Misplaced Pages

DigitalC, thanks for even more evidence. We have already presented Murphy as another piece of evidence. Further, the feelings of leading researcher such as Ernst and Shekelle have also been presented as even more evidence that there is OR in the Effectiveness section. That some editors don't agree with this evidence is fine. However, agree with it or not, everyone here knows that evidence of OR has been presented. To deny that evidence has been presented is just foolish. -- Levine2112 04:10, 24 October 2008 (UTC)

Slow down a bit and AGF. There is no doubt that you have presented what you believe to be "evidence". Yes, that's true. When others don't consider it to be proper, sufficient, or accurate "evidence", and even consider it to be misleading "evidence", then they of course will not consider it to be any real and valid "evidence". IOW, they will say "evidence" has not been presented. Sure, they'll admit you have attempted, but that's all. You would do the same in their shoes. I hope that clarifies the difference of opinion. I know this is frustrating to you, but it is also frustrating to the rest of us. Just AGF and be patient. -- Fyslee / talk 05:07, 24 October 2008 (UTC)

Levine2112 claims it "flies in the face of those researchers who say that it is not okay to do so." Levine2112, please show and not assert your view. Please tell us which researchers support your view that general chiropractic research is not directly related to chiropractic. When spinal manipulation is core to chiropractic it is relevant (and directly related per WP:OR) information for this article. If there are concerns with particular sources or parts of the article, please bring those up here. Maybe it would help to discuss specific issues with the current text one at a time instead of generalizing, per Shell Kinney. QuackGuru 23:38, 23 October 2008 (UTC)

arbitrary break

Nobody has shown that "leading researchers do NOT agree that all spinal manipulation research is directly related to chiropractic". And even if they had shown that, it would not therefore follow that the spinal manipulation research that is cited by Chiropractic #Evidence basis is not directly related to chiropractic. Nobody has demonstrated any source cited by Chiropractic #Evidence basis to be "non-chiropractic research"; as is standard in chiropractic, all the cited sources are derived from data taken either in whole or in large part from chiropractic sources. That is why no OR has been demonstrated in Chiropractic on this point. Eubulides (talk) 23:15, 22 October 2008 (UTC)

I disagree. I believe that Ernst does not agree that all spinal manipulation research is directly related to chiropractic as evidenced by statements in his 2008 paper and in his response to Meeker & Haldeman. I have also demonstrated that sources such as Murphy which - though rely on a mixed bag of practitioners performing spinal manipulation including chiropractors - in its conclusions says nothing specifically about chiropractic spinal manipulation. Despite this, we are using Murphy to say something definite about chiropractic spinal manipulation. That is a WP:NOR violation - using a source to discuss something which it in itself does not discuss. Furthermore, it has not been demonstrated that it is standard or acceptible practice to use generic spinal manipulation research to make conclusions about chiropractic spinal manipulation. In fact, it has been shown that doing so is considered downright unacceptible by leading researchers such as Shekelle and Ernst. -- Levine2112 23:34, 22 October 2008 (UTC)

It's true that there may exist spinal manipulation research that is not directly related to chiropractic. A study that looks only at osteopathic SM would qualify, for example. However, none of the sources in Chiropractic #Effectiveness are like that. Murphy et al. 2006 (PMID 16949948), which is cited by Chiropractic, does rely partly on non-chiropractic data, but also relies on chiropractic data; of the data we've looked at, most of it was chiropractic. Furthermore, Chiropractic takes care to not use Murphy to support any claim about "chiropractic spinal manipulation"; the claims in Chiropractic that cite Murphy are all about spinal manipulation, which is accurate citation. It certainly has not been demonstrated that Shekelle and Ernst would view such citations as OR; on the contrary, Ernst does the same thing himself in Ernst 2008 (PMID 18280103). More generally, Chiropractic #Evidence basis never does "use generic spinal manipulation research to make conclusions about chiropractic spinal manipulation". Eubulides (talk) 23:54, 22 October 2008 (UTC)

This is my point. If all we are using Murphy (an example of generic spinal manipulation research) for is to discuss spinal manipulation, then why include it in this article about Chiropractic instead of Spinal manipulation? Certainly, if all we are using it for is to discuss spinal manipulation, it is better suited for that article than this one. Agreed? If not, why do you feel it is more appropriate to use it here in the manner in which we are currently using it? -- Levine2112 00:04, 23 October 2008 (UTC)

This point is not an OR issue. If this is the point, then we should remove the OR tag, and start a new discussion thread on this point, which I'd be happy to do. Eubulides (talk) 07:29, 23 October 2008 (UTC)

Answer my question and let's read your explanation. Then we can talk about OR. First thing first. -- Levine2112 02:45, 24 October 2008 (UTC)

I just want to be on record that I agree that the OR tag should be removed. From what I have been seeing, most here want the tag removed and see no OR or Syn violations. As for using this information in this article, I personally feel it is helpful. I am not knowledgable about spinal manipulation but when I come to this article I know that SM is used by chiropractors and feel this article should be allowd to tell the story here without making the readers go to another article to learn more about it. --CrohnieGal 12:01, 23 October 2008 (UTC)

Is general spinal manipulation (GSM) technically different than chiropractic spinal manipulation (CSM)?

There has been a lot of discussion about original research but what is the difference? Is there any significant difference? According to what source there is any specific difference between GSM and CSM. QuackGuru 05:20, 16 October 2008 (UTC)

To get useful answers you'll need to use standard terminology. Please explain more specifically what you are referring to. Is GSM the same as HVLA spinal manipulation, and is CSM the same, but performed by a chiropractor, and thus if it is a straight chiropractor, will be termed a spinal adjustment? If so, the only difference is the performer and the intention. A chiropractor (especially a straight one) manipulates/adjusts with the intention of "correcting" vertebral subluxations (VS). Regardless of intent, both practitioners are causing the same effect on the structures being manipulated, but will be causing different beliefs about what is happening in the minds of their patients. Physically equal, but mentally different.

If by CSM you are allowing the myriad techniques that are also (in addition to HVLA spinal manipulation) included under the umbrella term spinal adjustment, then the sky's the limit, as techniques vary quite a bit, including mechanical and electrical devices, and including techniques that don't have an earthly chance of having any real effect on a spinal motion segment.

Basically, "adjustment" is a code word for the claimed "correction" of anything any chiropractor claims is a VS, and thus is the manipulation of an imaginary lesion. There is often no known objective method of identifying them. When the original Medicare requirements for objective proof (x-rays) were made, it turned out that such proof was not forthcoming, and finally the requirement was dropped in 2000. Now there is no requirement for proof. Medicare just accepts the subjective word of any chiropractor that they have corrected a VS. -- Fyslee / talk 05:58, 16 October 2008 (UTC)

Yes Chiropractic adjustments are different than other doctors or nondoctors application of spinal manipulative therapies. . . Chiropractors use different technique favoring short lever, high velocity, low amplitude where osteopaths tend to do long lever movements. . . chiropractic adjustments are much more specific than any other kind of smt.TheDoctorIsIn (talk) 20:39, 18 October 2008 (UTC)

Please provided a reference to support your view. Do you have and specific recommendation to improve the article with a reference that supports your position. Without a reference your position is speculation. QuackGuru 23:14, 18 October 2008 (UTC)

I too would like to see proof for that straight chiropractic claim. The claim can be documented from straight chiro literature, but that is not evidence that the claim is true. Apparently User:TheDoctorIsIn/User:DoctorIsOut is not aware that DOs, PTs, and some MDs learn these same techniques, with equal specificity. The one thing that remains different is the intention. Only DCs, especially straight ones, claim to "correct vertebral subluxations". Otherwise the HVLA manipulations/adjustments are physically/biomechanically the same. Keep in mind that Palmer learned from osteopaths, and that spinal manipulation predates both professions, having been used by medical physicians and bonesetters for ages. Both osteopaths and chiropractors have shared their techniques for years with MDs and PTs. Of course the term "chiropractic adjustment" can also include chiropractor-performed long lever movements, and also includes myriad non-HVLA techniques which are performed using instrumentation and electric devices, and some of which don't even touch the body, yet the DC doing it claims to be "correcting subluxations". Go figure....

Yes, I would like to see real published evidence that this claim is true. -- Fyslee / talk 03:29, 19 October 2008 (UTC)

Are you insinuating that TDII is a sockpuppet of the banned user DoctorIsOut? This isn't the proper venue, if so. If not, you should strike that from your comments.

Practitioners rely on "chiropractic adjustments" comprised of quick, forceful thrusts by hand to the spinal vertebrae in order to release an impinged nerve, thus removing a subluxation. It should be noted that chiropractors consider the technique of "adjustment" to be exclusive to their profession, and distinguish the clinical procedure as separate from the more general medical term of "manipulation," which is a more generic, often long-lever movement of joints, not restricted to the spinal vertebrae, alone. Villanueva-Russell 2004

Manipulation, as an abstract concept, was interchangeably used by some researchers and practitioners affiliated with osteopathy, chiropractic, physical therapy and orthodox medicine; whereas chiropractic "adjustments" were more specifically applied using "the spinous and transverse process as levers to restore the misaligned vertebra into normal position" Williams 1994

That standard, written in the Mercy report, has reduced the profession of chiropractic to a modality of manipulation. A manipulation technique that is to be prescribed in a limited way for a limited kind of musculoskeltal condition. ACA Journal of Chiropractic 1992

These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Ernst 2008

-- Levine2112 02:30, 22 October 2008 (UTC)

The TDII/DIO connection has been noted many times by many people, including admins, and TDII has never denied it to my knowledge. BTW, it would be DIO that would be the sock, not the other way around. Sockpuppetry isn't forbidden here, but misusing them for stacking votes or for seeking to avoid the scrutiny of other editors is forbidden. This isn't the venue to actually make a case for or against possible misuse, but if you wish to investigate, be aware that some of the evidence no longer exists for public scrutiny because of article and list deletions, which also delete user contributions from their contribution histories. Such evidence can be resurrected if necessary, but I have no intentions of doing so at the present time. Certain other socks of another user - like User:CuTop - (note Shot Info's comment on his talk page) have also been under observation for some time, as you well know.

Your choice of quotations is interesting. I suppose they are in response to my last comment above: "Yes, I would like to see real published evidence that this claim is true." To avoid confusion, I am referring to evidence that the "claim" itself is true, not that the claim has been made. There is no doubt about that. Fringe straight chiropractors (and their supporters, like yourself) do that all the time. The Villanueva-Russell quote even mentions that "chiropractors consider" it to be true. Yes, we know they "consider" it to be so, but that's no proof that they are correct. Claims are not proof that HVLA spinal manipulations are physically/biomechanically different than HVLA spinal "adjustments", regardless of performer. I have never seen any evidence that they are, only claims by you and straight chiropractors. Other chiropractors don't normally make such claims.

The Villanueva-Russell descriptions of adjustments and manipulations describe perfectly the types of spinal manipulations performed by DOs, PTs, and some MDs. They use all those types in an identical manner, since they have often taught each other, and even had chiropractors as teachers.

The only difference is in the intention of the performer. Only chiropractors claim to correct non-existent, subjectively-defined-in-a-thousand-ways "vertebral subluxations" (not the same as clearly and objectively verifiable orthopedic subluxations). The intention is the difference, not the technique. I am of course speaking of comparable methods, not HVLA spinal manipulation compared to various totally different "adjustments". I'm speaking of identical methods that when used by a non-chiropractor will be termed "spinal manipulation", and when performed by a chiropractor will be termed "spinal manipulation" (the same terminology) by both chiropractic and non-chiropractic researchers, but will consistently be termed "adjustments" by straight chiropractors.

The Mercy report was an attempt to bring chiropractic into line with scientific evidence, and has been a thorn in the side of straight chiropractors who felt it was a betrayal of the profession's identity as a vitalistic profession dedicated to solely correcting blockages of Universal Intelligence by vertebral subluxations, all metaphysical concepts that are repudiated by mainstream science and progressive chiropractors.

BTW, what is the source of your 2008 Ernst quote?

-- Fyslee / talk 05:26, 22 October 2008 (UTC)

I really don't know the TDII/DIO/Cutop case well enough to comment intelligently on it, but if you would like to share some details with me, I'd love to hear it. It seems like you are implying something there about another editor's behavior and I'm not sure what that is. Just be careful with the personal attacks - even those pointed in my direction (I am not a "fringe" supporter of straight chiropractic and I'd like very much for you to remove the personal attack). As for your comments, well, we are not here to prove that GSM is different from CSM; only that there are reliable sources which make such a claim. I have provided you now with several such sources. The Ernst source which supports such a claim is from his 2008 paper entitled "Chiropractic: A Critical Evaluation". -- Levine2112 08:06, 22 October 2008 (UTC)

I have moved the "fringe" word to make it a more accurate description. Straight chiropractic is the original Palmerian position of what I call "real" chiropractic, and it is still a common and very influential position in the profession, but it is becoming more and more fringe within the profession. As it relates to scientific evidence, it/chiropractic has always been fringe, and you have always championed and defended the straight position here as if it was the "correct" chiropractic position for this article. That's not a personal attack, just an accurate description of your activities here.

As to the documentation that "claims" of a physical difference between GSM and CSM have been made, we can certainly use such documentation, which is a very different matter than what you have been proposing all along, which is that there really is a physical difference. That is an important distinction. You seem to have bought into that claim, which is your right. Since the claim is incorrect, you might wish to reconsider your position and stop repeating the claim as if it were true. I'll outdent the rest of my reply. -- Fyslee / talk 13:53, 22 October 2008 (UTC)

No, I am not a supporter of Straight chiropractic. That is your assumption. Just like you have falsely assumed I am a chiropractor or a chiropractic assistant for years now. I am a supporter of NPOV. That you have mistaken the POVs of the sources which I present as my own POV, is probably just as much my fault as your own. Let me be clear with you now. You don't know any of my personal POVs other than my stance on various Misplaced Pages policies and their application. Please don't assume anything beyond that.

Yes, claims of physical differences between GSM and CSM have been made. But they have been made by more than just "straight" chiropractors. Several researchers which I have cited many times now have pointed out the physical differences. -- Levine2112 17:06, 22 October 2008 (UTC)

We have been editing here for quite a few years now, and you have myriad times clearly expressed your own personal POV, without mention of sources. Period. That is abundantly clear from your editing history. You have consistently promoted, defended, edit warred over, and supported the POV of straight chiropractic. If you have been playing devil's advocate all this time, then you have certainly fooled all of us and such deception renders anything you say to be untrustworthy. Play with open cards. Denial will get you nowhere. We happen to "know any of my personal POVs other than my stance on various Misplaced Pages policies and their application," many, many more. If you didn't identify yourself with the straight POV, you wouldn't be so defensive.

I have not "falsely assumed" anything after you clarified things. I have acted in good faith based on what seemed apparent from your own utterances. That's all I have to go on. From the first time you denied being a chiropractor I have believed you. That's many years ago. You have also consistently proven that your originally stated mission here to defend the "good reputation" of chiropractic has proven true. That it doesn't have a good reputation seems to elude you. It has a very poor reputation, so trying to attempt to hide that amounts to whitewashing.

Yes, "claims" have been made. Now who are these researchers who "have been cited many times"? That sounds like you are claiming that such researchers have done more than just claim physical differences. Please elaborate. -- Fyslee / talk 04:10, 23 October 2008 (UTC)

(outdent)

• No reliable source has been presented that supports claims that there are "physical differences" between chiropractic SM and general SM that would significantly affect scientific studies of effectiveness or safety. On the contrary, we have a high-quality reliable source, namely Meeker & Haldeman 2002 (PMID 11827498), which says precisely the opposite, and we have multiple high-quality reviews of chiropractic that do precisely the opposite.
• The quote from Ernst 2008 (PMID 18280103) does not "support such a claim" that "general spinal manipulation (GSM) technically different than chiropractic spinal manipulation (CSM)". Ernst is merely being careful in noting where his evidence came from. This note does not make or or support the point that there is a significant technical difference between chiropractic and non-chiropractic SM.
• I believe Fyslee already addressed the other quotes, so I won't bother.
• It may be helpful to place the Ernst quote in its context. Here is the containing paragraph:

"Numerous controlled clinical studies of chiropractic are now available, but their results are far from uniform. Rather than selecting single studies according to their findings, it is therefore preferable to consider the totality of this evidence. 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."

• This paragraph cites the following studies. I've put a * next to the studies that Chiropractic does not cite, as it may be worth considering them as sources for Chiropractic:

• Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
• Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• * Ernst E (2003). "Chiropractic spinal manipulation for neck pain: a systematic review". J Pain. 4 (8): 417–21. doi:10.1067/S1526-5900(03)00735-1. PMID 14622659.
• Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link) (Ernst actually cites the previous issue, issue 2, of this systematic review.)
• Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S (2003). Spinal Manipulation for Infantile Colic (PDF). Technology report no. 42. Ottawa: Canadian Coordinating Office for Health Technology Assessment. ISBN 1-894978-11-0. Retrieved 2008-10-06.{{cite book}}: CS1 maint: multiple names: authors list (link)
• * Balon JW, Mior SA (2004). "Chiropractic care in asthma and allergy". Ann Allergy Asthma Immunol. 93 (2 Suppl 1): S55–60. PMID 15330012.
• * Reid SA, Rivett DA (2005). "Manual therapy treatment of cervicogenic dizziness: a systematic review". Man Ther. 10 (1): 4–13. doi:10.1016/j.math.2004.03.006. PMID 15681263.

Eubulides (talk) 18:36, 22 October 2008 (UTC)

So in essence, Ernst has stated that reviews which include trials of spinal manipulation as performed by practitioners other than chiropractors are NOT exclusively an evaluation of chiropractic. This further supports his position in his critque of Meeker and Haldeman, that the majority of the 43 RCTs for SM in treating LBP are not related to chiropractic SM. Given this, I think it is plainly obvious that Ernst thinks that not all trials of SM are related to chiropractic SM, nor should they necessarily be used as an evaluation of chiropractic. This is further supported by Shekelle's complaint when his spinal manipulation research was being used by chiropractors to validate their version of spinal manipulation. Shekelle distinguished his research as being about spinal manipulation regardless of the practitioner and not necessarily applicable to the form of spinal manipulation which chiropractors employ. -- Levine2112 19:21, 22 October 2008 (UTC)

No, they were not trying to misuse Shekelle's research to "validate their version of spinal manipulation.", but to validate chiropractic - quackery, cultism, metaphysics, false advertising, unscientific claims, and all - including "their version of SM". In fact "their version" wasn't even addressed as a separate matter, since it made up probably 90+% of that research and was placed on an equal footing as any other similar SM studies. Shekelle and other researchers, including chiropractic researchers don't make a difference because there is NO physical difference. -- Fyslee / talk 19:44, 22 October 2008 (UTC)

Ernst never states nor implies that the 43 studies in question should not "be used as an evaluation of chiropractic". He states merely that their sources of data should be identified. Fyslee's characterization of Shekelle's complaint is accurate. Eubulides (talk) 20:51, 22 October 2008 (UTC)

Yes, I know full well of your misunderstandings of both Ernst's criticism of H&M and of Shekelle's rebuke; however, I would like to read more on your understanding of what Ernst meant in his 2008 paper in the quote you provided above. I believe Ernst has stated that reviews which include trials of spinal manipulation as performed by practitioners other than chiropractors are NOT exclusively an evaluation of chiropractic. Do you disagree with that? -- Levine2112 21:32, 22 October 2008 (UTC)

I am not misunderstanding Ernst. I would go even farther than what Ernst says in his 2008 paper. I would say that trials of chiropractic spinal manipulation are not exclusively evaluations of chiropractic, as the two topics are not the same (chiropractic includes many things besides SM). Chiropractic spinal manipulation is highly relevant to chiropractic, though, so there would be no OR violation to cite such trials here. Eubulides (talk) 23:15, 22 October 2008 (UTC)

It would help if editors made a specific proposal rather than arguing over what the sources means. QuackGuru 21:39, 22 October 2008 (UTC)

Proposed wording

Now how can we include that information here? Let's try to formulate something that can be included about the claim, without seeming to endorse it as if it were true. Here's a very rough sketch of an attempt:

• "Straight chiropractors claim that chiropractic spinal adjustments are more specific, careful and safer than spinal adjustments performed by other practitioners, but they have not produced any scientific evidence that such claims are true."

That's very rough, but I think you get the picture. -- Fyslee / talk 13:53, 22 October 2008 (UTC)

What is the source for the last clause? Also, more than just straight chiropractics have claimed that chiropractic spinal adjustments are different from spinal manipulation performed by other practitioners. As such, this statement is misleading. -- Levine2112 17:06, 22 October 2008 (UTC)

• I very much agree with Levine2112 that we need a reliable source. Not only for the last clause, but for the entire sentence.
• Generally, I find that it's better to find reliable sources first, and summarize what they say, rather than writing the text first and then searching for reliable sources to support it. This practice tends to produce text that contains less POV.

Eubulides (talk) 18:36, 22 October 2008 (UTC)

References are needed for a specific proposal. QuackGuru 21:39, 22 October 2008 (UTC)

• I naturally agree with all the comments above (except Levine2112's ;-). My wording was a quick and rough sketch without refs. It was only provided to help us get moving. If such attempts aren't allowed....!?! I certainly don't think that my wording in that form without any refs is at all suitable for inclusion. Why not try to understand what I mean and be constructive, instead of just criticizing?

• The first half of the proposal needs sources that can best be supplied by Levine2112, since he is the one who is fighting for dubious straight chiropractic claims. I believe the claims exist, and he has stated that they can be documented with sources, even from researchers. Let's see the sources and maybe use them. The International Chiropractors Association, World Chiropractic Alliance, and Journal of Vertebral Subluxation Research websites would be good places to start for those types of claims. They are V & RS for such fringe opinions. PlanetChiropractic would also be good, but it's not a RS.

• -- Fyslee / talk 04:36, 23 October 2008 (UTC)

I briefly looked for reliable sources supporting the first half of the above claim, and I'm afraid I came up dry. Editors with access to a high-quality chiropractic library may have better results. I did come up with the following reliable source saying just the opposite, though, if that helps:

"Spinal manual therapy, also known as spinal adjustment or manipulation, is widely recognized as a valid treatment option for low back pain. In the United States, 94 percent of spinal manipulation is delivered by chiropractors." Redwood D (2003). "Spinal adjustment for low back pain". Semin Integr Med. 1 (1): 42–52. doi:10.1016/S1543-1150(03)00008-5.

Eubulides (talk) 07:29, 23 October 2008 (UTC)

I'm not sure how that applies here. We need to distinguish between documenting the factual accuracy/inaccuracy of the straight claim vs. documenting that the claim has been made. It is the last that we need here. The closest one I've found right now is this one from the ultra fringe (but very influential) ICA:

SPINAL ADJUSTMENT AND SPINAL MANIPULATION

The ICA holds that the chiropractic spinal adjustment is unique and singular to the chiropractic profession. The chiropractic adjustment shall be defined as a specific directional thrust that sets a vertebra into motion with the intent to improve or correct vertebral malposition or to improve it juxtaposition segmentally in relationship to its articular mates thus reducing or correcting the neuroforaminal/neural canal encroachment factors inherent in the chiropractic vertebral subluxation complex.

The adjustment is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion.

Chiropractic is a singular field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession.

It was found in this search of the ICA website. It happens to document that it is the "intention" that is the deciding difference. Similar searches of the other sites might turn up similar statements:

• Search of WCA website

• Search of JVSR website

Note that these searches turn up plenty of examples of how even straight chiropractors use the terms interchangeably! -- Fyslee / talk 14:25, 23 October 2008 (UTC)

The ICA quote defines spinal adjustment (SA) based on subluxation, but that topic is more suited for Chiropractic #Vertebral subluxation than for Chiropractic #Evidence basis. What the proposed text needs first is a source for its talk about claims that SA is "more specific, careful and safer" than spinal manipulation (SM) in general. I guess the ICA quote supports "specific", although I would much prefer a reliable secondary source to a primary source written by a fringe group. However, the ICA quote doesn't support "careful" or "safer". Sorry to be such a stickler here, but if we can't find reliable secondary sources saying that chiropractors claim the superiority of chiropractic SM over other SM, then we probably shouldn't be saying that either. Eubulides (talk) 17:02, 23 October 2008 (UTC)

I wholeheartedly agree, except that primary sources are acceptable for such claims, if they are V & RS for such opinions. They would of course need to be attributed. What I am basically doing is Writing for the enemy, which is a good NPOV, AGF, and collaborative practice for editors of all persuasions. Levine2112 has repeatedly expressed such sentiments (even before this latest RfC), and even claimed that researchers have written things that supposedly back up his POV. I have even requested sources from him. This is actually Levine2112's job, but I was attempting to show some good faith by helping him, since I do believe his claims are made by chiropractic sources, even though I believe they are false claims, like so many other chiropractic claims. I will now pass the baton and leave it up to him if he really does want such information in the article. -- Fyslee / talk 00:35, 24 October 2008 (UTC)

Exclusively?

Levine2112 seems to miss the point of the "not exclusively an evaluation of chiropractic" quote.(Emphasis added.) The important point is the word "exclusively", ergo not 100%. Yes, most SM research includes a very, very small amount of non-chiropractor performed SM. Since chiropractors perform 90%+ of SM, and most of these studies include the SM performed by these chiropractors, the studies say much, much, much, much, more about chiropractic SM (and therefore chiropractic, and the efficacy and safety of chiropractic SM), than it says about the miniscule numbers from the few others whose numbers were included. -- Fyslee / talk 06:13, 23 October 2008 (UTC)

Possibly misleading text or a weight violation from a source was added without discussion or consensus

Please revert and discuss major changes to the text. Or are we back to being WP:BOLD for this article. We can remove the controversy template that is towards the top of the talk page if editors agree. QuackGuru 01:53, 18 October 2008 (UTC)

• No, the usual style for Chiropractic is that we discuss possibly-controversial changes on the talk page, giving other editors adequate time to think and comment about the changes, before installing them. That was done for the previous version of the text in question: in Talk:Chiropractic/Archive 28 #Misleading sentence, four editors discussed an older version, proposed and refined the previous version over a period of eight days, achieved consensus, and eventually installed the change.
• In contrast, the edit you refer to simply installed a controversial change without discussion. This isn't a good way to proceed, for obvious reasons. I reverted the edit and am copying it here for further discussion (inserted text in italics):

A 2002 review of randomized clinical trials of SM was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular chiropractic SM in particular and studies of SM in general - most of which do not relate to chiropractic SM;

• The inserted text incorrectly summarizes Ernst 2002 (PMID 12379081), the cited source, for two reasons:

• Ernst 2002 nowhere says that these 43 trials are "studies of SM in general".
• As was explained repeatedly in #RfC comments, Ernst 2002 is not referring to "most" of the "studies of SM in general"; it is clearly referring to just the 43 SM randomized controlled trials cited by Meeker & Haldeman (PMID 11827498).

• Levine2112 originally claimed Ernst wrote that most studies of SM are not relevant to chiropractic SM, and responded to the explanations to the contrary (documented in the previous bullet) at first by disputing them and then by saying "As you know, I continue to disagree with you on this point. Enough said."
• Given that Levine2112 knew that the edit was controversial, it is disappointing to see that the edit was installed anyway, despite consensus on the talk pages that potentially-controversial changes should be discussed here first. I urge that we stick with that consensus; otherwise, editing on Chiropractic will degenerate back to the revert-war-happy state that it had not so long ago.
• I don't see an easy way to repair the edit above, other than by reverting. Perhaps another editor can come up with better wording. But please propose it here first, rather than installing it; this is a controversial area.

Eubulides (talk) 05:59, 18 October 2008 (UTC)

I read the source and what Levine wrote is documented in the source. . . may be we should just quote the source. . . that way there is no room for interpretation.TheDoctorIsIn (talk) 20:35, 18 October 2008 (UTC)

This edit is very misleading. The source does not support the change. Please specify where in the source documented this or revert your edit. QuackGuru 23:11, 18 October 2008 (UTC)

The way to settle this needs to start with an analysis of the source and the two conflicting edits. See below and comment there. -- Fyslee / talk 04:01, 19 October 2008 (UTC)

Analysis of the source and other versions

• "... The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation." - Original Annals of Internal Medicine source

Various versions:

• "... has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;..." - Previous version
• "... was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular;..." - Consensus version
• "... was criticized for not distinguishing between studies of chiropractic SM in particular and studies of SM in general - most of which do not relate to chiropractic SM;..." - version proposed by TheDoctorIsIn and Levine2112

Analysis comments

• Again, the source is not referring to "most" of the "studies of SM in general"; it is clearly referring to just the 43 SM randomized controlled trials cited by Meeker & Haldeman (PMID 11827498). This has been explained several times. in #RfC comments. No explanation to the contrary has been presented.
• I see that the incorrect version has again been installed, again without discussion here in advance, with the only comment being that the claim is "documented in the source". This claim is clearly not at all documented in the source; the source does not at all say that "most" "studies of SM in general" "do not relate to chiropractic SM".
• Again, the usual style for Chiropractic is that we discuss possibly-controversial changes on the talk page, giving other editors adequate time to think and comment about the changes, before installing them. Please do that here. It is not helpful to repeatedly apply this incorrect change.
• By the way, it's not correct to call the first version "Eubulides' version". That text was originally proposed by TimVickers here, and was the product of a consensus of four editors arrived at during a discussion over a period of several days (see Talk:Chiropractic/Archive 28 #Misleading sentence). More accurate would be "consensus version".
• For reference, here's the version that was in place before the consensus version was installed. Perhaps it can be used to come up with a compromise version.

"... has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;..."

Eubulides (talk) 07:21, 19 October 2008 (UTC)

Noted and changed. -- Fyslee / talk 16:23, 19 October 2008 (UTC)

Sorry if my edit seemed WP:BOLD, but I figured that we had discussed Ernst's quote ad nauseum, so making the tweak to reflect what I feel he is saying was no more controversial than what leaving what another editor interprets Ernst to mean. I saw it suggested - I believe in TDII's edit summary - that we simply quote Ernst rather than interpret what he is saying in his criticism. Clearly we disagree with what he is saying and we may never agree. Perhaps quoting is the best solution. How about this?

A 2002 review of SM was criticized because it claimed "that 43 randomized, controlled trials of spinal manipulation for back pain have been published," but failed "to mention that most of them do not relate to chiropractic spinal manipulation"; however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.

Reasonable? -- Levine2112 02:08, 22 October 2008 (UTC)

At first glance this seems like a good solution. What say others? -- Fyslee / talk 04:38, 22 October 2008 (UTC)

Stricken in lieu of Eubulides correct analysis of the situation. My comments were indeed a quick "first glance"! -- Fyslee / talk 19:32, 22 October 2008 (UTC)

The current writing style for this article is it to avoid quotes. Stating it claimed is not the way I would write the sentence. What is the point to say "most of them do not relate to chiropractic spinal manipulation"? That point can easily be misleading if the reader reads it wrong. The reader could think it means that most SM research does not relate to chiropractic spinal manipulation when we know that is false. The neutrally written and consensus version is: A 2002 review of randomized clinical trials of SM was criticized for not distinguishing between studies of SM in general... QuackGuru 04:55, 22 October 2008 (UTC)

• Certainly the quote marks are not necessary. Worse, in the proposed wording the quote marks are quite misleading, since they imply that the quote "43 randomized, controlled trials of spinal manipulation for back pain have been published," comes from Meeker & Haldeman 2002, which is certainly not the case. (Also, as a quibble, the Misplaced Pages style is to not put wikilinks in direct quotations.)
• Furthermore, this proposal seems to be ignoring Talk:Chiropractic/Archive 28 #Misleading sentence, the talk-page discussion that established consensus for the current wording. The earlier discussion said that the earlier wording "Some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM" was confusing, which it was. And yet this proposal merely resurrects the confusing wording, albeit with some misleading quote marks added to it (which makes things even more confusing). That is a step in the wrong direction. We need a better proposal, not one that is worse than what we had before the current wording.

Eubulides (talk) 06:22, 22 October 2008 (UTC)

Let's see. What could possibly be more misleading? A direct quote or an editor's interpretation of the quote? This material is contentious because we each have different interpretations of what it means. So let's just quote it and be done with it. It really is the most reasonable course of action here which will ensure that no editor is putting a POV twist on the quote's meaning. -- Levine2112 07:56, 22 October 2008 (UTC)

Certainly a direct quote can be more confusing if (as is the case here) it is cited so poorly that it appears to be from a different source than what it's really from. And there is nothing inaccurate or confusing about the consensus summary in Talk:Chiropractic/Archive 28 #Misleading sentence of what the source says. That summary is much briefer and clearer than the proposed replacement, and is therefore better suited for an encyclopedic article. Eubulides (talk) 08:11, 22 October 2008 (UTC)

I disagree that the summary is more accurate or clearer than the quote. I don't agree that the summary is an accurate depiction of the source. Can you explain how the quote is cited poorly and how it appears to be from a different source than what it's really from? Can you suggest any improvements using the quote? -- Levine2112 17:09, 22 October 2008 (UTC)

• The consensus in Talk:Chiropractic/Archive 28 #Misleading sentence is that the currently-installed text is clearer. If we can further improve it, that would be good, but simply reverting to the previous version (even with a couple of quote marks added) would go against that consensus.
• The proposed revision starts off this way:

'A 2002 review of SM was criticized because it claimed "that 43 randomized, controlled trials of spinal manipulation for back pain have been published,"...'

• This proposed wording makes it appear that the 2002 review of SM contains the text "that 43 randomized, controlled trials of spinal manipulation for back pain have been published". But it doesn't contain that wording.
• If words along the lines of the proposal are to be included, I suggest starting with the wording that was present before the consensus version was installed. This wording does not use the misleading quote marks. Here's the previous wording:

'A 2002 review of SM has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;...'

• The problem with this previous wording, as mentioned in Talk:Chiropractic/Archive 28 #Misleading sentence, is that it's confusing.
• Part of the confusion, I think, is that the surrounding discussion is quite general and then all of a sudden the text breaks into a very specific criticism of one relatively-old review. It would be better if we could keep the discussion general, always of course citing reliable sources. (This problem of confusion also exists in the current consensus wording, but it's a smaller problem there.)
• Perhaps you can think of a way to merge the clearer wording in the Talk:Chiropractic/Archive 28 #Misleading sentence consensus with the point discussed in the previous-to-consensus wording.

Eubulides (talk) 18:36, 22 October 2008 (UTC)

Please do me a favor so that I know you and I are on the same page. Please provide the quote of Ernst's in full which you believe I have quoted in part above. -- Levine2112 19:12, 22 October 2008 (UTC)

I did not state that the quote was from Ernst 2002 (PMID 12379081), nor have I checked whether the quote came from Ernst. The problem is that, with the proposed wording, the quote appears to come from Meeker & Haldeman 2002 (PMID 11827498), which it does not. At any rate, please think over the comments and suggestions above. Eubulides (talk) 20:51, 22 October 2008 (UTC)

Please proposed rewording so that the qoute is depicted more faithfully then. -- Levine2112 21:27, 22 October 2008 (UTC)

I disagree with having quotes. QuackGuru 21:34, 22 October 2008 (UTC)

(outdent)If a verbatim quote is seen as confusing by some editors, summary text cannot be agreed on, and even the meaning of the quote cannot be agreed on, then perhaps there is no consensus for inclusion? Why not just leave it out? --Surturz (talk) 11:27, 22 October 2008 (UTC)

There is consensus for the current version. The current version was included due to consensus and is much clearer. The new proposal is misleading. I disagree with deleting the consensus version. QuackGuru 16:04, 22 October 2008 (UTC)

There may have been consensus for that version, but consensus can change. It appears that there is no longer consensus for that version. DigitalC (talk) 01:02, 23 October 2008 (UTC)

So what version do you think has consensus? I think consensus has not changed. The current version is the consensus version IMHO. QuackGuru 01:07, 23 October 2008 (UTC)

I am not sure that consensus currently exists for any version. DigitalC (talk) 06:08, 23 October 2008 (UTC)

Most editors prefer the current version IMHO. QuackGuru 06:12, 23 October 2008 (UTC)

A majority opinion and a consensus are not the same thing. Consensus develops from agreement of the parties involved. You should know this by now. DigitalC (talk) 06:39, 23 October 2008 (UTC)

There was broad consensus for the current version. See Talk:Chiropractic/Archive 28 #Misleading sentence. Consensus has not changed. QuackGuru 06:43, 23 October 2008 (UTC)

3 editors does not make a broad consensus, and editors that did not respond then have responded now, so consensus HAS changed. Are you misrepresenting this on purpose? I believe a quote, or something more verbatim would be better. DigitalC (talk) 06:50, 23 October 2008 (UTC)

There were 4 editors back then, not just 3. Clearly the consensus that existed back then no longer exists, but there is no consensus for a new version either. Let's work together here in coming up with a new version. Eubulides (talk) 07:29, 23 October 2008 (UTC)

There were 4 editors, but one did not provide any comments towards a consensus other than that the paragraph should be reworded, which is hardly support for the current version. I may have missed this editors support for the current version ELSEWHERE, but it doesn't exist at the link provided. In fact, only one editor responded to the version you provided, and that was QuackGuru. I agree that we need to work together to a mutually agreeable version. DigitalC (talk) 09:55, 23 October 2008 (UTC)

Consensus has not changed to a different version and most editors are against the quotes. DigitalC, what is the problem with the current version and why would you think the quotes taken out of context is better? I don't think we need to continue to work towards a newer version when the current version is accurate and nothing proposed is as good as the current version. No problems have been pointed out with the current version but the quotes are problematic. QuackGuru 17:20, 23 October 2008 (UTC)

No one is stating that consensus has changed to a different version, however you are ignoring consensus that we need to work towards a better version. I don't believe that the quotes are taken out of context, and I do believe the current version is an inadequate summary. I believe it is very important that we include "most of them do not relate to chiropractic spinal manipulation", because this is quite relevant. You have not replied to my question as to whether you were misrepresenting the "broad consensus" on purpose. DigitalC (talk) 21:50, 23 October 2008 (UTC)

We don't need to work towards changing the current version when no problem with the current has been shown and no better version has been proposed. The better version is the current version. It was already worked on and improved. See Talk:Chiropractic/Archive 28 #Misleading sentence. The suggestions made here are not improvements. We have established consensus for the current version and I disagree with the proposed changes. QuackGuru 22:54, 23 October 2008 (UTC)

Consensus does not exist for the current version, please do not misprepresent that it does. You have still failed to answer whether you were purposely misrepresnting the "broad consensus". DigitalC (talk) 00:57, 24 October 2008 (UTC)

More potentially controversial edits

Here is the next possibly controversial edit for today. This changed or added text without a reliable reference. However, that section of the article has always been difficult to find highly reliable references. QuackGuru 23:22, 18 October 2008 (UTC)

Here are the conflicting edits:

• "Straight chiropractors believe that vertebral subluxation leads to interference with an "Innate Intelligence" within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment." - Original

• "Straight chiropractors believe that vertebral subluxation leads to interference with an "Innate Intelligence" normally communicated through the human nervous system. This interference creates a state of dis-ease (loss of homeostasis) within the body and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary in providing chiropractic care." - New version by anon IP

Let's analyze these and figure out which is closer to the truth of the straight position, and if it is justified by the source that has been used (). I have emphasized the changes in bold letters. -- Fyslee / talk 04:10, 19 October 2008 (UTC)

• The first change, '"Innate Intelligence" within normally communicated through the human nervous system', has some justification but is not quite right. The source says "Innate, he believed, was an intelligent entity which directed all the functions of the body, and used the nervous system to exert its influence." A better change would be 'Innate Intelligence" within exerted via the human nervous system'.
• The second change, "This interference creates a state of dis-ease (loss of homeostasis) within the body and is a primary underlying risk factor for almost any disease." is not supported by the cited source: it mentions "dis-ease" as the result of inflammations, but does not connect it to homeostasis. Also, the second change would modify Misplaced Pages so as to appear to endorse the theory of the straights, which we can't do.
• The third change, "unnecessary for treatment in providing chiropractic care" is I guess distinguishing chiropractic treatment from medical treatment, which has some justification. However, here's a shorter and better change: "unnecessary for chiropractic treatment".

Eubulides (talk) 06:30, 20 October 2008 (UTC)

• I for one am sad to see this edit removed. I laughed, anyway. --Surturz (talk) 02:25, 24 October 2008 (UTC)

Network Chiropractic

Is network chiropractic sufficiently noteworthy to be mentioned?

http://www.associationfornetworkcare.com/whatisnsa.shtml Campingcar (talk) 13:12, 19 October 2008 (UTC)

Currently Chiropractic #Treatment techniques lists only adjustive procedures received by more than 20% of patients of licensed U.S. chiropractors in the survey reported in Christensen & Kollasch 2005 (PDF), and neither Network Chiropractic Technique nor Network Spinal Analysis make that cut. There are a whole bunch of chiropractic techniques and we don't have room here to list them all. According to Table 10.12 of that source, Pierce-Stillwagon and Meric (which also didn't make the cut) are more popular than NCT or NSA (which I assume are are lumped into "other"). Eubulides (talk) 06:30, 20 October 2008 (UTC)

Thanks for the explanation.Campingcar (talk) 14:26, 20 October 2008 (UTC)

You might consider starting a separate article just for Network chiropractic. See if you can find third-party sources (not just ones promoting Network chiropractic) which discuss the topic. If you are able to find some good ones, then it might pass the WP:N threshold for article creation. -- Levine2112 02:12, 22 October 2008 (UTC)

Sounds like a good idea. There might be enough V & RS, so give it a try Campingcar. You could start it in a sandbox in your userspace and seek help and comments there. Then when it seems good enough to pass muster without immediately getting nominated for deletion, you can "go public" with it. Here's a sandbox for you to start with, if you wish:

• Network Spinal Analysis

Just start adding what you find there and format it like any other decent article. Good luck. -- Fyslee / talk 04:48, 22 October 2008 (UTC)

Trim vaccination section

A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination.

These are my reasons:

• It infers that antivaccination views are propagated by the College, when the article clearly states that this is not the case - antivaccination views were obtained from sources outside the curriculum.
• The sentence refers to a chiropractic students, not actual chiropractors. The preceding sentence talks about the policies and practices of actual Canadian chiropractors, and as such talking about Canadian chiro students is redundant
• The study did not follow a cohort through their studies, it compared seniors with freshmen. i.e. it did not measure an ACTUAL change in vaccination views - it assumed one.
• If certain editors want to push the line that chiro study teaches anti-vaccination, then they should say it outright and reference the assertion appropriately. I do not believe that it can be verified that any chiropractic curriculum teaches anti-vaccination views.

--Surturz (talk) 11:52, 22 October 2008 (UTC)

Well argued. I am persuaded to agree with you here, Surturz. -- Levine2112 17:19, 22 October 2008 (UTC)

I disagree. The current version accurately summarizes the reference. Editors can always make a rewrite proposal to improve on any sentence. We don't delete a sentence if it needs improvement. If improvements are needed, then make a proposal to improve it. QuackGuru 17:29, 22 October 2008 (UTC)

• Chiropractic students are not redundant; they are a different topic. The topic is, how do chiropractors come by their antivaccination attitude?
• There is no desire to "push a certain line". There is a desire to summarize what reliable sources say.
• The summary does not say that the study followed a cohort. On the contrary, it says that the survey was done in one school year, which means that the study cannot have followed a cohort. This point can be made more clearly by adding the phrase "cross section" to the summary.
• Certainly it can be documented by reliable sources that some chiropractic colleges teach a negative view of vaccination. For example, Campbell et al. 2005 (PMID 10742364), a reliable source already cited by Chiropractic, states that most colleges (presumably including CMCC) try to instill a responsible attitude toward vaccination, but: "Nevertheless, several colleges had faculty who seemed to stress a predominantly negative view of the role of immunization in public health."
• Rather than simply remove this well-sourced material, how about expanding it to cover the points you mention? Something like this, perhaps:

Although most chiropractic colleges try to teach about vaccination responsibly, several have faculty who seem to stress negative views. A survey of a 1999–2000 cross section of students of Canadian Memorial Chiropractic College, which does not formally teach antivaccination views, reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination.

Eubulides (talk) 18:36, 22 October 2008 (UTC)

Surturz, it's time to stop your endless campaign to delete this section because you don't like it. This article (and thus you) are under ArbCom-determined increased scrutiny and possible sanctions if certain conditions are violated, such as:

• "... editor repeatedly or seriously fails to adhere to the purpose of Misplaced Pages,..."

Disruption is such a violation, and these attempts of yours have been repeated again and again and again and are thus way beyond disruptive. Disruption here is sanctionable, and this type should lead to an article ban for a short period of time. You need to drop it and start collaborating instead of obstructing.

We don't delete content because of supposed imperfections, we improve it. In this case improvement will most likely mean better coverage, so if you insist on objecting more, we can always enlarge the section, because it must need it. Maybe you should read about what a Pyrrhic victory means and reconsider your strategy. Misplaced Pages history shows that whenever fringe POV have been pushed in alternative medicine articles like this one, it has inevitably resulted in the mainstream position being strengthened, since it has more credibility and far more and enormously better V & RS. In so doing it gets the weight it deserves. -- Fyslee / talk 03:25, 23 October 2008 (UTC)

I support the removal of this sentence. There is currently too much weight given to the vaccination sentence, and trying to ADD to it (as Eubulides suggested) would only add more weight. We already have information about the views of Chiropractors, so why include the views of Chiropractic students (from 10 years ago)?? DigitalC (talk) 06:14, 23 October 2008 (UTC)

We are using the most reliable sources available per WP:MEDRS. Surturz has concerns and the proposal addresses these concerns. The proposal adds context and makes it clearer to the reader. QuackGuru 06:19, 23 October 2008 (UTC)

My objection to the material has nothing to do with the reliability of the source, it has to do with the weight of the section. Adding more "context" does not reduce the weight of the section, but I also disagree that this information gives any more context. DigitalC (talk) 21:54, 23 October 2008 (UTC)

It makes is much clearer to have the new sentence in the article. QuackGuru 23:16, 23 October 2008 (UTC)

Can someone point to me a reason why this was removed from the vaccination section though? "A relatively small number of authors continue to disseminate antivaccination views." I believe THAT adds context, and should be paired with "the majority of writings", as has been agreed upon in the past. DigitalC (talk) 22:00, 23 October 2008 (UTC)

There was never any agreement for that sentence. It was no consensus. I believe it did not add context. QuackGuru 23:16, 23 October 2008 (UTC)

How about a compromise on the SM issue?

As far as I can tell from the time I've spent watching this page, there isn't a strong consensus as to whether or not general SM reviews can be used in this article without violating WP:OR. Mostly there are two camps on this: the first says that any use of general SM reviews is OR and not acceptable, the second says that any use of these reviews is not OR and is acceptable. Depending on which RFC or section is pointed to, the rough consensus appears to change; this is usually a strong sign that actual consensus on the issue isn't present. So, how about a compromise? It seems to me that there must be a middle ground between the two stances, and if an acceptable middle ground can be found everyone should be happy (at least marginally).

From what I've read, I believe that the following is a reasonable compromise. Keep in mind that this is only my editorial opinion and is in no way official. I also apologize if it is worded poorly.

My suggested compromise is to determine which exact types of SM chiropractors use, and then allow general studies about those forms of SM to be used in this article. In the most recent RFC, it was stated that when chiropractors and other professionals use the same technique, there are not significant differences between them. It therefore seems appropriate that these techniques specifically are considered directly related to chiropractic, and only general SM reviews (or parts thereof) which are about these techniques can be used in the article.

Anyways, I'm sure the regulars here can come up with a better compromise, I just thought I'd prime discussion with one of my own. Cheers, guys. lifebaka++ 19:44, 22 October 2008 (UTC)

• As far as we know all the spinal-manipulation sources currently cited in Chiropractic are based on data derived from techniques used by chiropractors. So I'm afraid we can't partition the studies in the way that you suggest. That is, the controversy arises here because some of the data was generated by non-chiropractors, not because some of the data was generated by techniques that chiropractors don't use.
• Furthermore, as far as we know there are no scientific studies on the effectiveness of individual SM techniques.
• In this respect, SM is like many other treatments. For example, acupuncture is used both by professional acupuncturists and by other professions (including MDs), and there are a zillion different acupuncture techniques (Lemington 5, Japanese Meridian, Korean Constitutional, French Energetic, etc., etc.), but reliable sources routinely amalgamate data from all professions and techniques to come to conclusions about the effectiveness of acupuncture in general. See for example, Furlan et al. 2005 (PMID 15674876).
• I agree that it would be nice to come up with some sort of compromise.

Eubulides (talk) 20:51, 22 October 2008 (UTC)

Copied from above, since it's relevant here. Levine2112 seems to miss the point of the "not exclusively an evaluation of chiropractic" quote.(Emphasis added.) The important point is the word "exclusively", ergo not 100%. Yes, most SM research includes a very, very small amount of non-chiropractor performed SM. Since chiropractors perform 90%+ of SM, and most of these studies include the SM performed by these chiropractors, the studies say much, much, much, much, more about chiropractic SM (and therefore chiropractic, and the efficacy and safety of chiropractic SM), than it says about the miniscule numbers from the few others whose numbers were included. Excluding such studies would be to exclude major sources of the existing research on the subject. There are some studies that clearly state that no chiropractor performed manipulations were included, and those might be excluded, but they are a small minority of studies. Since those aren't included at present, we have no real problem. -- Fyslee / talk 00:44, 24 October 2008 (UTC)

I feel that you are missing the point, Fyslee. If these studies are not exclusively about chiropractic (according to Ernst), then we shouldn't be using them to evaluate chiropractic. They are however exclusively about spinal manipulation. Thus it makes more sense to use them at that article. Anyhow, I am in favor of reaching a compromise. I will work my best at suggesting one and discussing other ones. -- Levine2112 00:50, 24 October 2008 (UTC)

My point is that you are demanding that we exclude studies that are usually about 95% chiropractic spinal manipulation (IOW "adjustments"), because they might include an extremely insignificant 5% or less non-chiropractor performed SM. To claim that they are not about or related to chiropractic SM is rather puzzling, since these are the highest quality studies that exist.

Are you really advocating that we reject the high quality studies in favor of the few low quality studies (5% more chiros) produced by chiropractors who have grown up in a tradition where rigorous scientific research skills and experience are lacking, as has been the case until very recently? There are even a few who don't understand scientific methodology and are clinging to those poor research skills, and they are producing (and publishing in) the JVSR.

Using your reasoning, it's interesting that the way to make a high quality study (5% non-DCs) into a low quality study is to just replace them with 5% DCs. Hmmm... food for thought. I guess that could imply that having no DCs in the study at all could make them astronomically high quality, but it takes more than that to make a high quality study. It takes a long tradition for producing high quality scientific research, and that is one thing the chiropractic profession lacks. Fortunately some DCs are learning (with the notable absence of the JVSR, ICA, and WCA crowd) from the medical establishment's long experience in this regard. -- Fyslee / talk 05:30, 24 October 2008 (UTC)

It doesn't matter how high quality the study is; if it doesn't specifically address chiropractic in its conclusions, we cannot apply those conclusions to chiropractic. If the researchers intent was that their study was about chiropractic, then they would've mentioned it in their conclusions. If they don't mention it in their conclusions, then we can't assume that it can be applied to chiropractic. I can find you the highest quality research on palm trees, but it doesn't mean that we should include that in an article about icebergs. So you see? I am not demanding that we exclude studies because the might include non-chiropractic performed SM (as you state above). Rather, I am suggesting that we exclude studies that make no conclusions specifcally about chiropractic (you know, the subject of this article). If the conclusions are only about spinal manipulation in general, then let's put it in that article. -- Levine2112 07:10, 24 October 2008 (UTC)

Since we just completed an RfC that showed a clear consensus that SM is relevant to this article, its not helpful to continue the argument that they studies aren't relevant for that reason. If you have specific concerns about text or studies being used in the article currently other than "the study was on SM, not specifically chiropractic" then please state them and give other editors a chance to address those concerns. Shell 07:30, 24 October 2008 (UTC)

Clarification of manipulation/adjustment

The article needs a short explanation of the similarities (plural) and difference (singular) between spinal manipulation (SM) and chiropractic spinal adjustment (SA). The issue is sufficiently clouded even among expert editors here that it must be even more unclear to readers, and therefore we need to make sure they understand the matter.

There are multiple physical similarities between SM/SA performed by DCs and SM by non-DCs. There is only one difference between SA performed by straight DCs, and SM performed by non-DCs, mixer DCs, and reform DCs, and that is the mental intention to "correct a subluxation". It's a philosophical distinction, not a physical one.

We need to show that chiropractors and published chiropractic research often use the terms interchangeably as synonyms, and that it is only straight chiropractors who insist on using the "adjustment" terminology, since they are the only ones who consistently adhere to the "subluxation correction" principle. Yes, other DCs may use the term, but not consistently, and pretty much never in quality research.

There are currently multiple examples of uses of the terms in the article, with a vast overweight of SM in relationship to SA, which is proper since SA is a special and esoteric term used primarily by straight chiropractors.

There are two places in the article where this can be addressed:

• Schools of thought and practice styles

• Treatment techniques

-- Fyslee / talk 05:59, 24 October 2008 (UTC)

I am concerned with how you are starting this off. It seems to be weight heavily by your own opinion rather than by reliable sources. I have already presented several non-chiropractic reliable sources which suggest that there are more than just one difference between spinal manipulation as performed by chiropractors and spinal manipulation as performed by other practitioners. For instance, Villanueva-Russell 2005 (PMID 15550303) draws the distinction between chiropractic adjustments and general manipulation: "It should be noted that chiropractors consider the technique of "adjustment" to be exclusive to their profession, and distinguish the clinical procedure as separate from the more general medical term of "manipulation," which is a more generic, often long-lever movement of joints, not restricted to the spinal vertebrae, alone." We might also want to consider Association of internal carotid artery dissection and chiropractic manipulation'' from The Neurologist 2003 where we learn the vionet long-lever manipulation technique that has lead to some injuries is actually used by other practitioners and is not taught in chiropractic schools:

Violent long-lever manipulation, commonly used by untrained manipulators, is not taught in any of chiropractic institutions in the United States. This may be the reason nonchiropractic providers have been responsible for a disproportionate share of reported cases of manipulation following ICAD. CMT is a highly specialized procedure that is the focal point of the educational process of chiropractic physicians. Some would argue that osteopathic physicians are comparably trained in manipulation, yet, according to the Policy Statement on Spinal Manipulation published by the American Chiropractic Association, most osteopathic schools only offer spinal manipulation on an elective basis. This compares with chiropractic education, which devotes approximately 52% of its 4-year education to diagnosis and manipulation.

CMT encompasses short-lever, low-amplitude thrusts that are directed segmentally, and simultaneous neck extension with rotation are minimized, whereas less-formal cervical manipulation may consist of long-lever thrusts, with contact only applied to the patient’s head.

With regards to Fyslee's proposal, I hope reliable sources like these are factored in more, and editors' opinions are factored in less (if not at all). -- Levine2112 07:35, 24 October 2008 (UTC)

References

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