Talk:Chiropractic/Mediation

This is a mediation talk page for Chiropractic.

Ground rules

 * Assume good faith until your eyes bleed.
 * Focus on content; avoid "you" statements in favor of "I".
 * To avoid mediation creep, please do not open new topics while a discussion is on-going.

Moderator - try Limited Edit War?
Moderator, can we try my 'limited edit war' idea? Moderation is clearly failing when there is still no consensus after 6000 words+ discussing two sentences. This subpage (click here) is how I see it working --Surturz (talk) 05:24, 13 November 2008 (UTC)


 * Encouraging edit wars, even limited ones, doesn't sound promising. If edit wars don't work in articles, why would they work here? Eubulides (talk) 08:47, 13 November 2008 (UTC)
 * Fine, don't call it an "edit war". Call it "wiki-editing". I think it's a good idea; why not try it? The proposal above includes the idea that you can't revert to a previous version but must always change it to something new. That prevents any edit warring from happening.  Every edit will be productive: it will create a new proposed version of that part of the article.  Also, the proposal specifies that it must be done in a spirit of cooperation and of trying to arrive at a version everyone will accept. We might want to use some of the rules Elonka had established here; I was going to say but not the 0RR part, but actually maybe we do want to use that part too: no reverting to an identical previous version, but you can change things. ☺ Coppertwig(talk) 14:10, 13 November 2008 (UTC)


 * Oh no, I don't think applying the rules from Quackwatch is a good idea at all. In my opinion that got a lot of editors to cease editing at the article and a lot of problems occurred.  Maybe use the talk page and keep adding until the section is at an acceptable version, but wait, this is what they have been doing all along and look where it's at.  Maybe each sentence under dispute can be put in this mediation separately and then the sentence, or whatever, can be worked on under the protection of the mediator's descretions to prevent circular arguments.  I think Shell has been doing a great job trying to prevent the same arguments to go on here and that the editors need to be specific in there changes, as the mediator has requested often.  -- Crohnie Gal  Talk  14:44, 13 November 2008 (UTC)


 * I really like the idea presented in Surturz's subpage; since we're already trying to throw back and forth new suggestions to find one that works for everyone, this would let everyone see those changes and make tweaks of their own without filling up copious space on talk pages. Crohnie, the difference here would be editing on a subpage trying to find a compromise within restrictions, not any restrictions on the article itself.  Shell    babelfish 00:50, 14 November 2008 (UTC)


 * Thanks Shell, I missed this comment that you made explaining things, sorry, thanks for being so patient and taking the time to explain. -- Crohnie Gal  Talk  19:07, 22 November 2008 (UTC)

Keep going?
It looks like the first section finally reached a point where everyone could tolerate it for the time being. I know there are still some outstanding concerns about OR in the section in general and hopefully we'll be having a few more admins review those discussions and see what conclusions they come to. In the meantime, how would everyone feel about working on other sections? Did the limited edit war work well? Are there things we can do to improve the technique? Shell   babelfish 22:28, 7 December 2008 (UTC)
 * Prolly needs a new name other than LEW. I liked being able to see the "current proposed version", rather than having to keep all the discussion in my head at once. QuackGuru and Levine2112 had issues with the process, so it would be good to get their feedback on any improvements to the process. The key thing is that all editors aimed for text that was considered an improvement by everybody. It's a lower bar, but for contentious articles, much more practical. --Surturz (talk) 00:23, 8 December 2008 (UTC)
 * It makes sense to draft a new version here first. The logical next thing to work on would be the next bullet, namely, the "Whiplash and other neck pain" bullet of Chiropractic . But if all this might be overturned by admin review, perhaps we should hold off on further work until admins have a chance to review what's been done so far. Eubulides (talk) 06:00, 8 December 2008 (UTC)
 * I don't believe there's reason to be concerned that work here will be overturned. The issue in question was my determination of consensus on the general issue of SM studies being OR.  Either other admin's will agree with my determination, in which case nothing will happen or they will decide there was no consensus, in which case further discussion needs to happen or they may decide that consensus runs the other direction which would mean revisiting the text to determine what should be removed or how the text should be handled.  I believe the last scenario would be the only one which would affect any text worked out here, but its also the least likely to happen.  Shell    babelfish 05:37, 9 December 2008 (UTC)

Two changes to the lead

 * A couple of weeks ago Sciencewatcher suggested (in what is now Talk:Chiropractic/Archive 29 ) that the article's lead contain more information about the significant criticism of chiropractic within the medical and scientific community. The followup discussion continued at some length in Talk:Chiropractic and Talk:Chiropractic, without consensus, and an edit war was recently sparked off by this edit.
 * I propose breaking this disagreement about the lead into two parts, as follows:
 * Battle between chiropractic and the AMA
 * Here, the edit war was over replacing this:
 * "For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic. Vaccination remains controversial among chiropractors. "
 * with this:
 * "For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are not based on solid science. Vaccination remains controversial among chiropractors. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. "
 * Effectiveness of chiropractic care
 * Here, the edit war was over replacing this:
 * "Opinions differ as to the efficacy of chiropractic treatment and the efficacy and cost-effectiveness of maintenance chiropractic care are unknown. "
 * with this:
 * "Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. "

Eubulides (talk) 10:05, 26 December 2008 (UTC)
 * These two parts can be discussed relatively independently, and we can discuss either one first.

Battle between chiropractic and the AMA

 * The new version that is currently in place is much better than the old. It gives a very good context for the reader. I suggest keeping the new version. ScienceApologist (talk) 15:37, 26 December 2008 (UTC)


 * Support new version. A great improvement. -- Fyslee (talk) 03:11, 27 December 2008 (UTC)


 * Support new version -- Crohnie Gal Talk  12:54, 27 December 2008 (UTC)


 * I think it could be better. Something like, In 1965, the American Medical Association called chiropractic an "unscientific cult"[9] and boycotted its members from referring patients to chiropractors until losing a 1987 antitrust case.[10]--Hughgr (talk) 23:47, 27 December 2008 (UTC)
 * As can be seen from Cherkin 1989, that's not quite right: the AMA allowed physicians to refer patients to chiropractors starting in 1978 (not 1987). The "In 1965" is unnecessary and could easily be misinterpreted as implying that the AMA started battling chiropractic in 1965, which isn't right. Also, the phrase "boycotted its members" doesn't make grammatical sense, as the AMA did not boycott its own members. Eubulides (talk) 09:14, 28 December 2008 (UTC)


 * Thats not quite right either, the source says in 1978 the AMA's Judicial Council adopted new opinions under which physicians could refer patients to chiropractors, and in 1980 the AMA revised its Principles of Medical Ethics by eliminating previous proscriptions against any associations between physicians and "unscientific practitioners. I would say 1980 because thats when it appears on paper? Maybe we should use a better source besides a "Letters to the Editor"?
 * I think "In 1965" is important because it adds context, but perhaps it would help if we moved the comma so it becomes "In 1965 the American Medical Association called chiropractic an "unscientific cult", and ..."--Hughgr (talk) 21:38, 28 December 2008 (UTC)
 * Context is provided by the "For most of its existence" in the previous sentence. And "For most of its existence" is better context, as the battle between chiropractic and organized medicine began long before 1965; mentioning "1965" in the lead, without providing information that is so detailed that it is not even present in the body of the article, would mislead the reader into thinking that the battle really began in 1965. Also, the cited source does not support the "1965"; nor is "1965" in the body. Please see Talk:Chiropractic for a proposal to fix the 1980 versus 1978 business. Eubulides (talk) 22:04, 28 December 2008 (UTC)


 * Oppose the phrase "that are not based on solid science", per NPOV. I'm not convinced that this is "a piece of information about which there is no serious dispute"; the source establishes that it's the stated opinion of one author, Ernst.  Alternative phrases which I would consider improvements include:
 * that are not based on generally accepted science
 * that are not recognized as based on solid science
 * that have been criticized as "not based on solid science"
 * of which a scientific basis has not been firmly established
 * that have been criticized as unscientific
 * etc. ☺ Coppertwig(talk) 01:16, 30 December 2008 (UTC)
 * I disagree with the new proposal. No serious disagreement exists among reliable sources presented in the article. QuackGuru (talk) 04:39, 30 December 2008 (UTC)
 * There is no dispute among reliable sources that the chiropractic dogma of subluxation is not based on solid science. Indeed, as we have seen, reliable sources go much farther and use words like "antiscientific" and "pseudoscientific" to describe the original chiropractic theory of subluxation. Saying "not based on solid science" is about as mild as we can get, and still be supported by reliable sources. The rewordings proposed above are all euphemisms that introduce far more POV than they remove: they would give the naive reader the false impression that there is genuine doubt among reliable sources over whether the chiropractic theory of subluxation is scientific. There is no such doubt. Eubulides (talk) 07:20, 30 December 2008 (UTC)


 * Support improved, new version. QuackGuru (talk) 04:39, 30 December 2008 (UTC)
 * Oppose - per Coppertwig and also I would like the AMA bit expanded to discuss the AMA's current take on chiropractic - "It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic. (V, VI)" source Perhaps we need something to this effect in the body of the article as well. It certainly completes the story. -- Levine2112 discuss 06:36, 5 January 2009 (UTC)
 * I have followed up after Coppertwig's comment above, and hope that Coppertwig can reply there. As for expanding the material to talk more about the AMA's revision to its policies, I gather that this is alluding to possible additions to both the body and the lead, but no specific wording is being being proposed. The current text already says that the court decision "ended the AMA's de facto boycott of chiropractic". It's not clear that details from the AMA's revised policies are needed in the body, much less the lead: after all, this level of detail is not present even in the main article Chiropractic history. Eubulides (talk) 08:06, 5 January 2009 (UTC)
 * Are you open to balancing the article? If we present the AMA's opinions from nearly 4 decades ago, should we not present their most current, published opinion on the same subject?--Hughgr (talk) 04:56, 6 January 2009 (UTC)
 * Of course the article should be WP:NPOV. No wording proposal has been made yet, so it's hard to give a specific opinion. However, any wording proposal should rely on the weight given to the topic by reliable secondary sources such as Cooper & McKee 2003, Keating et al. 2005, and Villanueva-Russell 2005 . Eubulides (talk) 05:39, 6 January 2009 (UTC)

Effectiveness of chiropractic care

 * Obviously the new version is far superior to the old version letting the reader know of the current state of evidence-based research on the subject. I suggest keeping the new version. ScienceApologist (talk) 15:37, 26 December 2008 (UTC)


 * Support new version. A great improvement. -- Fyslee (talk) 03:12, 27 December 2008 (UTC)


 * Support new version -- Crohnie Gal Talk  12:55, 27 December 2008 (UTC)


 * Support--Hughgr (talk) 23:42, 27 December 2008 (UTC)


 * Oppose. I'm not comfortable with the phrase "not demonstrated that spinal manipulation is effective". A reviewer can look at any collection of evidence and state that there is not enough evidence to be convincing.  I think a better reflection of the source would be to base our statement on this quote from Ernst:  "... and its therapeutic value has not been demonstrated beyond reasonable doubt."  I suggest including the phrase "beyond reasonable doubt".  Different people will have different thresholds for how much evidence is required to convince them. ☺ Coppertwig(talk) 01:21, 30 December 2008 (UTC)


 * I disagree with the new proposal. The phrase "beyond reasonable doubt" sounds like something that someone would say in a court case. QuackGuru (talk) 04:35, 30 December 2008 (UTC)


 * According to the source: "The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science." The phrase "beyond reasonable doubt" is not specific about subluxation and might fail verification. QuackGuru (talk) 05:08, 30 December 2008 (UTC)


 * The proposal to add the phrase "beyond reasonable doubt" is not specific. What would the proposed text look like after the phase was added, and how would this text be supported by a reliable source? I don't offhand see how it could be done, without a rewrite that's more substantial than merely adding that phrase. Eubulides (talk) 07:20, 30 December 2008 (UTC)

Opposemainly for this sentence. . . Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. . . this is not an accurate portayal of the sources. . . further, it confuses the effectiveness of spinal manipulation with chiropractic. . . they are not one in the same.TheDoctorIsIn (talk) 01:13, 2 January 2009 (UTC) I have moved the preceding comment has been moved here - the appropriate section for this discussion. -- Levine2112 discuss 06:29, 5 January 2009 (UTC)
 * Support improved, new version. QuackGuru (talk) 04:35, 30 December 2008 (UTC)
 * Support as an improvement over the previous version. Eubulides (talk) 19:30, 2 January 2009 (UTC)
 * Oppose per Coppertwig and TheDoctorIsIn 's misplaced comments just above . moved below. -- Levine2112 discuss 06:25, 5 January 2009 (UTC)
 * This is an accurate portrayal of the source presented. No evidence to the contrary has been presented. QuackGuru (talk) 03:42, 2 January 2009 (UTC)
 * This "oppose" seems to be out of place, as the "Collectively" sentence belongs to, not to this subsection. Anyway, The "Collectively" sentence accurately portrays Ernst 2008 , "Chiropractic: a critical evaluation", which says this (p. 8): "Table 3 gives an overview of the most up-to-date systematic reviews by indication. These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain. For this condition, manipulation may be as effective (or ineffective) as standard therapy." Eubulides(talk) 19:30, 2 January 2009 (UTC)

Whiplash and other neck pain

 * Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SM, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SM and mobilization are effective for neck pain. Of three systematic reviews of SM published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review found that SM and mobilization are beneficial only when combined with exercise. A 2005 review found consistent evidence supporting mobilization for acute whiplash, and limited evidence supporting SM for whiplash.

Comments on whiplash and other neck pain
Me thinks we might be able to shorten this section a bit. QuackGuru (talk) 20:31, 30 December 2008 (UTC)

I made this change to trim this long section. QuackGuru (talk) 01:29, 30 March 2009 (UTC)

I went ahead and made the change in mainspace. I suggest we remove the last sentence from this section. See WP:UNDUE weight. QuackGuru (talk) 02:00, 30 March 2009 (UTC)

I think we can shorten the section the same way we shortened the other sections. See WP:WEIGHT. QuackGuru (talk) 07:35, 30 March 2009 (UTC)

Other

 * Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizziness, high blood pressure, and vision conditions. Other reviews have found no evidence of benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, kinetic imbalance due to suboccipital strain (KISS) in infants, menstrual cramps, or pelvic and back pain during pregnancy.

Comments on other
A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.

The reference done by chiropractors is favorable to sciatica and radicular pain in the leg treatments. This may be WP:UNDUE weight to have a reference written by chiropractors to have such prominence. QuackGuru (talk) 20:31, 30 December 2008 (UTC)

I made this change to reflect my proposal. QuackGuru (talk) 07:33, 7 January 2009 (UTC)

I made this change to fix the undue weight. QuackGuru (talk) 01:25, 30 March 2009 (UTC)

I made this change in accordance with Wikipedia policy. QuackGuru (talk) 18:46, 16 April 2009 (UTC)

This edit did not match the edit summary. The previous discussion is here at this mediation page and there is no specific objection based on Wikipedia policy. QuackGuru (talk) 20:41, 17 April 2009 (UTC)

No further comments have been made so I made this change. I shortened the long run on sentence and removed the lower quality reference. QuackGuru (talk) 02:38, 23 April 2009 (UTC)

Chiropractic improvements
I explained what ideas mean, removed the extra spacing added to the table, restored the deletion of a sentence to the philosophy section, and shortened a long run on sentence. QuackGuru (talk) 05:41, 1 May 2009 (UTC)


 * The chiropractic article's talk page is thataway, not here. -- Brangifer (talk) 06:10, 1 May 2009 (UTC)