chiropractic theories and practice.

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

CONCLUSION: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Postural rotations and translations, which are the main motions studied in spinal coupling research, and altered configurations of the normal sagittal plane curves are the cause of both normal and abnormal spinal coupling patterns in three dimensions. Chiropractic letter listings (such as PRS, ASRP, etc.) are outdated, incomplete, invalid representations of coupled segmental movements. Mechanical loading of the neuromusculoskeletal tissues plays a vital role in position, dynamics, proper growth, repair and symptoms. Future studies of spinal kinematics should study the postural translations of the skull and thorax for their associated coupling in three dimensions. Combined postural rotations and translations along with altered sagittal curvatures need to be studied for their associated coupling characteristics as well. -Harrison DE. Three-dimensional spinal coupling mechanics: Part I. A review of the literature. J Manipulative Physiol Ther. 1998 Feb;21(2):101-13.

Quote: CONCLUSIONS: We believe that the term torque is misused in chiropractic literature. This misuse has been perpetuated in chiropractic college courses, student clinic examinations and state and national board examinations. We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources. -Harrison DD. Torque: an appraisal of misuse of terminology in chiropractic literature and technique. J Manipulative Physiol Ther. 1996 Sep;19(7):454-62.

Abotnick (talk) 14:19, 9 December 2010 (UTC)


 * Hi Abotnick. Again, these sources are all over 10 years old. They also don't say what you want to say in the article. If you want the article to say "One explanation for the local discomfort is mild joint sprain injury arising from biomechanically flawed techniques which lead to jamming at the vertebral facet joints" then we need to find a source that says that (all of it - that is mentioning local discomfort/adverse events, sprain, biomechanically flawed techniques, and jamming of the facet joints). We don't combine a bunch of different sources at wikipedia to come up with conclusions. For more on that, I would point you towards WP:SYN. I hope this helps and that I don't come across too discouraging. DigitalC (talk) 19:27, 9 December 2010 (UTC)


 * Digital, those references were more for the other passages, they weren't intended to address the facet jamming. Anyway, I'll dig around.  I think I've seen this referenced around in material on general sprains.  It shouldn't be that hard. As for the date, this isn't that kind of information likely to change with the passage of time.  It's like the periodic table of the elements in chemistry-don't criticize fluorine because it was discovered 50 years ago.  It's the same element it ever was, same with biomechanics.Abotnick (talk) 04:48, 10 December 2010 (UTC)


 * General ligament injuries. Sprains.  Mechanisms of injury-occur when a joint is forced beyond its normal anatomical limits, resulting in the stretching or tearing of ligaments, joint capsule or both. (http://www.docstoc.com/docs/26839396/Tissue-Mechanics, page 3)


 * grade 1 (acromiocravicular) sprain shows "Point Tenderness, slight swelling," some motion loss. http://www.athleticadvisor.com/injuries/ue/shoulder/a_-_c_sprain.htm


 * These are common signs of sprained joints anywhere. By definition, incorrect biomechanical analysis leads to jamming joints due to moving them against their end ranges of motion, causing the signs and symptoms of a grade 1 sprain.


 * "Sprains are ligamentous injuries that are caused by a sudden violent contraction, sudden torsion, severe direct blows, or a forceful straightening from a crouched position. All major ligaments (ie, anterior longitudinal, posterior longitudinal, yellow, intertransversal, capsular, interspinosus, supraspinosus) can sustain sprains; however, the posterior ligaments are more prone to injury. The posterior longitudinal ligament, for example, is the biggest of this group of ligaments and is less developed than its anterior counterpart."(Radebold, A. Lumbosacral Spine Sprain/Strain Injuries, http://emedicine.medscape.com/article/95444-overview) Abotnick (talk) 05:14, 10 December 2010 (UTC)


 * I'm sorry that you haven't understood me. If you want the sentence to say "One explanation for the local discomfort is mild joint sprain injury arising from biomechanically flawed techniques which lead to jamming at the vertebral facet joints", then you will need to find a source that says this. The sentence includes A) local discomfort (after manipulation) comes from sprain B) sprain is from biomechanically flawed techniques C) the techniques jam the facet joints. So, your source would need to include A, B, and C. For more information on this, please see WP:V, WP:SYN and WP:OR. DigitalC (talk) 02:02, 15 December 2010 (UTC)


 * DigitalC is correct and has listed the policies which are being violated. You'll need at least ONE RS that specifically mentions ALL of this in ONE place to avoid a SYN violation. -- Brangifer (talk) 02:21, 15 December 2010 (UTC)

2004
This change added an old 2004 reference. The old ref does not meet MEDRS. QuackGuru (talk) 19:09, 17 December 2010 (UTC)
 * I must disagree. Being a peer-reviewed research article, published in a very reputable research journal (Arch Intern Med), I thought the reference that I added actually met MEDRS more than the dissenting viewpoint, which came from a book published in the vanity press. Despite the fact that the book chapter likely does not meet MEDRS ("Most self-published books or books published by vanity presses undergo no independent fact-checking or peer review and consequently are not reliable sources"), I left it in the section, as other editors clearly saw fit to include it before I arrived, and it provides balance to the article. However, I am relatively new here, so I am open to dissenting comments from other editors. Puhlaa (talk) 19:40, 17 December 2010 (UTC)
 * I think QG is addressing its age. MEDRS prefers the last 5 years, but 2004 is not too far back from that.  If it's the best source for this issue, it should get consideration. Ocaasi (talk) 21:51, 17 December 2010 (UTC)
 * I understand the issue now. Does MEDRS not consider that sometimes 5 years can go by without an analysis of an issue? If not, then if no research were done for 5 years, the topic could not be discussed on wikipedia? Anyways, this is the latest peer-reviewed article that exists to speak to X-ray use by DCs, and no secondary sources exist that examine the issue. The only reference that currently addresses X-rays in the wikipedia article is a book published in the vanity press, and only takes a critical approach. Thus, to maintain NPOV we need to include the 2004 peer-reviewed article, or delete the current reference to the book chapter that also does not meet MEDRS. Puhlaa (talk) 22:24, 17 December 2010 (UTC)
 * We can use discretion, but MEDRS establishes guidelines. 2001 sources are not as desired as 2005, and 2005 not as much as 2009, though very recent studies might not have benefited from a full review cycle.  Ocaasi (talk) 23:02, 17 December 2010 (UTC)
 * According to MEDRS, this dated source is unreliable. QuackGuru (talk) 18:23, 18 December 2010 (UTC)
 * MEDRS is a guideline which recommends ideal sources; it needs to be used with editor discretion and applied in context. 2004 does not make a source unreliable per MEDRS, it makes it slightly less reliable than 2005.  We can use it with discretion, and in context. Ocaasi (talk) 19:05, 18 December 2010 (UTC)
 * According to MEDRS, the source it contradicts is also unreliable, as it is a reference to a book published in the vanity press. I would be content to delete the entire section from the article. Puhlaa (talk) 18:37, 18 December 2010 (UTC)
 * How does it contradict any other source. The source you added to safety is not about safety. What book you claim is unreliable. QuackGuru (talk) 18:39, 18 December 2010 (UTC)

(outdent) ''Although there is no clear evidence for the practice, some chiropractors may X-ray a patient several times a year. [Book: trick or treatment, vanity press, does not meet MEDRS] One study found that people with chiropractic insurance coverage, compared with those without chiropractic coverage, actually had a lower utilization of X-rays (Peer-reviewed article in a reputable journal, 2004, meets MEDRS but not best source possible).'' Either both can go, or both can stay, I am ok with either approach.Puhlaa (talk) 18:51, 18 December 2010 (UTC)
 * Puhlaa. This specific study is more about overall healthcare costs than safety.  It's a synthesis to suggest that lower utilization of x-rays means Chiropractic is safe, only that Chiropractic is associated with lower x-ray usage (I haven't read the study to be more specific).  We can consider it, but there might be a better spot for it outside the Safety section.


 * Also not a bad point about Trick or Treat. The author is an authority, but the book itself is not MEDRS.  I think there's a case to be made that the book is more similar to un- peer-reviewed critiques of Ernst published by Chiropractors, such as Anthony Rosen on ChiroAccess or others. Ocaasi (talk) 19:05, 18 December 2010 (UTC)
 * The 2004 ref is not about safety and is obviously unreliable. The book written by an expert on the topic is one of the most reliable sources available. QuackGuru (talk) 18:57, 18 December 2010 (UTC)
 * The 2004 ref is about associations between Chiropractic coverage and lower x-ray utilization. It's not "obviously unreliable".  Trick or Treatment is not a top MEDRS source, QG, only the studies it cites are. Ocaasi (talk) 19:05, 18 December 2010 (UTC)
 * The reference from the book is not with regard to the safety of Xray, this is undisputed that they are dangerous. The book described DCs as Xraying people excessively, which the 2004 reference seems to contradict to some extent. Thus, both sources are weak MEDRS, and both address the # of Xrays being taken by DCs. Thus, it is my opinion that they could both stay and be moved to controversies, or both be removed altogether.Puhlaa (talk) 19:27, 18 December 2010 (UTC)
 * The association between Chiropractic coverage and lower x-ray utilization is not about safety at all. The way is it being used in safety seems to be SYN to advanced a position when it is not specifically about safety. No editor has shown how the 2004 source is reliable. Is there any editor who thinks Ernst is not an expert on the topic. QuackGuru (talk) 19:44, 18 December 2010 (UTC)
 * I this change that removed the dated study from safety per MEDRS guideleines and possible misuse of a source that is not about safety. QuackGuru (talk) 20:54, 18 December 2010 (UTC)

I propose removing the "trick or treatment" references from the article, a vanity press publication does not meet MEDRS. If the author is an expert, he will likely have referenced valid publications in his vanity press book? Thus, those references should be cited, not the book, as they may meet MEDRS and other editors will have an oportunity to comment.Puhlaa (talk) 20:59, 18 December 2010 (UTC)

Proposed edits to "Education" take 2
The "Education" section is cuurently one sided/biased because the only mention of DC curriculum is: "Although chiropractors often argue that this education is as good as or better than medical physicians', most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing." Another problem is that the source of this sentence that is currently referenced (Morrison P, Adjusting the role of chiropractors in the United States, Health Matrix Clevel, 2009), is a narrative rather than a review and is not the original source of this sentence. The sentence is quoted from a 1992 book published in the vanity press: "Kurt Butler, a consumer's guide to "alternative medicine": a close look at homeopathy, acupuncture, faith-healing, and other unconventional treatments". This original source is very old, and is published in the vanity press, however, the older source is now cited in a newer article.
 * Proposal #1

To keep the controversial sentence described above, but still conform to NPOV, I propose adding the sentence "A comparative study of the curriculum content of North American chiropractic and medical colleges concluded that with regard to basic and clinical sciences, medical and chiropractic programs are similar, both in the types of subjects offered and in the time allotted to each subject." Like the situation described above, this sentence is found in a new reference (Johnson et al 2010, 100 Years After the Flexner Report: Reflections on Its Influence on Chiropractic Education, J Chiropr Educ), which is a narrative rather than a review, and not the original source of this sentence. Like the previously described sentence, this sentence is quoted from a 1998 study ''Coulter et al., A comparative study of chiropractic and medical education. Altern Ther Health Med (1998)''. This original source is old, however, as described above, the older source is now cited in a new article.

Thus, if the first sentence is appropriate for wikipedia, so will be the sentence I propose to include to bring balance. The question is, do we cite the original source for both sentences, or the more recent articles which quote the older source for both? I know it is appropriate in the peer-reviewed literature to cite the original source so misinterpretation is not propagated, but things seem to be done different here. Puhlaa (talk) 02:41, 19 December 2010 (UTC)


 * "The standard medical education format that chiropractic colleges mimicked in their early years, and for the most part continue to do so, includes the first years focusing on basic sciences (anatomy, physiology, pathology, etc) and the later years focusing on clinical topics (diagnosis, clinical practice methods). It is interesting to note that a study comparing chiropractic and medical education in the mid-1990s showed strong similarities in medical and chiropractic education based on number of hours and subjects taught, such as hours of course work in basic science and clinical courses.11 Coulter et al.11 concluded that
 * Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar, both in the types of subjects offered and in the time allotted to each subject. The programs also share some common areas in the clinical sciences."


 * I propose adding this sentence. "The curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences, medical and chiropractic programs has been more similar than not similar, both in the kinds of subjects offered and in the time assigned to each subject." QuackGuru (talk) 10:30, 21 December 2010 (UTC)


 * I am satisfied with this proposal.Puhlaa (talk) 16:02, 21 December 2010 (UTC)

Proposed compromise to Treatment techniques
A 2009 study assessing chiropractic students giving or receiving spinal manipulations while attending a U.S. chiropractic college found Diversified, Gonstead, and upper cervical manipulations are frequently used methods. This proposed compromise is for Chiropractic. QuackGuru (talk) 20:50, 20 December 2010 (UTC)

I made the change and kept the text very short to satisfy WEIGHT. QuackGuru (talk) 01:53, 22 December 2010 (UTC)

Revision to evidence for "Low Back Pain"
I have added the most recent cochrane review to examine complete chiropractic care and otherwise reorganized the section to group ideas. I have retained one reference that criticises treatment guidelines "However, the methods for formulating such treatment guidelines for low back pain have been criticised because of significant differences between countries, casting some doubt on their reliability.[ref]" because they were included by another editor, although I do not think they belong in this section. If someone else agrees that the reference should come out I would be in agreement. However, any comments at all would be appreciated before I incorporate the changes into the actual article.Puhlaa (talk) 23:39, 15 December 2010 (UTC)
 * Proposed revised paragraph:

The two most recent Cochrane reviews to evaluate the treatment of low back pain (2004 & 2010) found that the effectiveness of either spinal manipulation (SM) alone, or total chiropractic care, was equal to other commonly used therapies such as pain medication, physical therapy, exercises, back school or the care given by a medical doctor. A 2010 systematic review found that SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. In 2007 the American College of Physicians and the American Pain Society jointly recommended that clinicians consider spinal manipulation for patients who do not improve with self care options such as rest and ice. However, the methods for formulating such treatment guidelines for low back pain have been criticised because of significant differences between countries, casting some doubt on their reliability. Reviews published in 2008 and 2006 suggested that SM for low back pain was equally effective as other commonly used interventions. A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain. Of four systematic reviews published between 2000 and 2005, one recommended SM and three stated that there was insufficient evidence to make recommendations. Puhlaa (talk) 01:28, 16 December 2010 (UTC)
 * I wonder why the refs don't come through. Doc James (talk · contribs · email) 01:37, 16 December 2010 (UTC)
 * I have tried....but I am a newbie as it is, These are references from a section above, posted by abotnick, I cannot figure out how to 'reset' the referencing so 'mine' appear on this list? Puhlaa (talk) 01:45, 16 December 2010 (UTC)
 * Ah I get it now. I agree that what you have written above is better and have added it. Cochrane should usually go first. Doc James (talk · contribs · email) 01:48, 16 December 2010 (UTC)
 * Yes, my intent was to move 2004 cochrane up (as per our earlier discussions on the LBP page), add 2010 cochrane, and organize the paragraph better in general. Thanks for adding it, I had planned to wait until multiple editors approved to avoid controversy, but this will do :) What do you think of the sentence bringing guidlines into question? "However, the methods for formulating such treatment guidelines for low back pain have been criticised because of significant differences between countries, casting some doubt on their reliability.[ref]" I kind of think this would be better suited for a Wiki article on medical guidlines, although, LBP guidlines are the focus in this paper...so.... either way is fine with me. Best wishes Puhlaa (talk) 01:54, 16 December 2010 (UTC)
 * I reverted it back after reading the conclusions from the 2010 review which says "However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." This is different than saying they are the same as other treatments... Not sure how to address this. As other have concerns as well I have brought it back here for further discussion. Doc James  (talk · contribs · email) 07:49, 18 December 2010 (UTC)
 * I think that it is the same as saying equal effectiveness. The plain language summary the authors present says: "The review shows that while combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute and subacute low-back pain, there is currently no evidence to support or refute that combined chiropractic interventions provide a clinically meaningful advantage over other treatments for pain or disability in people with low-back pain. Any demonstrated differences were small and were only seen in studies with a high risk of bias." Thus, DC care is not better, only as good as other treatments. Further, the authors state that there were very few high quality studies that examines total DC care rather than just spinal manipulatio alone, limiting the utility of their review. I have not heard anyone else express concern, however I dont mind waiting to see what others have to say. Puhlaa (talk) 16:18, 18 December 2010 (UTC)
 * This proposal went against OR, SYN and MEDRS. For example, the first sentence "The two most recent Cochrane reviews..." did not come to the same conclusion. This is OR and SYN. The part "most recent" is vague. The 2007 reference is not a systematic review. This change added an obvious MEDRS violation. The low back pain section is a summary of recent systematic reviews. There is no reason to cherry pick references to argue against the most reliable systematic reviews. QuackGuru (talk) 05:19, 19 December 2010 (UTC)
 * From the 2007 Study: "The literature search for this guideline included studies from MEDLINE (1966 through November 2006), the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and EMBASE. The literature search included all English-language articles reporting on randomized, controlled trials of nonpregnant adults (age >18 years) with low back pain (alone or with leg pain) of any duration that evaluated a target medication and reported at least 1 of the following outcomes: back-specific function, generic health status, pain, work disability, or patient satisfaction. The American College of Physicians (ACP) and the American Pain Society (APS) convened a multidisciplinary panel of experts to develop the key questions and scope used to guide the evidence report, review its results, and formulate recommendations. The background papers by Chou and colleagues (15, 16) provide details about the methods used for the systematic evidence review." In other words, what makes you say it's not systematic or reliable? Ocaasi (talk) 05:32, 19 December 2010 (UTC)
 * According to the 2007 reference it is a general review. It is indexed as a review but not a sytematic review. This change went against MEDRS. QuackGuru (talk) 05:42, 19 December 2010 (UTC)

QG, The 2007 guidelines by the American College of Physician and American Pain Society are a secondary source and 100% consistent with MEDRS. "Ideal sources for these aspects include general or systematic reviews in reputable medical journals; professional and academic books written by experts in a field and from a respected publisher; and medical guidelines or position statements from nationally or internationally reputable expert bodies." The American College of Physicians and the American Pain Society are very reputable expert bodies. Further, "A secondary source in medicine summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic, to make recommendations or to combine the results of several studies. Examples include the literature reviews and systematic reviews found in medical journals; specialist professional or academic books; and position statements or medical guidelines published by major health organizations." Thus the 2007 guidelines are a secondary source and 100% consistent with MEDRS. Puhlaa (talk) 16:03, 19 December 2010 (UTC)

Further to the above, as we are clearly keeping very strict adherence to MEDRS, I propose removing the following sentence and the respective references as it is not consistent with MEDRS (Of four systematic reviews published between 2000 and May 2005, only one recommended SM). MEDRS says "Look for reviews published in the last five years or so, preferably in the last two or three years." Thus, the sentence described is outdated, and should be removed in favour of the multitude of newer reviews and guidelines that are available. The 2004 Cochrane study presented at the end of that sentence should stay, as "Cochrane Library reviews are generally of high quality and are routinely maintained even if their initial publication dates fall outside the above window."Puhlaa (talk) 15:51, 19 December 2010 (UTC)


 * "Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[ref] found that SM or mobilization is no more or less effective than other standard interventions for back pain. "
 * The MEDRS compliant reference is 2006 "Ernst-Canter". ^ a b c d e Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. . PMC 1420782. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22). It is a systematic review of systematic reviews that summarises systematic reviews and the Cochrane review. A systematic review of systematic reviews is a higher quality source than a typical systematic review. You want to delete a 2006 systematic review of systematic reviews for no legitimate reason when it is one of the best sources.
 * The Low back pain section is a summary of systematic reviews and Cochrane reviews. To reach down into a general review or guideline is consistantly against MEDRS when there are several state of the art higher quality sources presented.
 * See WP:MEDASSESS: "Knowing the quality of the evidence helps editors distinguish between minority and majority viewpoints, determine due weight, and identify information that will be accepted as evidence-based medicine. In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, (e.g., conventional wisdom).


 * The best evidence comes from meta-analyses of randomised controlled trials (RCTs), and from systematic reviews of bodies of literature of overall good quality and consistency addressing the specific recommendation. Narrative reviews can help establish the context of evidence quality. Roughly in descending order of quality, lower-quality evidence in medical research comes from individual RCTs, other controlled studies, quasi-experimental studies, and non-experimental studies such as comparative, correlation, and case control studies. Although expert committee reports or opinions, along with clinical experience of respected authorities, are weaker evidence than the scientific studies themselves, they often provide helpful overviews of evidence quality. Case reports, whether in the popular press or a peer-reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources."
 * We should stick to the highy quality sources rather than general reviews. QuackGuru (talk) 19:01, 19 December 2010 (UTC)
 * I agree, the 2006 systematic review of systematic reviews is ok. However, with regard to the 2007 guidelines, I dont see in any of the text you quoted where guidelines from established expert medical bodies constitutes a general review, nor a lower form of evidence. What I do see though, is under secondary sources the point that guidelines from established expert bodies is recommended as among the best forms of evidence, "Examples include the literature reviews and systematic reviews found in medical journals; specialist professional or academic books; and position statements or medical guidelines published by major health organizations" Further, it is not being used to argue against anything, the recommendations have been quoted as they appear in the guidelines, you should argue with those experts if you dont like their recommendations. Thus, while I can agree that Ernst 2006 systematic review should stay, you have failed to show why 2007 guidelines should not also stay.Puhlaa (talk) 19:12, 19 December 2010 (UTC)


 * 1.Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.


 * Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel.


 * Ann Intern Med. 2007 Oct 2;147(7):478-91. Erratum in: Ann Intern Med. 2008 Feb 5;148(3):247-8.
 * [PubMed - indexed for MEDLINE] Related citations


 * 2.Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.


 * Chou R, Huffman LH; American Pain Society; American College of Physicians.


 * Ann Intern Med. 2007 Oct 2;147(7):492-504. Review. Erratum in: Ann Intern Med. 2008 Feb 5;148(3):247-8.
 * [PubMed - indexed for MEDLINE] Related citations


 * According to WP:MEDASSESS we should use higher quality sources. A similar 2007 source is a general review and it is indexed at PubMed as a general reivew. The current source is a guideline recommendation. You have not shown at all how the source is reliable per WP:MEDASSESS. You have not shown how this source is as reliable as the other sources in the low back pain section. You have failed to show how the 2007 source is compliant with WP:MEDASSESS. You are unable to make an argument that the 2007 source meets WP:MEDASSESS. I have shown there are better sources found in Low back pain. The 2007 source is dubious when there are several higher quality sources such as Cochrane reviews and systematic reviews. QuackGuru (talk) 19:41, 19 December 2010 (UTC)
 * Again, I see nowhere in any of the guidelines you have posted that the 2007 guidelines should not be included, thus you have failed to show how they do not meet WP:MEDASSESS. I dont think the burden of proof is always on the editor opposing your opinion is it? MEDASSESS does not say anything about lower quality sources being omitted, only that they be weighed according to the strength of the source. The guidelines are not a minority view, nor are they low quality evidence. They are a secondary source as per MEDRS and deserve to be included in the low back pain section. However, as the Review that was used to generate these guidelines in currenly also used in the section, I could find a way to combine the two (eg: A 2007 review by ACP and APS found ____, leading to these recommendations ____).Puhlaa (talk) 19:49, 19 December 2010 (UTC)
 * A possible compromise is keeping the similar source but we agree to remove the recently added guidelines.
 * This is a similar source that is a review.
 * Let's use the 2007 review but remove the guidelines. Both sources are very similar. Do you think it would be duplication to use both sources in Low pack pain section. Which source do you think is more reliable per WP:MEDASSESS. The review or the guidelines. QuackGuru (talk) 19:56, 19 December 2010 (UTC)
 * In my opinion, they are both important. The review found SM to be effective for a specific condition and this was deemed strong enough evidence for the respective "expert medical societies" to make recommendations for physicians. Recommendations from "expert bodies" seems important, and MEDRS seems to agree. Doesnt the fact that this is all stated after all of the reviews ensure that the guidelines are not given more weight than the systematic reviews. Why is omitting the recommendations so important? They put the relevence of the evidence at the time in perspective. Alternatively, as per your proposal (kind of), perhaps we could compromise by removing the mention of the guidelines here completely to appease your wishes, but you could conform to some mention of DCs criticism of the Ernst reviews in "Risk-Benefit" to show good faith in return? Puhlaa (talk) 20:08, 19 December 2010 (UTC)


 * Wisely, as per my previous comments, perhaps you could try to understand my point of view that DCs criticism of the Ernst reviews in "Risk-Benefit" is a fringe tiny minority view. Let's stick to higher quality sources and not turn this article into a battleground for the chiropractic minor view or add a duplicate similar references to the "Low back pain" section.
 * You are using two similar sources in the article. This is clearly duplication. The 2007 review is at least a review. But then you added the guidelines which is not the review and is a lower quality source. The 2007 review is a review of the guidelines. There is no reason to add duplication and reach down into guidelines when there is a review of the guidelines. This controversial change is misusing a guideline when the 2007 review of the guidelines was already in the article. I disagree with the merging of similar sources. WP:MEDASSESS does not agree to use a guideline when there is a review of the guideline. QuackGuru (talk) 20:28, 19 December 2010 (UTC)

I still think that there is a problem here. I am new here, and I was born at night, but not last night. The 2007 review was already included. The guidelines that came from the review have been added but you want them removed. It is not a compromise to agree to include what was already there, but prevent any addition which may benefit the article; that is not a compromise, it is just the staus-quo. MEDASSESS says "Knowing the quality of the evidence helps editors distinguish between minority and majority viewpoints". The quality of evidence is determined according to MEDRS. As the Guidelines are consistent with MEDRS as a secondary source, and add context to the 2007 review which the reviews themselves do not bring, I still think it important to include them. As you are unwilling to bend in Risk-benefit and conceed that 6 letters that have criticized Ernst's reviews have been deemed significant enough by journal editors to warrant publishing in high quality medical journals, thus must at least be a significant but minor point of view, I am going to hold fast here for the time being. I am open to comments from other editors, but it seems that you expect me to "bend" each time, and you are unwilling to be equally "pliable". Thus, I propose maintaining the guidelines for now, and I will refrain from adding the 6 letters as a minor significant view in the risk-benefit section, until we have input from additional editors.Puhlaa (talk) 22:02, 19 December 2010 (UTC)
 * As previously explained, you have not shown how the guidelines is as reliable as a review of the guidelines or as reliable as other sources such as systematic reviews. The "low back pain" section is too long and needs to be shortened a bit. We can't include every detail. We should remove the similar but less reliable source per MEDASSESS (In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence,...).
 * "Chiropractors have criticized the quality of the studies which arrive at these conclusions.[54][55][56]" As previously explained, this proposal is OR and SYN. I requested WP:V but none was provided. I did suggest we might include the "response to the critique of deaths after chiropractic". QuackGuru (talk) 18:45, 20 December 2010 (UTC)
 * My attempts to shorten other sections did not seem to be a high priority to you, why here I wonder? I alreay explained that MEDASSESS and MEDRS does not say anywhere that less reliable sources be omitted, just given due weight. I have also already explained how the guidelines qualify as one of the highest levels of evidence according to MEDRS. The fact that we disagree on this, and a direct quote from MEDRS does not convince you that I may have a point, suggests to me that a 3rd opinion may be required. If you want to shorten the section more, remove older sources, not newer ones that meet MEDRS but that you dont like. Another option to shorten this paragraph is to re-examine the 2010 Cochrane review and look back at my original proposal for this paragraph. I have quoted the discussion of Cochrane 2010 below, and have proposed a new revision to this paragaph.

''"Combined chiropractic interventions (rather than SMT alone) provide short- and medium-term relief for pain and disability for individuals with acute and subacute low-back pain when compared to other treatments, but the effect sizes are small and although statistically significant, they are not clinically relevant. Also, the studies that demonstrated this effect were assessed as having a high risk of bias. There was no evidence of a significant difference between chiropractic and other treatments for any outcomes for individuals with chronic or mixed duration low-back pain." ''Puhlaa (talk) 20:11, 20 December 2010 (UTC)
 * From the Discussion of "Combined chiropractic interventions for low-back pain, Cochrane database, 2010"

New proposal for low back pain
There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. A 2010 Cochrane review determined that the effects of combined chiropractic interventions for low back pain were the same as that of other commonly used treatments. A 2010 systematic review found that most studies suggest SM achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. a 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration. A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks. Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review found that SM or mobilization is no more or less effective than other standard interventions for back pain. Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability. Puhlaa (talk) 00:42, 21 December 2010 (UTC)


 * "The two most recent Cochrane reviews to evaluate the treatment of low back pain (2004 & 2010) found that the effectiveness of either spinal manipulation (SM) alone, or total chiropractic care, was equal to other commonly used therapies such as pain medication, physical therapy, exercises, back school or the care given by a medical doctor.[9][10]"
 * I thought I previously explained combining the two reviews together like this is SYN. It is also a WEIGHT violation it limit the Cochrane reviews. QuackGuru (talk) 20:34, 20 December 2010 (UTC)
 * You dont really explain anything really well, you just state things. Perhaps you should be willing to provide the same level of explanations for your claims as you expect of others dont you think? I have always provided relevant quotes from policy, where I bold relevant text pertaining to my claims. Regardless, I have now separated the 2 cochranes in my above proposal so it is not SYN as per your complaint. I have quoted the discussion of the 2010 Cochrane review and the abstract of the 2004 Cochrane review. Are we now any closer to consensus?Puhlaa (talk) 21:05, 20 December 2010 (UTC)


 * "However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." The however part is missing from the 2010 Cochrane review. The 2010 Cochrane review should be rewritten to avoid quotes. The 2004 Cochrane review is out of place and I disagree with the rewrite of the 2004 review. I think the section can be shortened without moving or drastically changing the text. If your proposal does not include the guidelines it can be removed now. QuackGuru (talk) 22:37, 20 December 2010 (UTC)
 * No, I am not sufficiently convinced that the guidelines should be removed. The quotation I proposed from the discussion of Cochrane 2010 says the same thing as the quote you added from the abstract, but is shorter. You were concerned about space and you also recently added a quotation from Cochrane 2010 to the actual article so dont now say that quotations should be avoided. Your inconsistencies make it difficult to efficiently communicate here and suggest that you are just playing games. I am open to removing the guidelines if the paragraph is modified to sufficiently express to a reader the same context that the guideline provide, however, you continually reject all of my proposals to modify the text and have not shown any compromise. Perhaps you could return the favour that I have provided you and propose something in talk? You constantly reject my proposals...how about taking some time to type up a proposal rather than just reject all of mine?Puhlaa (talk) 22:42, 20 December 2010 (UTC)
 * I might be willing to remove the guidelines if we quote the discussion of the 2010 cochrane review rather than the abstract as I have done in the above proposal. This has the added advantage of beiing shorter and easier to understand. Alternatively, if you now have decided that you dont want quotes, we could change it to the way I proposed it originally, "the Cochrane review suggests SM is equal to other commonly used therapies".... Puhlaa (talk) 22:54, 20 December 2010 (UTC)
 * I prefer no quotes and the text be rewritten. I forgot to rewrite the 2010 Cochrane review. The text should be rewritten and shortened and the guidelines deleted. QuackGuru (talk) 23:01, 20 December 2010 (UTC)
 * Why should the guidelines be removed? 24.57.77.99 (talk) 17:49, 22 December 2010 (UTC)

In the proposed low back pain paragraph above I have rewritten the 2010 Cochrane discussion, the original text from the discussion is:
 * "Combined chiropractic interventions (rather than SMT alone) provide short- and medium-term relief for pain and disability for individuals with acute and subacute low-back pain when compared to other treatments, but the effect sizes are small and although statistically significant, they are not clinically relevant. There was no evidence of a significant difference between chiropractic and other treatments for any outcomes for individuals with chronic or mixed duration low-back pain.",

I have re-written it to say:
 * "A 2010 Cochrane review determined that the effects of combined chiropractic interventions for low back pain were the same as that of other commonly used treatments.".

I also removed the guidelines and used the existing paragraph from the article as the starting template. Please read it and let me know if this can be used as is? If it can be used verbatum then I will be satisfied with this and we can move on. If you still dont like it, I would ask that you modify the proposed paragraph above so that it is consistent with what you want and we can discuss it. Puhlaa (talk) 00:42, 21 December 2010 (UTC)


 * "Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." This is the main point from the conclusion. Your proposal would greatly weaken the low back pain section because you did not summarise the conclusion from a 2010 Cochrane review. I suggest you just edit the article if you can summarise the conclusion. QuackGuru (talk) 02:17, 21 December 2010 (UTC)


 * Your original proposal in this thread was for combining two Cochrane reviews as was your previous proposal. Combining different sources together like that is SYN and did not give DUE WEIGHT to both reviews. This is part of the reason you are consistently having problems with your proposals. I previously explained the problems with combining two Cochrane reviews. As for the 2010 Cochrane review we should make sure to also summarise the part "However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." This was previously explained by Doc James that there are concerns about the previous proposal.
 * "A 2010 systematic review found that most studies suggest SM achieves equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.[127]" This is a long run on sentence that can also be shortened. QuackGuru (talk) 04:23, 21 December 2010 (UTC)
 * Thank you QG for explaining it for me. I think I am happy with most of what is being proposed here, however I am concerned with your interpretation of the 2010 Cochrane review. YOu are focusing on the sentence :"However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions" as if it says that chiropractic interventions were not as good as other therapies, when in fact the opposite was found. The Dicsussion states that chiropractic interventions were statistically significantly BETTER than other therapies, but not clinically significantly better, thus, it was concluded there was no difference between them.

From the discussion: "Combined chiropractic interventions (rather than SMT alone) provide short- and medium-term relief for pain and disability for individuals with acute and subacute low-back pain when compared to other treatments, but the effect sizes are small and although statistically significant, they are not clinically relevant. Also, the studies that demonstrated this effect were assessed as having a high risk of bias. There was no evidence of a significant difference between chiropractic and other treatments for any outcomes for individuals with chronic or mixed duration low-back pain.

Moreover, the plian language summary says: "The review shows that while combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute and subacute low-back pain, there is currently no evidence to support or refute that combined chiropractic interventions provide a clinically meaningful advantage over other treatments for pain or disability in people with low-back pain. Any demonstrated differences were small and were only seen in studies with a high risk of bias." The differences are as described in the discussion, DC care was statistically, but not clinically better than other therapies. This will need to be resolved before I am satisfied with this paragraph.Puhlaa (talk) 16:05, 21 December 2010 (UTC)


 * I and Doc James are concerned the however part is being left out of your previous proposal. The 2010 Cochrane review thought it was important to explain it and we can do the same. I am against weakening the conclusion of the Cochrane review. Your newer proposals also weaken the meaning of the Cochrane review because the proposals left out the conclusion. I prefer we stick to the conclusion. I understand you will not be satisfied with sticking to the conclusion. The conclusion is plain enough language to summarise. QuackGuru (talk) 19:41, 21 December 2010 (UTC)


 * I am happy to use an ACCURATE summary of the conclusions, however, I have not seen a proposal from you for an accurate summary of the conclusions, I have only seen you quote the conclusions. I am happy to leave the LBP section in the article as it exists currently. I have tried to provide summaries to appease your views, you reject everything. I have asked you to propose a summary and you have not. I am still waiting from your proposed summary. Take as long as you like, I am not in a hurry as I am not busy, I am on holiday. Merry Christmas. Puhlaa (talk) 20:26, 21 December 2010 (UTC)


 * You have not provided a summary of the conclusions. It seems you want to replace the conclusions with weaker text. QuackGuru (talk) 20:35, 21 December 2010 (UTC)


 * I am happy to review and discuss a summary of the conclusions that you write if you want to change it. You can put it here in talk and we can edit it until we both agree. It may take a while, but I was told to expect things to move slow here, so I am prepared for that. Clearly my making changes to the text gets us nowhere, you are never satisfied, so I will await your proposal. Puhlaa (talk) 21:03, 21 December 2010 (UTC)


 * It is a non-controversial change to just remove the quotes with a rewrite of the conclusion. All of your proposals ignored the conclusion. You never tried to summarise the conclusion with the however part. QuackGuru (talk) 21:12, 21 December 2010 (UTC)


 * It is not a summary to just remove the quotes and change 2 words, that is an odd proposal. I will try again:) How about this (you will note that I used the word "however"):

"Combined chiropractic therapy slightly improved pain and disability for acute and subacute LBP, however, there is currently no evidence of a significant difference between chiropractic and other commonly used LBP interventions" If you are ok with this, I will be happy to put it in the article.Puhlaa (talk) 21:35, 21 December 2010 (UTC)


 * "A 2010 Cochrane review found no evidence of a meaningful difference between the effects of combined chiropractic interventions and other interventions for chronic or mixed duration low back pain, however, there is no current evidence to support or refute that these treatments give a clinically significant difference when compared to other treatments.[128]"
 * You are continuing to argue for changes that dilute the meaning of arguably the most reliable source in low back pain. I think it is puzzzling you continue to object to non-controversial changes. We must give DUE WEIGHT to a recent Cochrane review and try to accurately summarise the review. QuackGuru (talk) 01:51, 22 December 2010 (UTC)
 * It seems like an accurate summary to me. What are your specific objections to this summary? How is it inaccurate? DigitalC (talk) 17:55, 22 December 2010 (UTC)

Revision to "Education, licensing, and regulation"
I have made some modifications to the aforementioned section, with the aim of making the section flow a little better and more succinct. The proposed revision is 100 words shorter (not much, but a start for the page as a whole). I believe that all of the ideas and references have been retained, except one sentence/idea that I have removed, as it is based on an opinion article by a lawyer, and not a critical evaluation of chiropractic education: "Although chiropractors often argue that this education is as good as or better than medical physicians', most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing.[50]" However, if other editors think this sentence should be retained in the article I believe it would be best suited in the "controversies and critisisms" section, along with an opposing perspective from another Author (I can do all this if it is thought important).Puhlaa (talk) 22:04, 15 December 2010 (UTC)
 * Below I have posted my proposed revision to this section, I am hoping for comments, criticism and suggestions before I try to actually change the article itself. Thanks in advance for having a look and providing some feedback! Puhlaa (talk) 22:04, 15 December 2010 (UTC)
 * Thank you for taking the time and effort to do this. It has been 2 years since large portions of the article were re-written, but at the same time it is a huge process, and some of us are happy to see the article just stay in a stable form with no edit warring. My initial review of the text below: first para, remove capitol letter on chiropractors, and remove duplication of orthopedics/chiropractic orthopedics. Last paragraph, remove the However at the start of the sentence. In normal academic writing, you fuse sentences and ideas together with words like however, but at wikipedia fusing ideas together is seen as a violation of WP:SYN/WP:OR. I will have a closer look at the proposed text later. DigitalC (talk) 00:17, 16 December 2010 (UTC)
 * Thanks for the comments, I have made the changes you recommended. Please note the section immediately above as well, where I have proposed changes/an addition to the LBP evidence paragraph. Regards Puhlaa (talk) 00:28, 16 December 2010 (UTC)
 * I will definitely take a look at the above section as well, but that one will take a bit more time I think. I would also remove "Today" from the sentence talking about the number of schools/programs in area of the world, even though it is in the current version. DigitalC (talk) 00:43, 16 December 2010 (UTC)

Puhlaa (talk) 01:57, 16 December 2010 (UTC)
 * The current version includes "Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine.[83]", which seems to be missing from your proposed version. DigitalC (talk) 02:15, 16 December 2010 (UTC)
 * Yep...I see that I missed it. I added it in to the second paragraph last night (which I can do again if you dont like the following proposal), but have now removed it again this morning. After thinking about it, it doesnt fit well, despite being with regard to education. The rest of this section is fact about DC education and its regulation, etc., and then there is that sentence, which is a viewpoint/opinion piece, although from a published work. My thought is that it, along with the other sentence I removed (described at the beginning of this section above), it would make a good short paragraph in the controversies and critisisms section. I would like to add with them a sentence regarding the criticism of clinical education that DCs recieve. I have posted the proposed controversies and criticisms paragraph below and left the proposed Education section as is for now. What is your opinion? Puhlaa (talk) 13:53, 16 December 2010 (UTC)

"Although chiropractors often argue that this education is as good as or better than medical physicians', most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing.[50]"

I think this sentence should remain. The controversy section is for a WP:SUMMARY of another article. QuackGuru (talk) 04:57, 18 December 2010 (UTC)
 * The problem with this sentence, which you want to remain in the "Education" section, is 2 fold. First, the source that is currently referenced for this sentence is low quality, online opinion piece that is not-peer reviewed, plus the online site has advertising on its pages. A quick read through the archives of this talk page has revealed that articles from "Chiroaccess" are not allowed for these very reasons. Second, this sentence is not actually a finding by the source that it was referenced to, it is originally taken from a 1992 book published in the vanity press: "KURT BUTLER, A CONSUMER'S GUIDE TO "ALTERNATIVE MEDICINE": A CLOSE LOOK AT HOMEOPATHY, ACUPUNCTURE, FAITH-HEALING, AND OTHER UNCONVENTIONAL TREATMENTS 74 (1992)" and proper referencing should be of the original source (at least in any medium I have ever published in). However, rather than remove it entirely for reasons #1 and #2 described, I tried to remain NPOV and put it into a discussion of controversy regarding Chiropractic education. Puhlaa (talk) 06:26, 18 December 2010 (UTC)
 * I don't see how the proposal is an improvemnt to "Education, licensing, and regulation". For example, the last paragraph in the section should not be combined with the previous paragraph. It is confusing that way it was combined.QuackGuru (talk) 04:57, 18 December 2010 (UTC)
 * The proposed revision is an improvement because the 1) scattered ideas are grouped into meaningful paragraphs, 2) the section is 15% shorter, 3) the references to low quality sources have been removed and replaced with better sources, 4) other low quality and controversial sources have been moved to the appropriate section (controversies, eg: the sentence discussed immediately above). Lastly, I disagree with your claim that "the last paragraph in the section should not be combined with the previous paragraph", both paragraphs are with regard to regulation of the profession and the success of that regulation, the merged result follows a logical flow a) there are this many chiros b) regulated by these bodies c) this is why they need regulation d) this suggests that perhaps regulation is currently inadequate. Please explain how this is not a good and logical flow? Puhlaa (talk) 06:26, 18 December 2010 (UTC)


 * The controversy section is only for a WP:SUMMARY of another article. It is not meant as a place to move criticisms. Grouping different ideas into paragraphs is confusing to me. It will be more different to understand. Putting controversery into the controversy section does not summarise the lead of the controversy article. QuackGuru (talk) 18:23, 18 December 2010 (UTC)
 * The ideas that are grouped are similar ideas, not different ideas. Try reading it again. I have added the controversies paragraph to the section as per your objection to it being moved to the controversies section. Again, one of us is bending to try and reach consensus, it would be nice to see a reciprocal move?Puhlaa (talk) 19:37, 18 December 2010 (UTC)


 * See WP:SUMMARY: Basic technique
 * Longer articles are split into sections, each several good-sized paragraphs long. Subsectioning can increase this amount. Ideally many of those sections will eventually provide summaries of separate articles on the subtopic covered in that section (a Main article or similar link would be below the section title—see Main, Details,...) Each article on a subtopic is an encyclopedic article in its own right and contains its own lead section, which will be quite similar to the summary in its 'parent' article.
 * QuackGuru (talk) 18:48, 18 December 2010 (UTC)
 * QuackGuru (talk) 18:48, 18 December 2010 (UTC)


 * Proposed addition to controversies and criticism section
 * Education
 * Chiropractors often argue that their education is as good as or better than medical physicians', but it has been suggested that most chiropractic training is confined to classrooms, with much time spent learning theory, adjustment, and marketing. The most recent comparative study of the curriculum content of North American chiropractic and medical colleges concluded that with regard to basic and clinical sciences, medical and chiropractic programs are similar, both in the types of subjects offered and in the time allotted to each subject. However, medical school was found to far exceed chiropractic college in their students clinical practice training. The clinical education that chiropractic students receive has been criticised as often consisting of friends and family members, some of whom are even paid by interns to attend the clinics for care, not truly representative of patients seen by chiropractors in the field. Chiropractic curricula in the U.S. have also been criticized for failing to meet generally accepted standards of evidence-based medicine. Puhlaa (talk) 16:48, 17 December 2010 (UTC)


 * This won't work for a controversy section. The section is a summary from the lead of the main controversy article. QuackGuru (talk) 04:57, 18 December 2010 (UTC)
 * Putting the critical comments along with the counter arguements into the "Critisisms" section is a great way to produce a balanced article, and much better than simply deleting the critical sentences altogether. As discussed above, the first sentence should probably just be removed. But I dont mind having a balanced article that mentions these criticisms anyways, they just need to be in the appropriate section, ie, "Controversies and criticisms". It seems silly to have these types of back and forths between sources within the Education section, when we have a controversies section and this is a controversial topic. Puhlaa (talk) 06:26, 18 December 2010 (UTC)


 * These types of back and forths is how articles are written on Wikipedia. QuackGuru (talk) 18:23, 18 December 2010 (UTC)
 * I see. Then if it will bring us closer to consensus, I would be more than willing to move the paragraph on the controversies of DC education into the "Education" section along with the rest of my proposition for the section. The question would be, between what other 2 paragraphs of the 4 is it most appropriate to include a paragraph on controversies regarding DC education? Perhaps after the 3rd paragraph before the section shifts into a discussion of DC, their regulation and the inadequacies of regulation?Puhlaa (talk) 19:31, 18 December 2010 (UTC)


 * I did not propose the change you made. Here are some suggestions. Rather than you proposing a major rewrite you could propose a small change. Is there any new references you want to include that are reliable. Is there anything missing from the section you want to include. So far I don't like the proposed rearranging of text. QuackGuru (talk) 19:53, 18 December 2010 (UTC)

Yes, I propose 1) removing from current multiple locations and grouping together the references that are critical of DC education, and adding the opposing view (as I did in the proposed controversy paragraph). 2) I propose moving the discussion of WHO guidlines for curricula to the same paragraph as the mention of existing curricula (which I did). 3) I propose adding better references for the regulatory colleges (which I did). Otherwise, the only other change I made was joining the last 2 paragraphs, which both discuss DC regulation. Perhaps you should read it again?Puhlaa (talk) 20:06, 18 December 2010 (UTC)


 * I disagree with moving text from different locations into one paragraph. How are the references better. I disagreed with joining the last two paragraphs. The proposal is too confusing to me. QuackGuru (talk) 20:16, 18 December 2010 (UTC)
 * Ok, to avoid confusion with 'big' changes, I will start a new section dealing with Education, and we can discuss changes 1 at a time.Puhlaa (talk) 20:25, 18 December 2010 (UTC)
 * I don't see how to proposal is confusing at all. It seemed like a very good re-organization of the section. Previously we have had a consensus to spread the criticism throughout the article, rather than lump it all into one section in the article. However, now that we have a criticism section in the article, I have no problems with moving the critical content there. DigitalC (talk) 18:09, 22 December 2010 (UTC)
 * I would still be very much in in favour of using the re-organized, shortened and improved Education section as I proposed it.Puhlaa (talk) 18:28, 22 December 2010 (UTC)


 * We don't exactly have a criticism section for criticism. As previously explained, we have a WP:SUMMARY of the WP:LEAD of the Chiropractic controversy article.
 * I oppose the dis-organized, confusing Education proposal. I did, however, agree with the Proposed edits to "Education" take 2 when it was an improvement. QuackGuru (talk) 19:09, 22 December 2010 (UTC)

Proposed revision to Education, licensing and regulation section
Chiropractors obtain a first professional degree in the field of chiropractic. Accredited chiropractic programs in the U.S. require that applicants have 90 semester hours or three years of undergraduate education with a grade point average of at least 2.5 prior to starting chiropractic college; some programs now require a bachelor's degree. Canada requires a minimum three years of undergraduate education for applicants, followed by at least 4200 instructional hours of full-time chiropractic education for matriculation through an accredited chiropractic program. Since 2005, graduates of the Canadian Memorial Chiropractic College (CMCC) are formally recognized to have at least 7–8 years of university level education. Upon graduation, chiropractic students must pass national and/or state/provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required each year to renew these licenses. Specialty training is also available to chiropractors, available through part-time or full-time postgraduate residency programs such as chiropractic orthopedics, chiropractic clinical sciences, sports chiropractic, and radiology.

The World Health Organization (WHO) guidelines for chiropractic education suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. There are 18 accredited Doctor of Chiropractic programs in the U.S., 2 in Canada, 6 in Australasia, and 5 in Europe. All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges. Of the two chiropractic colleges in Canada, one is publicly funded (UQTR) and one is privately funded (CMCC). In 2005, CMCC was granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act, which sets the program within the hierarchy of education in Canada as comparable to that of other primary contact health care professions such as medicine, dentistry and optometry.

Chiropractors often argue that their education is as good as or better than medical physicians', but it has been suggested that most chiropractic training is confined to classrooms, with much time spent learning theory, adjustment, and marketing. The most recent comparative study of the curriculum content of North American chiropractic and medical colleges concluded that with regard to basic and clinical sciences, medical and chiropractic programs are similar, both in the types of subjects offered and in the time allotted to each subject. However, medical school was found to far exceed chiropractic college in their students clinical practice training. The clinical education that chiropractic students receive has been criticised as often consisting of friends and family members, some of whom are even paid by interns to attend the clinics for care, not truly representative of patients seen by chiropractors in the field. Chiropractic curricula in the U.S. have also been criticized for failing to meet generally accepted standards of evidence-based medicine.

In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE), in Canada they are accredited through the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB), while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK. It is the job of these councils to determine and to certify the achievement and maintenance of appropriate national standards of education for chiropractors in their respective nations. The accreditation councils in the U.S., Canada, Australia and Europe have also joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials standardized internationally.

There are an estimated 49,000 chiropractors in the U.S. (2008), 6,500 in Canada (2010), 2,500 in Australasia (2000), and 1,500 in the UK (2000). A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. To achieve this, regulatory colleges and chiropractic boards in the U.S., Canada, Mexico, the UK and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. 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). Puhlaa (talk) 19:37, 18 December 2010 (UTC)

Proposed edits to Risk-Benefit
I am hoping for other editors opinions on 2 things here: #1, I have included some published responsed from chiropractors to some of the Ernst articles to bring balance to this section, but it may need some editing. #2, I propose moving this entire paragraph to the "controversies and criticisms" section of the chiropractic article, as it is clearly not established fact, but rather controversial (evidenced by the fact that Ernst has written all the negative articles and chiropractors have written all the rebuttles). Comments/criticisms are welcome and appreciated. Puhlaa (talk) 22:38, 16 December 2010 (UTC) A 2010 systematic review found 26 reports of death following chiropractic manipulation since 1934 and concluded that "the risks of chiropractic neck manipulations by far outweigh their benefits." A 2007 systematic review found that with uncertain efficacy and definite risks, the risk-benefit balance of spinal manipulation can't be positive. A 2006 systematic review of systematic reviews found the risk-benefit balance does not favor spinal manipulation over other treatments like physical therapy. Chiropractors have criticized the quality of the studies which arrive at these conclusions. A 2008 study found that the best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible. A 2009 review evaluating maintenance chiropractic care stated that because spinal manipulation is routinely associated with considerable harm, and because no compelling evidence exists to indicate that chiropractic maintenance care can prevent symptoms or diseases, the risk-benefit balance is not in favour of chiropractic maintenance care. Puhlaa (talk) 17:11, 18 December 2010 (UTC)
 * Proposed revision of risk-benefit paragraph


 * COMMENTS
 * Ernst 2010 seems a better WP:MEDRS than the criticism. — Arthur Rubin  (talk) 23:19, 16 December 2010 (UTC)
 * Not sure if I understand what you mean? Ernst 2010 is more reliable than his previous critical works? or Ernst 2010 is more reliable than the opposition to his early critical works? Either way, what do you suggest I change to reflect this? I could move his 2010 review to the beginning of the paragraph? Puhlaa (talk) 23:29, 16 December 2010 (UTC)
 * I have moved the mention of 2010 Ernst review to the beginning of the paragraph as it is the most recent article that discusses risk-benefit, and in hopes of addressing Arthur Rubin's comment. Puhlaa (talk) 23:52, 16 December 2010 (UTC)
 * Puhlaa, this is the sensitive part of the article. WP:MEDRS describes a hierarchy of sources which make medical claims.  Per that guideline, we can't put a high-quality systematic review up against a lower quality criticism in a point-rebuke fashion.  I would, very much, like to find a way to include the Chiropractic response to these studies, in some way, per WP:NPOV if not per MEDRS.  I think the solution is to aggregate the criticisms at the end of the section in a shorter sentence.  Something as simple as, "Chiropractors have criticized the quality of the studies which arrive at these conclusions."  I can't see how NPOV doesn't give us room for that, at least. Ocaasi (talk) 16:55, 17 December 2010 (UTC)
 * I see what you are saying Ocaasi. My hope was that by moving this paragraph to the controversies section it would allow more 'leniency' with the whole MEDRS thing to allow balance between the 2 perspectives. This seems especially 'fair' as the Ernst articles also appear in the "Safety" section, which maintains strict MEDRS guidelines. Thus, the issue of safety and risk-benefit could appear 2x in the article, once under SAFETY (following strict MEDRS) and a second time under CONTROVERSIES (allowing for the chiropractors perspective to be included despite not being 100% consistent with MEDRS). Perhaps an alternative would be dropping this paragraph altogether, as the critical ERNST articles all appear under the topic of safety already, it is the risk-benefit issue that becomes controversial and I thought deserves some better balance. Puhlaa (talk) 17:04, 17 December 2010 (UTC)
 * There's the problem. The Ernst studies are not controversial by Wiki standards; they are reliable.  The response by Chiropractors is part of the controversy, relevant per NPOV but not reliable per MEDRS. So we have to either split them up (Ernst in the Risk-Benefit section and criticism in the Controversy section, or we have to clearly privilege the studies as the main point and only briefly mention the Chiropractic response afterward.  This is not how I'd like us to do things, but MEDRS requires it at the moment, and it's not wholly without reason. Ocaasi (talk) 17:21, 17 December 2010 (UTC)
 * Fair enough. I will move the mention of responses by DCs to the end of the paragraph and make it brief (now done and ready for inspection). Does this mean that the Risk-benefit paragraph should also not be moved to the controversies section? If not to bring up controversy then this paragraph seems redundant, as the 4 reviews by Ernst are already presented in the safety section? Puhlaa (talk) 17:39, 17 December 2010 (UTC)
 * "Chiropractors have criticized the quality of the studies which arrive at these conclusions? Chiropractors have not criticized the quality of all the studies in the risk-benefit section. See WP:OR. This is a WP:WEIGHT violation to use the minority view. QuackGuru (talk) 19:06, 17 December 2010 (UTC)
 * In part, fair enough. I have added additional detail to the sentence "Chiropractors have criticized the quality of some of the studies which arrive at these conclusions", but I feel it is important to provide some kind of indication that the critical reviews (all written by one author) are not the only view on the subject. Puhlaa (talk) 19:48, 17 December 2010 (UTC)
 * I think it's a misreading of Weight to take it as saying minority views don't get any mention. They just don't get as much.  Weight is not binary.  Ocaasi (talk) 21:49, 17 December 2010 (UTC)


 * See WP:WEIGHT: Wikipedia should not present a dispute as if a view held by a small minority deserved as much attention overall as the majority view. Views that are held by a tiny minority should not be represented except in articles devoted to those views. To give undue weight to the view of a significant minority, or to include that of a tiny minority, might be misleading as to the shape of the dispute. Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject. This applies not only to article text, but to images, wikilinks, external links, categories, and all other material as well.
 * If you want to include the chiropractic tiny minority view then an editor would have to start a new article created specfically for the Chiropractor's view. I will support a new article devoted to the minority view. QuackGuru (talk) 04:39, 18 December 2010 (UTC)
 * I disagree that the criticism of Ernst reviews by chiropractors is the 'tiny minority view' as you put it QG. The cricisms of his articles has been done via published letters to the editor, which is considered a form of post-publication peer-review. ("Wikipedia articles should be based on reliable, published sources, making sure that all majority and significant minority views that have appeared in reliable, published sources are covered") I fail to see how a letter to the editor is not a significant minority view at least, clearly the editor of these two well respected journals thought these criticisms of Ernst' work were worth publishing. Further QG, I have already diminished their size from my original inclusion, and then moved them to the end of the paragraph, and then indicated it was only a criticism of SOME of Ernst' critical works. When is it exactly that YOU bend a little to meet other editors half way to achieve concensus? Puhlaa (talk) 06:35, 18 December 2010 (UTC)

Weight requires we present disputes in proportion to their representation in reliable sources. NPOV more generally encourages that we, with appropriate contextualization and coverage, present both sides to situations. The offer here is not, as you put it, to characterize the chiropractic response as equal, merely to mention the chiropractic response at all. If you think we need a separate article for that, then I think we have a bigger problem with applying MEDRS and Weight, neither of which should keep out of an article on Chiropractic what Chiropractors think of the evaluation of their field. Ocaasi (talk) 09:21, 18 December 2010 (UTC)
 * The editor of the international journal of clinical practice has just found it reasonable to publish 4 rebuttles to Ernst' 2010 review of "Deaths after Chiropractic" in the Jan 2010 issue. I would be happy to email full texts to anyone who does not have access to them. Now that there are criticisms of 3 of 4 works of Ernst, plus a review that finds a different outcome, the idea that the outcomes he presents seems even less "tiny and insignificant". I have modified the proposed risk-benefit paragraph accordingly for other editos to review. You will note that I still put Ernst work primary, with the opposing critiques and outcomes secondary to appease those who still consider them as only significant minority views. The analysis of maintenance care is a somewhat different topic so it alone concludes the paragraph. Puhlaa (talk) 17:11, 18 December 2010 (UTC)


 * Only chiropractors are complaining about the research. This is not new. Chiropractors have a history of anti-science beliefs.
 * Ernst 2010 seems a better WP:MEDRS than the criticism. — Arthur Rubin  (talk) 23:19, 16 December 2010 (UTC)
 * I'm not the only person who has questioned the original proposal. QuackGuru (talk) 18:23, 18 December 2010 (UTC)
 * I have qualified in the paragraph that it is DCs that are criticising the work of Ernst, however, if the editor of a high quality journal such as Int J clin prac feels the criticisms are worth publishing in the journal, clearly they deserve mention in the wikipedia article. In addition, QG, It seems from a look at the history of this talk that Arthur rubin is not who posted the statement above yours, is it appropriate to fake a post from another editor? Puhlaa (talk) 18:31, 18 December 2010 (UTC)


 * Another editor wrote Ernst 2010 seems a better WP:MEDRS than the criticism. — Arthur Rubin  (talk) 23:19, 16 December 2010 (UTC) It seems that Arthur Rubin disagrees with the original proposal.
 * The original proposed changes to risk-benefit was modified to address Arthur rubins concern and to attempt to reach consensus. You have editorialized his original comment to support a claim that he objects to the paragraph after it was modified as well. You seem to have a very unethical and disrespectful approach to working together for consensus. Puhlaa (talk) 19:07, 18 December 2010 (UTC)


 * The original proposal was changed but it seems Arthir Rubin questioned the reliability of the sources when he wrote "Ernst 2010 seems a better WP:MEDRS than the criticism". The unreliable sources are the problem according to MEDRS. QuackGuru (talk) 19:30, 18 December 2010 (UTC)


 * You have included the fringe minority view but not the response from Ernst.
 * This recent edit added a 2008 study. The study may not meet MEDRS. QuackGuru (talk) 18:44, 18 December 2010 (UTC)
 * I am amazed how no study that contradicts your view ever seems to meet MEDRS in your opinion. The 2008 paper is recent, review in peer reviewed journal. It can stay.
 * I did not include Ernst' response to the criticism because to do so would require expanding on the criticism of his work (eg: He reported this, DCs claim its biased because..., Ernst refutes the claims because...). You objected to expanding the detail of the criticisms, so instead, the "majority view" is held by his papers and the "significant minority view" is held by the criticisms in the paragraph.Puhlaa (talk) 18:55, 18 December 2010 (UTC)


 * How did you determine the 2008 study is a systematic review or review. How does the study meet MEDRS according to MEDRS guidelines.
 * I did not say it was systematic review, only that it was a review, very recently (2008) published in a peer-reviewed journal that is indexed on "Index Medicus" (thus reputable). As per MEDRS "Ideal sources for these aspects include general or systematic reviews in reputable medical journals; professional and academic books written by experts in a field and from a respected publisher; and medical guidelines or position statements from nationally or internationally reputable expert bodies." Puhlaa (talk) 19:17, 18 December 2010 (UTC)
 * Lots of sources are indexed. Where did it say the source is a general review. QuackGuru (talk) 19:30, 18 December 2010 (UTC)


 * I objected to including the fringe point of view and now you want to exclude the response. Seems kind of one sided. If we are to include anything we should only include the response from Ernst and exclude the tiny minority view from chiropractors. QuackGuru (talk) 19:04, 18 December 2010 (UTC)
 * I have already addressed why I didnt include Ernst reply, however, if you are bothered that only his primary source gets mention I would be happy to include a sentence that reads something like "Ernst objects to the DCs objection" if it will prevent further stonewalling on your part and move us closer to consensus! Puhlaa (talk) 19:17, 18 December 2010 (UTC)


 * You wrote "Ernst objects to the DCs objection". Please provide the text from the source to verify the claim. I strongly object to including the fringe point of view from the chiropractic community. The sources with critiques from chiropractors are unreliable per MEDRS and the chiropractic minor view is against WEIGHT. QuackGuru (talk) 19:30, 18 December 2010 (UTC)
 * You are failing to understand that a response by DC to Ernst' review, that has been deemed publishable by the editor of the journal, is not unreliable, it is a post-publication peer review, and it one way that scientists evaluate the literature once it is published, by examining the responses of other scientists that the journal editors sees as valid arguements and decides to publish. Thus, it becomes a significant minority view. Your opinion that they are fringe and insignificant does not outweigh the opinion of the editor of a peer-reviewed journal that they are significant enough to warrant publishing. The appearance of the DC criticisms has been reduced to a mere mention and has been diminished as much as possible while still allowing the fact that opposing perspectives exist to be revealed. Puhlaa (talk) 19:56, 18 December 2010 (UTC)


 * You wrote "Ernst objects to the DCs objection". I previously asked you to provide the text from the source to verify the claim.
 * You wrote "Chiropractors have criticized the quality of the studies which arrive at these conclusions". All three sources criticized the quality of all those studies? Using three different sources to come to the same conclusion against the studies is SYN. Chiropractic criticisms is the definition of the fringe view according to WEIGHT. QuackGuru (talk) 20:16, 18 December 2010 (UTC)

Originally I had the respective criticism mentioned and cited behind each respective Ernst article, however, it was objected to by other editors, as the DC responses are only a significant minority view, not a majority view. Thus, the 3 references, 1 for each of Ernst papers are grouped together and minimmized. However, I further minimized the responses by clumping the 4 responses to his 2010 review as one citation. Thus, the 6 responses to Ernst' 3 papers have all been clumped, minimized and not described explicitly. It is your turn to help us achieve consensus by doing a little "bending" on your part. It is reasonable to indicate that published objections to Ernst articles exist, it is unreasonable to stonewall every attempt at making the section NPOV. I will quote Ocaasi's earlier statement to remind you "NPOV more generally encourages that we, with appropriate contextualization and coverage, present both sides to situations. The offer here is not, as you put it, to characterize the chiropractic response as equal, merely to mention the chiropractic response at all." I have provided some quotes of the criticisms of Ernst work below Puhlaa (talk) 20:13, 20 December 2010 (UTC)

Responses to Ernst reviews as per request for WP:V
QG, hopefully this is what you meant when you asked for WP:V. I have only quoted the conclusions for each, if you want full text I will require an email address I guess? “Indeed, this recent review included four `reviews of reviews' by the main author; this in itself would surely perpetuate any author bias, whether intentional or not.” And “At the end of the day, no matter how robust the methodology of a critical review, the authors are inclined to their own bias: to conduct a review of reviews of one's own opinions, adds little to a meaningful literature base.” ''Lewis BJ, Carruthers G. 2006. Systematic review of spinal manipulation: A biased report. J R Soc Med. Volume 99, Issue 6, Page 278. '' “Given the number of cervical spine manipulations done worldwide it is likely, even if under-reporting is as high as Professor Ernst suggests, that the level of risk of a serious adverse event is extremely low. To turn Professor Ernst's point on under-reporting and publication bias around, could it be that journals of medicine are unlikely to publish findings which might be considered ‘positive’? Good evidence on safety is of paramount importance; what we have here is poor quality evidence and unsubstantiated claims masquerading as a systematic review.” ''Bolton J and Thiel H. 2007. Adverse effects of spinal manipulation. J R Soc Med. Volume 100, Issue 10, page 446.'' “We found that in three separate cases, Ernst incorrectly assigned the care associated with death to a chiropractor. It is interesting that all three of the errors that Ernst made, in assigning professional identity, were errors that increased the apparent association between chiropractors and death.” ''Wenban A. B., Bennett M. 2011. Critique of review of deaths after chiropractic, 1. International Journal of Clinical Practice. Volume 65, Issue 1, page 102.''
 * Response to Ernst 2006, systematic review of SRs:
 * Response to Ernst 2007, Adverse effects of spinal manipulation:
 * Responses to 2010 Ernst review, Deaths after Chiro:

“The design of his research allows him to ignore these data and avoid an ‘inconvenient truth’ behind his argument –the fact being that the most comprehensive research on the subject has found no evidence of excess risk of vertebrobasilar artery (VBA) stroke associated with chiropractic care.” ''Poelsma C., Owen D. 2011. Critique of review of deaths after chiropractic, 2. International Journal of Clinical Practice. Volume 65, Issue 1, page 103.''

“We question the objectivity of research that does not follow its stated purpose, obtains information from non-public sources and mischaracterises this information, misquotes sources, ignores the best evidence on causation contrary to author views, and ignores high quality systematic reviews that clearly contradict review conclusions.” ''Perle S. M., French S., Haas M. 2011. Critique of review of deaths after chiropractic, 4. International Journal of Clinical Practice. Volume 65, Issue 1, page 104. ''

“Although the author described the study as a systematic review, it clearly did not meet standards recommended by The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (2). According to our review, the study met only two of the 27 PRISMA checklist items. The article is best described as a case series and although a case series is of value for generating hypotheses, it is not usually used for drawing conclusions about the efficacy or risks associated with an intervention. Ernst stated that spinal manipulation performed by chiropractors is less safe than that performed by other professionals and in support of this argument, he cited a study conducted by Terrett (4) that reported 17 deaths associated with chiropractic spinal manipulation and 13 deaths associated with spinal manipulation performed by other types of providers. However, because 90–95% of spinal manipulation is performed by chiropractors and 43% of the deaths reported in this study were caused by procedures performed by non-chiropractors, it appears as though chiropractors actually perform this procedure more safely than other professionals.” ''Whedon J. M., Bove G. M., Davis M. A. 2011. Critique of review of deaths after chiropractic, 5. International Journal of Clinical Practice. Volume 65, Issue 1, page 105'' — Preceding unsigned comment added by Puhlaa (talk • contribs) 19:24, 20 December 2010 (UTC)


 * You have not shown how a guideline recommendation is equal to the other sources in the long back pain section. It is obvious that this particular section should be trimmed and this controversial change should be reverted. If you continue to insist the DC critism is notable then I will add it myself as soon as this is resolved as a token of good faith. We can't include all the fringe views. Which one do you think is most notable. Do you think the response by Ernst is notable. QuackGuru (talk) 20:45, 20 December 2010 (UTC)
 * I do not need to show how guidelines are equal to the other sources. I have already explained that MEDASSESS does not limit us to using only systematic reviews, it asks that we consider the strength of the source and give appropriate weight. I have already shown you that the guidelines are a secondary source as per MEDRS, thus among the highest level of evidence. Would you like me to paste the exact wording from MEDRS again as I have already? Your statement "I will add it myself as soon as" suggests you dont want anyone else touching this article? Instead, I would be happy to comment on a proposal to include the minor but significant views of DCs, plus Ernst response, if you post one here in talk as I have courteously done for you. However, in the proposal that I have posted here, I have already reduced the weight of those minor but significant views a fair bit, I wonder how you could diminish them further without removing them? Perhaps I could merge the 7 references into a single citation so that after the statement "DC have criticised..." there is only one citation and it thus doesnt appear to get too much weight? Puhlaa (talk) 21:15, 20 December 2010 (UTC)


 * Per MEDASSESS In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, (e.g., conventional wisdom).
 * You do need to show how guidelines are equal to the other sources beucase we have a lot more higher quality sources presented. According to MEDASSESS, rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence.
 * "A 2010 systematic review determined that there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition and thus concluded, "the risks of chiropractic neck manipulations by far outweigh their benefits."[26]"
 * The systematic review in the risk benefit section is specifically about risk-benefit. Do you have a DC criticism of the risk-benefit.
 * Your proposal is vague, combines different conclusions together to come to a new conclusion and does not explain anything specific criticisms. If it was a specific DC criticism such as a DC criticism of the risk-benefit and a response by Ernst it might work.
 * We should choose only one reference to avoid a WEIGHT violation. Which CD criticism do you think is notable. QuackGuru (talk) 21:45, 20 December 2010 (UTC)
 * Perhaps instead I could merge the 7 references into a single citation so that after the statement "DCs have criticised..." there is only one citation and it thus doesnt appear to get too much weight? All the letters are to 2 journals, so I could combine all 7 into 1 citation.Puhlaa (talk) 21:55, 20 December 2010 (UTC)
 * Perhaps you could only choose the most notable source per MEDRS. QuackGuru (talk) 22:00, 20 December 2010 (UTC)
 * Sure, I would retain the most recent (2010), as it is most relevant per MEDRS. However, do we then need to move the mention of DCs criticism to immediately following the mention of the 2010 review? Do you want specific mention of the criticism? (“DCs question the objectivity of research that does not follow its stated purpose, obtains information from non-public sources and mischaracterises this information, misquotes sources, ignores the best evidence on causation contrary to author views, and ignores high quality systematic reviews that clearly contradict review conclusions.”)? This would give much more weight to the opposing view than a generic mention of DCs criticism as it currently exists in the proposal ("DCs question the quality of...").

Here is an interesting quote from Ernst response: "The authors criticise me for not evaluating the potential benefits of chiropractic. This detail was not the subject of my review"...so how does we use his article to make claims of risk-benefit? Anyways...I digress Puhlaa (talk) 22:28, 20 December 2010 (UTC)


 * We would only use this ref but limit the weight of the DC criticism. For the DC criticism we can limit it to rewriting the following quote. "The authors criticise me for not evaluating the potential benefits of chiropractic." This part can be rewritten without quotes and then we can include the specific response by Ernst. The mainstream view usually has more WEIGHT. All the other references do not meet MEDRS. Only this ref might possibly meet MEDRS. QuackGuru (talk) 02:30, 21 December 2010 (UTC)
 * A 2010 systematic review determined that there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition and thus concluded, "the risks of chiropractic neck manipulations by far outweigh their benefits."[26] "The authors criticise me for not evaluating the potential benefits of chiropractic." The rewritten sentence can go right after the first sentence as long as DUE WEIGHT is given to the response by Ernst. Things would move a lot faster if you just edit the article. I'm busy and I want to move on. If you can't think of a rewrite just add the quotes for now and I can rewrite it and format the ref too. QuackGuru (talk) 02:40, 21 December 2010 (UTC)


 * I previously explained we would only use one reliable reference that met MEDRS. This change using more than one reference was against consensus for including the fringe view using the unreliable reference. Puhlaa agreed to only use one reliable reference. I also disagree with the changes to the first sentence of risk-benefit. I don't see any agreement for all the changes. The meaning of the first sentence was changed and the text was taken out of context from the source. QuackGuru (talk) 19:29, 21 December 2010 (UTC)
 * You asked me to modify the article, I did so, using one criticism and Ernst's response. You wanted to hurry up and told me to choose and add one notable source and give due weight to Ernsts response. I did so. I am happy to comment on a proposal from you to replace the current edit. I am also happy to take alot of time and move very slow and make sure we get this exactly right.Puhlaa (talk) 20:31, 21 December 2010 (UTC)
 * You did not use only one ref as agreed. I did not ask you to modify the article using two references. You also changed the first sentence without consensus. QuackGuru (talk) 20:40, 21 December 2010 (UTC)
 * I did only use one reference as agreed, the other reference is not a criticism, it is Ernst response to said criticism. You said you wanted Ernst response to be given due weight so I included the response. Feel free to edit my edit and we can discuss your proposal. Heck, I would have been happy with just a generic mention that DCs criticise the reviews, you are the one who wanted to expand it to detail some of what they criticise.
 * I guess our next 'debate' is going to have to be the change to the first sentence, the summary of the 2010 review, is important as it puts the findings in context. As it was, the text said that the 2010 review found no benefit from spinal manipulation, however, the author admits himself that the review did not examine the benefits. Thus, the original sentence incorrectly attributed the examination of benefits of chiropractic to this review. I am happy to quote the conclusion "the benefits outweigh the risks" but I am not ok with attributing the statement "the review found no benefits" to this review when clearly this review did not examine the benefits of manipulation. This is stated in the Authors own words as per the response to the chiropractors "The authors criticise me for not evaluating the potential benefits of chiropractic. This detail was not the subject of my review".Puhlaa (talk) 20:59, 21 December 2010 (UTC)


 * You did agree to use only one reference but you clearly added two. I previously disputed the reference you added. You have taken the text from the source out of context. QuackGuru (talk) 21:16, 21 December 2010 (UTC)
 * I only added one critical reference, if you dont want 2 references added then I can remove the response from Ernst, but you originally asked for its inclusion. I think it is you who has taken the text from the source out of context, however, I would be happy to hear your reasoning and re-evaluate my interpretation. Puhlaa (talk) 21:41, 21 December 2010 (UTC)


 * I did not agree to adding any of the lower quality sources. I only agreed to including the reliable reference which does review the previous references. You originally agreed to include only one reference. You clearly indicated above that you added two references. You have not properly explained how I took the source out of context. You did not specifically complain about the text from the source when we were discussing the other changes. QuackGuru (talk) 21:53, 21 December 2010 (UTC)


 * You can clearly see from the proposed revisions to risk-benefit I made available in talk above that I had modified the first sentence to risk-benefits. The fact that you objected to other changes in the proposed paragraph but did not object to the proposed changes to the first sentence which I made clearly available, implied that you did not object to the changes in the first sentence.
 * Further, I have already stated that I would be happy to discuss the changes and consider your reasoning and re-evaluate my interpration to try to achieve consensus. Instead of helping the situation by opening dialogue with regard to your objections to those changes, you instead post another repetitive statement about how you didnt agree with the changes, which I already acknowledged. At what point will you decide to converse rather than just repeat yourself?
 * As an early attempt to compromise, what if I leave the first sentence as I have edited it currently, but remove the reference regarding criticisms of Ernsts work, leaving only the reference for Ernsts response? Puhlaa (talk) 22:50, 21 December 2010 (UTC)


 * We would only use this ref but limit the weight of the DC criticism. For the DC criticism we can limit it to rewriting the following quote. "The authors criticise me for not evaluating the potential benefits of chiropractic." This part can be rewritten without quotes and then we can include the specific response by Ernst. The mainstream view usually has more WEIGHT. All the other references do not meet MEDRS. Only this ref might possibly meet MEDRS.
 * A 2010 systematic review determined that there is no good evidence to assume that manipulation to the neck is an effective treatment for any condition and thus concluded, "the risks of chiropractic neck manipulations by far outweigh their benefits.[26 The authors criticise me for not evaluating the potential benefits of chiropractic." When this sentence is rewritten it can go right after the first sentence as long as DUE WEIGHT is given to the response by Ersnt. Things would move a lot faster if you just edit the article. I'm busy and I want to move on. If you can't think of a rewrite just add the quotes for now and I can rewrite it and format the ref too.''
 * My previous comment was for keeping the first sentence as is and giving due weight for the response while only using one ref. It seems you have taken the source out of context when I previously disagreed based on my proposal. What if you tried to collaborate with others and at least remove the unreliable reference and restore the first sentence. Also, you still have not shown how a guideline meets MEDASSESS when the low back pain section is littered with systematic review after systematic review. QuackGuru (talk) 00:22, 22 December 2010 (UTC)
 * It seems the text you added did not included the response by Ernst and actually misquoted Ernst. That is not how to write neutral text according to WP:NPOV.
 * Edzard Ernst stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors accross the world."[163] This is the response by Ernst in accordance with WP:WEIGHT. I checked my messages. I did have a copy of the source. As previously explained, you taken the source out of context. It was a possible WP:BLP violation to misquote a living person. See BLP: "Editors must take particular care when adding information about living persons to any Wikipedia page. Such material requires a high degree of sensitivity, and must adhere strictly to all applicable laws in the United States, to this policy, and to Wikipedia's three core content policies: Neutral point of view (NPOV), Verifiability (V) and No original research (NOR)." QuackGuru (talk) 01:40, 22 December 2010 (UTC)

I have left your edit to risk-benefit but have removed your controversial changes to low back pain. I hope you will take this as a sign of good faith. Puhlaa (talk) 03:48, 22 December 2010 (UTC)
 * The second half of the Ernst response has nothing to do with risk-benefit, only bashing chiropractic, it has nothing to do with the criticism of his reviews by DCs that he has not evaluated the benefits, which he admits to. The article could stay NPOV without it.Puhlaa (talk) 04:15, 22 December 2010 (UTC)
 * You agreed to including the response by Ernst which is relevant. We should not misquote Ernst and leave out the however part per BLP and WEIGHT. Ersnt did, however, refer to such evaluations. QuackGuru (talk) 04:27, 22 December 2010 (UTC)

A guideline is a lower quality source according to MEDASSESS
Per WP:MEDASSESS: In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, (e.g., conventional wisdom).

Editors do need to show how the recenty added guidelines are equal to the other sources because there are a lot more higher quality sources presented. According to MEDASSESS, rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence.


 * Review of guidelines.


 * The original guidelines.

There are two similar references being used in the low back pain section. There is a guideline and the review of the guidelines. A guideline is a lower-quality reference than the review of the guidelines. The low back pain section is too long and I think it can be shortened a bit. See under Chiropractic. For now, I think it would be better to at least remove the recently added guideline reccomendations because it is a weaker source. There is no extra room to use weaker sources when there is a currently two Cochrane reviews and a mix of recent state of the art systematic reviews summarised in low back pain. QuackGuru (talk) 21:21, 21 December 2010 (UTC)


 * The review is not a review of the guidelines as has been suggested. The review was a systematic review of the existing literature, and was performed first by the American Pain Society/American College of Physicians. Secondary to the publication of the review, the American Pain Society/American College of Physicians published a set of guidelines for physicians, for the "Diagnosis and treatment of low back pain".


 * As per WP:MEDRS: "A secondary source in medicine summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic, to make recommendations or to combine the results of several studies. Examples include the literature reviews and systematic reviews found in medical journals; specialist professional or academic books; and position statements or medical guidelines published by major health organizations."


 * As the guidelines meet MEDRS and in addition, bring context to the paragraph which the many systematic reviews in the paragraph alone do not bring, it is important to retain them in the section. If there is a problem with no extra room, then there are older references in the paragraph which could be removed, as their findings will have been covered in the newer reviews. As per WP:MEDASSESS: "Look for reviews published in the last five years or so, preferably in the last two or three years." AND "If recent reviews don't mention an older primary source, the older source is dubious.". Perhaps the older (2006) systematic reviews should be looked at for removal before discussion of removing newer secondary sources such as the 2007 guidelines by the American Pain Society/American College of Physicians? The Murphy et al 2006 reference is summarized twice in the paragraph and it is older than the 2007 guidelines, also, the Ernst 2006 reference is the oldest sytematic review and older than the guidelines. These 2 references should both be summarized in the newer systematic reviews thus add little to the paragraph and can be removed if we need to reduce the size of the paragraph.


 * As the guidelines are currently the only reference included in the paragraph which bring any context to the findings of the many reviews, it is important to retain them. As they are considered a secondary source as per MEDRS and are up-to-date evidence as per MEDRS, no valid reason has been provided for why they should be discarded in favour of older reviews such as Murphy 2006 or Ernst 2006.Puhlaa (talk) 22:37, 21 December 2010 (UTC)


 * Murphy 2006 gives context to the low back pain section such as explaining there is continuing conflict of opinion on the efficacy of SMT for nonspecific low back pain and methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability. If there is a newer source that summarises this point Murphy 2006 makes we can use a newer source. As for the 2006 Ersnt review, I thought you previously agreed to keep it in the low back pain section. Ernst 2006 is not a typical systematic review. It is actually a systemtic review of systematic reviews. It is of higher quality than even regular systematic reviews. The systemtic review of systematic reviews summarises, among other reviews, the 2004 Cochrane review. I proposed we just remove the guidelines for the time being but we have to look at both 2007 sources that are not systematic review per MEDASSESS. See MEDASSESS. QuackGuru (talk) 00:47, 22 December 2010 (UTC)


 * I agreed to keep the 2006 references and leave the section long, but I am not in favour of removing newer, high quality secondary sources so that older secondary sources can stay. If the section needs to be made shorter then older sources should be the first to go. The guidelines give context to the section and are newer than the Murphy reference and are from a more reputable medical body (American Pain Society/American College of Physicians), thus the guidelines can replace Murphy. Ernst is the oldest systematic review in the section, so if the section still needs to be shorter after removing Murphy 2006 then Ernst 2006 should be next to go as the new Cochrane 2010 and Spine Journal 2010 systematic reviews will mention the data from the older Ernst review.Puhlaa (talk) 03:56, 22 December 2010 (UTC)


 * This is not how to write encyclopedic text using quotes. I'm trying to remove all quotes from the section and remove lower quality sources. There is a discussion for other editors to evaluate this source. You have not explained how this source meets MEDASSES when there are 2 Cochrane reviews, recent systematic reviews, and even a very high quality 2006 systematic review of systematic reviews. A consensus has not formed with the disputed text in quotes from the guidelines recommendations. See Wikipedia talk:WikiProject Medicine. QuackGuru (talk) 05:13, 22 December 2010 (UTC)

I am in agreement with your wishes to remove all quotes. I would be happy to remove the quotes and simply summarize the recommendations.Puhlaa (talk) 05:56, 22 December 2010 (UTC)
 * I slightly tweaked the text to be a bit closer to the source. According to this comment the two sources are completely unrelated. So I removed the connection of the two sources. Each sentence is now independant. QuackGuru (talk) 07:28, 22 December 2010 (UTC)

Low level details to low back pain
The low level details from Murphy 2006 are unnecessary. The section need to be trimmed not continue to be expanded. QuackGuru (talk) 03:51, 22 December 2010 (UTC)
 * Shortening is fine, however, I was recently informed by you that misquoting the author is not the appropriate way of maintaining NPOV so I highly recommend that you dont shorten it by removing the second half of the sentence as it changes the meaning.Puhlaa (talk) 03:59, 22 December 2010 (UTC)
 * I don't think there was any significant change to the text. I want to trim the section and you want to trim the Cochrane review and continue to expand the low pack pain section. QuackGuru (talk) 04:02, 22 December 2010 (UTC)
 * There was significant change, he original "trimming" of the murphy quote made it sound like the general use of SM was controversial, not just that when it should be applied was controversial. The controversy is not about IF SM should be used for LBP but rather WHEN it should be used. The 2007 guidelines by the American Pain Society and American College of Physicians answer the question so Murphy is not even necessary. The 2007 guidelines say SM should be considered after self-care has failed.Puhlaa (talk) 04:07, 22 December 2010 (UTC)
 * CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.
 * According to the conclusion the shorter version is sourced and accurate. I don't see a reason to continue to expand and clutter the low back pain section. QuackGuru (talk) 04:14, 22 December 2010 (UTC)
 * The shorter version misrepresented, and you know it. Adding 7 words does not make the section excessively long. I did not change what was written there, I only added the remaining 7 words of the sentence that were conveniently left off. I am happy to leave the section as it is. Any deletions are obviously controversial and should be discussed on talk first. If we cannot find consensus I am happy to work up the chain of conflict resolution. Puhlaa (talk) 04:20, 22 December 2010 (UTC)
 * The conclusion did not support your recent controversial change. The shorter version represents the conclusion. QuackGuru (talk) 04:24, 22 December 2010 (UTC)

The shorter version was a gross misrepresentation by saying there is was controversy over the efficacy of spinal manipulation. There is no controversy over the efficacy, and Murphy certainly doesnt say that. All systematic reviews from 2006 on indicate that SM is equal or better than other therapies (most say equal, one says better). The inconsistencies in the guidelines according to Murphy are with regard to WHEN to apply SM. Regardless, Murphy should be removed altogether to appease your complaint about the section being too long. I will not remove it though until there is consensus, as it is controversial. Further, I am not interested in listening to you repeat yourself. If you have nothing new to say, and cant work with other editors on this and the above controversy regarding the low back pain section then I submit that we need conflict resolution.Puhlaa (talk) 04:33, 22 December 2010 (UTC)
 * You are right on one thing...my edit too Murphy was too long and is repetitive. Although I think Murphy should be removed to shorten the section (as per your concerns) I propose that until this is settled the Murphy reference text read:

"Specific treatment recommendations with regard to spinal manipulation for nonspecific LBP remain inconclusive." This is a direct summary of the first sentence of the conclusions. What is your opinion?Puhlaa (talk) 04:40, 22 December 2010 (UTC)
 * This is better than the longer WP:Bold changes version. QuackGuru (talk) 05:19, 22 December 2010 (UTC)

Recent change from causality to cause
The words do have different meaning and thus modified the meaning of the sentence. QuackGuru (talk) 08:37, 22 December 2010 (UTC)

I restored the wording that is explicitly used in the source per NPOV. QuackGuru (talk) 04:44, 23 December 2010 (UTC)
 * Could you explain the difference in meaning? We should avoid jargon where it is not necessary for precision.  What is the difference between 'cause' and 'causality' in this case?


 * Per prior posts, I would request that you change the title of this section, so that your conclusion is not announced in the place where we can discuss whether or not it is correct. Perhaps, 'Change from causality to cause?'  Ocaasi (talk) 05:04, 23 December 2010 (UTC)


 * In this case the term 'causality' is the relationship between chiropractic neck manipulation and the 'effect' of vascular accidents.
 * The word 'cause' claims it is the source of vascular accidents when there is only a relation with neck manipulation and the after effect. It not about a cause. It is about the 'relation' with the cause and the effect. It is the association with a relationship with manipulation of the neck and vertebrobasilar artery stroke or death. QuackGuru (talk) 05:51, 23 December 2010 (UTC)


 * Thank you for changing the header. I am wondering whether the current phrasing is accurate, actually.  I'll use your definition and 'plug it in'.
 * The current version: The dissection of a vertebral artery, typically associated with neck manipulation beyond the normal range of motion, is a possible causality.
 * The current version with your definition of causality: The dissection of a vertebral artery, typically associated with neck manipulation beyond the normal range of motion, is a possible relationship between chiropractic neck manipulation and the 'effect' of vascular accidents.
 * The current version with your definition of cause: The dissection of a vertebral artery, typically associated with neck manipulation beyond the normal range of motion, is a possible source of vascular accidents.
 * Does that still look right to you?. Ocaasi (talk) 06:06, 23 December 2010 (UTC)


 * I think this change simplified the sentence. The part 'dissection of a vertebral artery' was a bit technical. QuackGuru (talk) 06:18, 23 December 2010 (UTC)
 * I actually didn't mind that part, since it was specific. Is 'vascular accidents' a meaningful term to include dissection, as well?  Is there anything that happens to damage the VA that isn't a dissection? Ocaasi (talk) 06:22, 23 December 2010 (UTC)


 * Both have similar meanings but vascular accidents is more specific to spinal manipulation and is not the technical wording.
 * "In medical pathology, dissection (or dissecting aneurysm) refers to a tear within the wall of a blood vessel, which allows blood to separate the wall layers, creating a pseudoaneurysm." Here is a definiton of dissection. I'm not the expert on what else could happen to damage the VA. QuackGuru (talk) 06:39, 23 December 2010 (UTC)
 * I posted at project medicine about cause/causality. Editors seemed to prefer 'cause' in this case. Ocaasi (talk) 07:21, 23 December 2010 (UTC)
 * The word 'cause' is sourced? The source does explain about the causality between chiropractic intervention and arterial dissection. QuackGuru (talk) 08:00, 23 December 2010 (UTC)
 * I have read the source. I would request you refrain from commenting on my perceived but unseen behavior.  Verifiability is not a requirement for copying (in fact, without quotations it is advised against).  We are still encyclopedia writers and we make word choices to present sources in a way that makes sense.  This is not a violation of policy, it's just writing.  The source explains the causality, and I am not disputing that.  I am disputing our current usage of 'causality' which is not the best word choice in context.  We could rephrase it so that 'causality' is used, but the words we use have to fit the article as well as the source.  Do you think that 'cause' is some ploy to weaken to claim?  Cause seems just as clear, in fact more clear, that there is a suspected connection. Ocaasi (talk) 08:07, 23 December 2010 (UTC)
 * I think the word 'cause' is stronger than the wording used in the source. The source says the 'causality' between chiropractic intervention and arterial dissection is not proven but is at least likely. So when you claim it is a 'possible cause' it seems to be stronger than the source because a 'possible causality' explains there is a 'possible relationship or connection'. QuackGuru (talk) 08:26, 23 December 2010 (UTC)
 * Yes, the source's use of causality makes sense; ours does not. We aren't saying that 'the causality is not proven but at least likely'.  We are saying that 'vascular accidents... are a possible causality'.  That literally doesn't make sense.  Just using the same words does not guarantee that we are constructing a grammatically precise sentence.  In this case only two options are internally consistent:  to use 'causality is...likely', or, 'vascular accidents... are a possible cause'.  Either one is logical.  Either one is sufficiently supported by the source, in my opinion.  But the mix of the two, saying that 'vascular accidents... are a possible causality' is actually incorrect, not because of V, but because of English syntax.  If you require the phrase 'causality' be used, then I think we must choose the 'causality is...likely' phrasing. Ocaasi (talk) 09:02, 23 December 2010 (UTC)
 * I think this edit is closer to the source and fixes the English syntax. QuackGuru (talk) 09:22, 23 December 2010 (UTC)
 * I noticed that 'causality...is at least likely' turned into 'is probable'. Do you think that is supported by the source? Ocaasi (talk) 09:51, 23 December 2010 (UTC)
 * Synonyms are different words with almost identical or similar meanings. Words that are synonyms are said to be synonymous, and the state of being a synonym is called synonymy. I think probable is synonymous with at least likely. So I do think it is sourced. QuackGuru (talk) 09:58, 23 December 2010 (UTC)

Chiropractic draft
If there are any suggestions for improving the article it can be done here rather than proposing mass rewrites in a draft. QuackGuru (talk) 05:51, 23 December 2010 (UTC)


 * I know that it can be done here, but the editing environment here is, sometimes not particularly constructive. Is there a policy issue relating to working on userspace drafts, particularly on controversial articles? Ocaasi (talk) 05:55, 23 December 2010 (UTC)


 * I prefer the talk page is used for simpler proposals editors can understand rather than complex mass changes. Editors can start a draft. But you have not explained what is the issue with this article. A draft is usually done with short articles or when there are major problems with an article. There is also the mediation page where the mediator might have suggestions. See Mediation Cabal/Cases/2010-08-23/Chiropractic. QuackGuru (talk) 06:01, 23 December 2010 (UTC)


 * You are a strident advocate for your point of view, but don't always give other editors room to develop substantial suggestions without disagreeing with them on multiple fronts first. Doing a draft elsewhere allows changes to happen gradually and with input that doesn't view changes as inherently threatening to the article's integrity.  Mediation was not particularly different in that regard.  I'd prefer that changes offered here were not immediately accused of a variety of policy violations and were instead greeted with an effort to see how they intended to improve the article and constructive suggestions to aid in that.  Doing a draft in userspace is just a way to avoid friction between alternate views until they can be better formulated.  I recognize that any drafts: a) can't be content forks; b) should be in userspace or talkspace; c) have to be presented on the article talk page first; d) need to be improvements along the intention of policy; and e) should be presented in an accessible, systematic or itemized way to explain how they differ, when they do make it to the talk page. Ocaasi (talk) 06:17, 23 December 2010 (UTC)


 * A draft may be used to improve an article. I hope we don't go back to previous problems. QuackGuru (talk) 06:39, 23 December 2010 (UTC)


 * I think you've just proved my point, cheers. Ocaasi (talk) 06:49, 23 December 2010 (UTC)


 * WP:POVFORK: "In contrast, POV forks generally arise when contributors disagree about the content of an article or other page. Instead of resolving that disagreement by consensus, another version of the article (or another article on the same subject) is created to be developed according to a particular point of view..." I hope you are just trying to improve the article. QuackGuru (talk) 23:56, 24 December 2010 (UTC)


 * WP:Userspace: Work in progress or material that you may come back to in future (usually on subpages): Drafts, especially where you want discussion or other users' opinions first, for example due to conflict of interest or major proposed changes
 * WP:Forking: One technique sometimes used to reach consensus on difficult articles is to create a temporary copy which people can then edit to show others proposed refactorings, rephrasings, or other changes. This can be helpful for controversial subjects or controversial changes; editors can show others exactly what their vision for a proposed change is – without the controversy of having that new proposed version automatically replace the existing version...However, just as "spinout" articles have sometimes been mistaken for POV forks, temporary subpages have been mistaken for POV forks. Care should be taken on both sides to minimize such mistakes. New drafts should be written in the "user:" or "talk:" namespace and not in the main namespace; however, accidents happen and those who think they have found a POV fork, in turn, should check to see whether the article title indicates a temporary subpage and whether the talk page of the main article indicates that this is a place to work on consensus rather than to dodge it.
 * It's a draft, QG, in talk space, and that's clearly stated in the header. Your insinuations of ulterior motives speak to why such a draft is necessary.  Cheers, Ocaasi (talk) 01:09, 25 December 2010 (UTC)


 * Go for it. QG proved your point for you. To keep matters simple I suggest that one deal with one issue/section at a time, then propose it for approval on this talk page. (Work on other sections can still continue on the draft page.) Making vast changes to the whole article at one time often creates more problems than it's worth. -- Brangifer (talk) 03:08, 25 December 2010 (UTC)
 * That's good advice, and also what I was thinking, one section at a time. Please check in to see how it's going. Ocaasi (talk) 03:14, 25 December 2010 (UTC)

Recent changes to lead
This recent change did not summarise the body. See WP:LEAD. The change failed verification using the Ernst ref. The word "However" is not supported by the ref. There was also WP:OR editorialising. QuackGuru (talk) 17:25, 12 January 2011 (UTC)
 * Although I personally agree with some of the ideas that the change brings up, I also agree with QG that it is OR and definitely does not reflect the highly critical work by Ernst. If it were to stay as is then an appropriate source would have to be cited. Puhlaa (talk) 21:41, 12 January 2011 (UTC)
 * See WP:LEAD: "The lead should be able to stand alone as a concise overview of the article. It should define the topic, establish context, explain why the subject is interesting or notable, and summarize the most important points—including any prominent controversies. The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources, and the notability of the article's subject should usually be established in the first few sentences."
 * On the contrary, even if a source were cited it would not pass WP:LEAD. QuackGuru (talk) 22:10, 12 January 2011 (UTC)
 * You just love to cause other editors grief, even when one agrees with you hey QG?
 * However, now I do Disagree with your latest pointless point. If Ernst 2010 makes the cut, then a secondary source (if/when one exists) that contradicts Ernst 2010 needs to be included to maintain NPOV. Thus, if a recent secondary source made the statements added to the lead they would stay. However, as I said, as it exists currently the change is OR. I dont want to read a repeat of your pointless point, as until a secondary source is acctually presented and proposed to be included it is not worth my time to partake in your circular arguements over a theoretical inclusion.Puhlaa (talk) 22:17, 12 January 2011 (UTC)
 * You claimed "If it were to stay as is then an appropriate source would have to be cited." The text did not summarise the body even if a source were presented. Currently, a reliable systematic review is not avaliable that contradicts Ernst. QuackGuru (talk) 22:28, 12 January 2011 (UTC)
 * That doesn't mean it's not a broader Weight issue, though. Ernst-Death is one review on the risk of CSM via VAD, but we have Spine and Neurology and JMPT and Herzog all suggesting that the apparent causality presented in Ernst is insufficiently researched, incidental due to preexisting conditions, or unlikely for biomechanical reasons.  They should factor into our presentation of Ernst's results per NPOV. Ocaasi (talk) 08:36, 13 January 2011 (UTC)
 * When a MEDRS reference specifically contradicts Ernst we will evaluate it for inclusion in the body and the lead. I don't see any recent systematic review that is specific to death and the risk-benefit QuackGuru (talk) 22:07, 13 January 2011 (UTC)

A recent change by another new editor deleted sourced information from the lead. I restored it. QuackGuru (talk) 17:30, 14 January 2011 (UTC)

"A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits.[26]"

"The risk of harm from manipulations of the neck may outweigh the benefits.[26]"

This change reverted back to the attribtuion in the lead. This is the only sentence in the lead with in-text attribution. Do editors think we should add in-text attribution if an editor disagrees with a systematic reivew or thinks the text is controversial. I think editors should keep their personal disagreement off the page. QuackGuru (talk) 17:45, 14 January 2011 (UTC)

Some editors may want to continue to make WP:BOLD deletions to the lead without discussion or consensus. If we discuss possibly controversial changes to the lead first it may help with consensus. QuackGuru (talk) 18:02, 14 January 2011 (UTC)

I have tried to find other sources that contradict Ernst but I could not find any reliable MEDRS compliant sources. The Ernst 2010 source is a peer reviewed systematic review. We can't reach down to cherry pick unreliable sources to argue against reliable sources. It would help if editors don't try to add unsourced claims to the lead or use unreliable sources again. See WP:MEDRS. QuackGuru (talk) 22:14, 14 January 2011 (UTC)

The proponents of Ernst dispute his conclusion of the recent systematic reivew but on Wikipedia we must comply with MEDRS and WEIGHT. The marginal chiropractic view does not belong in the lead nor the body. QuackGuru (talk) 20:42, 15 January 2011 (UTC)

Pseudoscience?
Recently,, administrator Sandstein described the chiropractic page as "pseudoscience-related". It has become important to specify which pages are pseudoscientific, now that an editor has been blocked for editing a pseudoscience-related page, and editors have begun receiving pseudoscience arbitration sanctions warnings. Therefore we need to properly mark this article as pseudoscience so that editors who have been warned about (or forbidden from) editing pseudoscience articles will not accidentally get into trouble. Additionally, it is obvious that at least some of the beliefs of some versions of chiropractic are indeed pseudoscientific. These are the reasons why I added the pseudoscience category to this article. Cardamon (talk) 06:31, 16 January 2011 (UTC)


 * Support I support the addition of this tag for the reasons outlined above. Some of chiropractic is pseudoscience without a doubt with lots of references to support this.  Doc James  (talk · contribs · email) 07:04, 16 January 2011 (UTC)


 * Comment My real question is whether the category has to do with notifying editors of ArbCom or properly categorizing content. In other words, is this an administrative category (i.e. [pages covered under Pseudoscience sanctions]), or are we addressing the content directly, or some of both.  I agree that parts of Chiropractic are pseudoscientific, while some of it is anti-scientific, and other parts are scientific.  Is the category appropriate given the complexity of the actual field?  Also, we already should have a talk page warning that this page is under Pseudoscience sanctions, if it is.  Wouldn't that suffice? Ocaasi (talk) 08:00, 16 January 2011 (UTC)


 * Support a tag, not category Uncertain, but can be convinced . My uncertainty is based on the next paragraph, but I can see the point being made. Editors must not get in trouble when dealing with such a muddy area as this. There needs to be a clear indication for them. Since there are so many fundamental elements in the profession that are pseudoscientific, I can also go along with adding the category, but will wait to see the discussion. A side benefit (which isn't the business of Wikipedia ) is that doing so might actually motivate the profession to distance themselves from these things and clean up their act, but like I said, that can't be our motivation here, but would just be an interesting side benefit. I can maybe shed some light on the history of why we don't have this article in the PSI category, and we have indeed had some very hefty discussions about the matter. There are several aspects of chiropractic, including its most foundational belief (vertebral subluxation), which are indeed pseudoscientific, but to call the whole profession such was deemed inappropriate. The solution was to deal with those aspects, but not the profession, at List of topics characterized as pseudoscience. There you will see the pseudoscientific elements dealt with. I hope that info helps. An ideal solution would be to copy the content from the List into a section here with the heading "Pseudoscientific aspects". This section could be used to deal with the past and present history and why those elements are considered PSI by mainstream and even many chiropractic sources. Editors who are topic banned from PSI subjects would not be allowed to touch that section or its mention in the lead. What think ye? -- Brangifer (talk) 08:18, 16 January 2011 (UTC)


 * I have changed my !vote per Sandstein and Puhlaa. -- Brangifer (talk) 19:25, 16 January 2011 (UTC)


 * I have been asked to comment here. How articles should be categorized is a content issue, and the arbitration process does not resolve content issues. An opinion by an administrator, such as myself, that an article "relates to pseudoscience, broadly interpreted" and is therefore within the scope of the "Pseudoscience" topic ban, is therefore not dispositive for the article's categorization as pseudoscience or otherwise. The scope of the arbitration case is broader than only articles about topics that are accepted to be pseudoscience; it notably also includes topics whose description as pseudoscience is contested. You might want to consider a talk page warning template instead; I believe there is something like that for Israel-Palestine conflict articles.   Sandstein   08:34, 16 January 2011 (UTC)


 * Is there to be a group of articles that are sufficiently "pseudoscience-related" that editors can be warned for editing them, but which can't be categorized as pseudoscience? That seems like a potentially problematic class of article.  Cardamon (talk) 21:33, 16 January 2011 (UTC)


 * Editors are not warned just for editing pseudoscience-related pages, only if they edit pseudoscience-related pages in a problematic manner. I don't think that there is an easy way to classify all pseudoscience-related pages in the abstract. But, in addition to pages categorized and therefore generally accepted as pseudoscience, pages are normally pseudoscience-related whenever editors disagree about whether the respective topic is pseudoscientific or not.  Sandstein   07:28, 17 January 2011 (UTC)


 * Oppose I oppose labelling the entire category as pseudoscience as it incorrectly labels the profession too broadly. I fully agree that traditional foundations like subluxation, and some technique systems (used by a small proportion of the profession) are indeed pseudoscientific, but can be labelled as such at specifically at List of topics characterized as pseudoscience. However, Chiropractic in Denmark and Switzerland is now taught in their medical schools, and is considered one of the 5 mainstream health care professions in those countries. Further, in Canada, neither of the 2 schools (UQTR or CMCC) teach subluxation or unresearched therapies, and put a high emphasis on scientific inquiry as part of the curricula and as an expectation of faculty. Lastly, a large part of the profession in the US (representing about 7 schools) are actively trying to remove subluxation from their chiropractic vocabulary (as evidenced by the recently proposed changes to CCE legistlation). A talk page warning template is a more suitable option IMO.Puhlaa (talk) 16:23, 16 January 2011 (UTC)


 * A couple of quick points. First, I'm not opposed to some sort of notification on the talk page, but not all editors look at the talk page before editing, so there should be a notification on the article page too.  Using pseudoscience category is one of the less obtrusive ways to do this.  Second, I don't think all parts of a thing need to be pseudoscience for the category to be justified; it is enough that it contain a significant amount of pseudoscience. Cardamon (talk) 19:08, 16 January 2011 (UTC)


 * Not sure if by tagging your comments to my response you are trying to convince me, or other editors. Dont feel obliged to try to convince me...I provided my reasons for objecting, but I am happy to go with whatever the majority consensus is.Puhlaa (talk) 19:15, 16 January 2011 (UTC)


 * Just a couple comments. In Denmark it's not part of the medical school or curricula but a separate institute located within the Odense campus of the University of Denmark. The chiropractic students participate in some of the basic education along with the medical students before specializing in biomechanics. They receive the equivalent of a BS/MS (it's sort of in between) and are not termed "doctor", as in DC. The institute was created because of a large and undisclosed donation by the "Society for the Promotion of Chiropractic", a controversial organization. As such it is part of the university system, which was an unusual situation at the time. Chiropractic schools have always been privately owned institutions owned and controlled by individuals, families, or corporations. Things are changing! Puhlaa, would you please provide a link to the "proposed changes to CCE legistlation". If it's significant, we may be able to use it here. Thanks. -- Brangifer (talk) 19:38, 16 January 2011 (UTC)


 * I must have missed something (as how Denmark came into this conversation). Medical doctors in Australia do not have MDs - they have a BS/BM (Bachelor of Medicine/Bachelor of Surgery) or BSMB. Chiropractors in Australia also do not have a DC, they have a BChiro. However, both Medical doctors and chiropractors in Australia have the legal right to call themselves doctors. I am sure that it is similar in Denmark. DigitalC (talk) 01:14, 17 January 2011 (UTC)


 * Denmark was mentioned by Puhlaa above and I cleared up a little misunderstanding. No big deal. (Chiropractors aren't called "doctor" in Denmark.) Also because educational systems are different, a BS in one country isn't necessarily the equivalent of a BS in another. In Denmark a BS is about the same as a BS in the USA. MDs in Denmark study several more years longer than chiros, just as in the USA. In England and Australia a (medical) BS is equivalent to an MD in the USA, and I think a surgeon is called "Mr." -- Brangifer (talk) 09:45, 17 January 2011 (UTC)


 * Comment. The present proposal mixes two things that have little to do with each other: The content/categorisation (in article space) of the article, and applicability of pseudoscience sanctions. All editor-related pseudoscience sanctions exist for a specific reason and therefore extend to those pages for which the reason applies. E.g. if a topic-banned anti-pseudoscience warrior insists insisted that relativity theory is an example of pseudoscience, then the sanction would extend to that article, even though it is very obviously unrelated to pseudoscience by any objective criteria. Similar things apply for articles that are not related to pseudoscience but on which typical pseudoscience battles are fought out.
 * I have no opinion on whether chiropractic should be characterised as pseudoscience in article space, or in which way. This is a content decision that requires an overview over the best available sources. Hans Adler 21:59, 16 January 2011 (UTC)


 * Well put. -- Brangifer (talk) 22:25, 16 January 2011 (UTC)


 * Oppose: I think that putting Chiropractic within the category Pseudoscience labels Chiropractic as Pseudoscience in Wikipedia's voice. That clearly doesn't meet NPOV. Are there aspects of chiropractic that are pseudoscience? Absolutely. Are there aspects of massage therapy that are pseudoscience? (Ear candling for one) Absolutely. Are there aspects of dentristry that are pseudoscience? Absolutely. (I recently had a dentist perform "autonomic nervous system testing" on me to see if I needed a bite realignment to prevent TMJ issues). A warning at the top of the talk page should suffice. Pseudoscience sanctions should be used for problem editors, and every editor who wants to make a minor improvement need not know about the sanctions. A problem editor can be warned, and if they are following the WP:BRD cycle they should be seeing the talk page. DigitalC (talk) 01:14, 17 January 2011 (UTC)


 * Oppose - and I oppose the scope drift of the AE to cover matters outside of the intent of the original AE. If it's clear that this article is not pseudoscience then QED,  it is not covered by AE regardless of how much admins would love to flex their muscles over it.  HOWEVER if admins care to actual edit the article in question and join the actual editing discussion (rather than attempt to defend their particular tool usage for the day) then they are welcome - as all editors are here in the Project.  Shot info (talk) 09:34, 17 January 2011 (UTC)