Misplaced Pages

Revision as of 11:37, 28 July 2006

The subject of this article is controversial and content may be in dispute. When updating the article, be bold, but not reckless. Feel free to try to improve the article, but don't take it personally if your changes are reversed; instead, come here to the talk page to discuss them. Content must be written from a neutral point of view. Include citations when adding content and consider tagging or removing unsourced information.

Please stay calm and civil while commenting or presenting evidence, and do not make personal attacks. Be patient when approaching solutions to any issues. If consensus is not reached, other solutions exist to draw attention and ensure that more editors mediate or comment on the dispute.

Template:Cleanup taskforce closed

Archives
Mar 2003 to Apr 2004 Sep 2004 to Oct 2004 Feb 2005 to Jul 2005 Aug 2005 to Oct 2005 Nov 2005 to Dec 2005 Jan 2006 to Mar 2006 Mar 2006 to Apr 2006 Apr 2006 to May 2006 May 2006 to Jun 2006

anonymous stroke study

An anonymous editor added the following to the bottom of the chiro page;

• Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck.However, most publications describe only single case reports or a small number of cases. We analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with chiropractic neck manipulation. We conducted a countrywide survey at neurological departments of all medical schools to identify patients with VAD after chirotherapy followed by a standardized questionnaire for each patient. 36 patients (mean age 40+11 years) with VAD were identified in 13 neurological departments. Clinical symptoms consistent with VAD started in 55% of patients within 12 hours after neck manipulation. Diagnosis of VAD was established in most cases using digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. 90% of patients admitted to hospital showed focal neurological deficits and among these 11 % had a reduced level of consciousness. 50% of subjects were discharged after 20±14 hospital days with focal neurological deficits, 1 patient died and 1 was in a persistent vegetative state. Risk factors associated with artery dissections (e. g. fibromuscular dysplasia) were present in only 25% of subjects. In summary, we describe the clinical pattern of 36 patients with vertebral artery dissections and prior chiropractic neck manipulation.

J Neurol (2006) 253 : 724–730

This is interesting information and in the right format it could be used in the safety section. It needs to be properly referenced and cannot be original research. So, anonymous editor, please sign in and reintroduce this right here in this discussion section and lets consider this.

BTW I'll be out till sunday. Everyone have a great weekend! --Dematt 18:23, 30 June 2006 (UTC)

Series of copy edits completed to tighten - please check, don't think there's anything controversial in what I've doneGleng 19:45, 2 July 2006 (UTC)

Excellent work Gleng, it's amazing the things (mispelling, grammer, etc.) that you don't see after reading the same thing over and over:) I'm impressed that you actually read the whole thing at least twice! I only saw one change that I question , but I can't figure the best way to say it. Have you finally decided that it is USA, not US or U.S.A. or United States or Yanks:) --Dematt 23:20, 2 July 2006 (UTC)

Bonesetting

That was a joke, right! .. ... or was it?--Dematt 23:22, 2 July 2006 (UTC)

Okay, if not, IMO bonesetting is an art that has it's own history and relevance that is seperate from chiropractic. I don't know much about it, but I'm sure there is information out there that needs to be researched in its own right. If it is determined that it's relevance fits with chiropractic in some way, then we can wikilink it then. But, people looking for bonesetting are not looking for chiropractic. They should not be merged.--Dematt 02:56, 3 July 2006 (UTC)

Agreed. They are two divergent disciplines. Levine2112 04:45, 3 July 2006 (UTC)

Alot of principles apply to both, but bone-setting is new to me, chiropractic isn't. That should spell alot. Don't merge. Drdr1989 00:24, 5 July 2006 (UTC)

Ummmm, I think it should have it's own article expanded, not merged with chiropractic. Seperate and distinct.--Hughgr 02:39, 5 July 2006 (UTC)

"Fact" sheet?

I have been reviewing the so-called National Council Against Health Fraud "Fact Sheet" on Chiropractic and noticed that while it starts out with some facts, it quickly morphs into an anti-chiropractic opinion piece. Therefore I have removed the link. Steth 12:43, 4 July 2006 (UTC)

It is a useful external link, and completely harmonious with our external links policy. However, it would be acceptable to call it something other than a fact sheet on the links if you prefer. Jefffire 12:49, 4 July 2006 (UTC)

Science section

Hey guys, we have this sentence in the science section.

• However a bigger difference is that conventional medical treatments, especially new treatments, often have a stronger scientific foundation, in that their rationale is supported by experiments that analyse their mechanisms of action in detail.

I'm not sure that it is accurate, but I am open to rationale. The reason being that today's chiropractor was educated in the basic sciences along side pre-med students, has a degree in biology and/or human biology that was taught by PhD's in their fields and learned most of his/her rationale from the same sources as MD's, e.g. Physiology, Anatomy, Biochemistry, Human Dissection, etc., etc. Most chiropractors treat based on the same rationale that MD's treatments are based on. DC's read the same peer-reviewed studies that MD's do, though they also read other sources as well. From what I gather, the only difference may be that they do look at the same information from a vitalistic rather than allopathic POV. I think that is all we can realistically say.

Because the subject of chiropractic is so diverse, I think it is necessary to seperate the information into musculoskeletal and organic(for lack of a better word) conditions.

If we consider that there are theories (lets call them that for now) that are based on the musculoskeletal system and treatment of low back pain, neck pain, etc. And considering that most of what DC's treat are back pain, I think we can assume that most of what DC's do is based on science that is just as strong as conventional medicine, and I might even suggest, is the science that medicine now uses as well, i.e. ice instead of heat for acute low back pain. Just take a look at the research that has been going on at National College, Lincoln college, St. Louis College, etc., since they opened and you will find every approach evaluated long before conventional medicine even considered looking at them. DC's have been researching back pain, neck pain, ultrasound, electrical stimulation, ultraviolet, acupuncture, acupressure, radio waves, color therapy, light therapy, diagnostic tests, all types of equipment, etc. since the early 1900's. Most of the research that debunks several of the treatments of the past came from DC's. Certainly, initially, the research was not up to today's standards, but neither was conventional medicine's. The point is, that the research is there, the effort is and has been there, and continues to look for the best way to treat today's problems - and is just as valuable to the treatment of musculoskeletal problems as conventional medicines research into their medications. An unbiased evaluation reveals a system of pain management that conventional medicine strives to meet. We should assume that it is based on good science until proven otherwise rather than the other way around. Considering that, lets show some of the actual research that is out there.

Now, when it comes to the theory that subluxations cause organic (meaning non-psychosomatic)diseases, there is also research. Certainly the quality leaves some question, mostly because it is difficult to prove with current scientific methods, but that does not mean it is not there. IMO, it, too should be noted in the article as well as referenced (key word- referenced)comments about it's weaknesses and strengths.

Any thoughts?--Dematt 04:49, 6 July 2006 (UTC)

I guess that sentence was mine. The rationale for it is as follows; when new conventional treatments are introduced, clinical trials are just the final stage. Before that stage there is now very extensive basic research on animals and cell lines and then on human volunteers. The basic research seeks to validate the principle behind the treatment - so for a new drug, that research might test whether the drug is specific and selective in its actions, usually by showing that it binds competitively and selectively to a particular known receptor, and characterising its action as agonist/antagonist/invers agonist etc. After characterising the ligand there then need to be studies showing a)that disturbance in that receptor system has pathologically involved in the disease process and that interventions at that receptor can ameliorate it. This might be done for instance by human genetics studies looking for mutated alleles in the case of genetic diseases, or by gene microarray studies in the case of other diseasesThese days this is often achieved in part with transgenic animal models where the expression of the receptor (or an endogenous ligan) is genetically engineered to be up regulated or down regulated, and the phenpotype of the transgenic animal is studied. I don't want to go on, but my point is simply that validation of efficacy is generally only the last stage of introducing a new treatment; and that the rationale of the treatment generally will have been extensively tested in lab experiments beforehand. There is a huge amount of basic research behind new drug treatments, and most new drugs never get close to the clinical testing stage. I did not at all mean to denigrate the training or understanding of chiropractors, or suggest that clinical studies by DCs are less good than those by conventional medics. Many conventional medical treatments have not been scientifically validated in this way, and often it is difficult to do this - for example, a bugbear of mine, the current management of labor in maternity wards would not stand up to scientific validation, but it would clearly be potentially unethical to experiment with a mode of management that is known to be safe whatever your reservations, and has been used for 50 years. So many older treatments were introduced and continue to be used solely on the basis of clinical experience. However this is rarely true of new treatments. The analagous investigation for chiropractic would be studies on the anatomy and functional role of spinal nerves and of their involvement in specific disease processes. Again, this type of experiment could certainly be done in animal models - but I don't think has been. Gleng 16:31, 6 July 2006 (UTC)

I believe that the sentence could be reworked to be made more accurate and less denigrating. To say that there is less experimentation in existence for chiropractic's rationale than conventional medical treatment is rather unfair. Wilk has shown us that chiropractic has really only had but 20 years of funded and scientifically recognized research. What we do know clinically about chiropractic is certainly limited, but the rationale is certainly supported scientifically to some extent. My fear is that there are a lot of anti-chiros out there who claim chiropractic is no different that a faith-based medicine. I think we can all agree that it is not. They might see a sentence like the one in question and jump all over it.

Yesterday, I happened across a piece of research on reflex effects of vertebral subluxations at JMPT. It's not the best piece of research I've seen, but it does look at human and animal models and suggests that vertebral subluxations may modulate activity in afferent nerves. Anyhow, I thought Gleng might find it interesting based on his last paragraph above. Levine2112 18:30, 6 July 2006 (UTC)

No problem Gleng. In fact, I bring this up because it was you that made the statement and I know you would look at it objectively. My point is that if we think of chiropractic as two pronged; 1)treatment of back pain and 2)treatment of subluxation, then we have to compare apples to apples.

• The science for 1) back pain is the same science that conventional medicine uses as we both use the same information. Whether it was performed by MD's, DC's or PhD's.
• The science for 2) subluxation cannot be compared to science done by conventional medicine, because they have never performed science in an effort to test the subluxation hypothesis. If they had tried, I would venture to say that their methods would be no better than that presented by DC's as the difficulty in testing is the problem.

So, my contention at this point is that the statement;

• However a bigger difference is that conventional medical treatments, especially new treatments, often have a stronger scientific foundation, in that their rationale is supported by experiments that analyse their mechanisms of action in detail.

does not compare apples to apples. Make sense? or am I off the deep end? How can you say one is better than the other?--Dematt 19:24, 6 July 2006 (UTC)

The House of Lords committee report covers all CAM not just chiropractic - chiropractic is Group 1 and comes off well generally in the report, but the report seemed to make some apt points: "The Department of Health summed up their opinion of the evidence base "Evidence for CAM in the form of research has been criticised as being inadequate, and there is some justification in this claim" the Department of Health that the same could be said for some conventional medicine. It is our view that most modern conventional therapies are backed by scientific evidence. ...There are two notable weaknesses of the evidence base for CAM. One is that in most of these areas little research is being done, and the second is that the few studies which have been completed are given disproportionate weight. ..All the therapies .. in Group 1 either have done, or are working on, rigorous trials to test their claims. However, one or two studies with positive results in support of their claims for efficacy are not enough. ..... Evidence for the efficacy of the treatment itself is not the only important factor .. evidence of the validity of diagnostic procedures is as important as evidence supporting efficacy of a treatment.....Diagnostic procedures must be reliable and reproducible and more attention must be paid to whether CAM diagnostic procedures as well as CAM therapies, have been scientifically validated."

I accept that physical therapies may be just as empirically driven as chiropractic. Any implication that chiropractic practices are faith based is unintended. I also agree that much conventional medicine is validated in a very similar way to chiropractic. Validation of a medical treatment is multi-facetted, Clinical trials are not the whole answer -in all trials there are non-responders, so even when a trial validates the general effectiveness of a treatment, this is not the same as declaring its universal effectiveness. The key to rational medicine is identifying in advance which patients will respond to a treatment, and this means understanding the differing aetiologies of disease and diagnising them accurately. The role of basic science is to establish the mechanisms of disease in a way that translates into diagnosis and treatment, and in a way open to scientific test and falsification or verification. Chiropractic has a strength in seeking to understand the "whole patient" and seek individualised treatment. I think the chiropractor uses his or her experience and the collective empirical experience of chiropractors to come to a diagnosis and recommend a treatment. However these circumstances are precisely those when the influences collectively called the placebo effect will be most influential, so part of the effectiveness of chiropractic seems certain to be accounted for by a strong placebo effect. To refine and improve treatment it is important to identify where the effects of treatment go beyond this. This I think is where the scientific basis of chiropractic looks weak because of a shortage of research. I think the theory needs to be elaborated with more detailed functional and anatomical studies, (studies exactly like those found by Levine above - thanks for finding this Levine; obviously there are people on the case here). However, that's my opinion; what I was trying to do here was to characterise the nature of the evidence for the effectiveness of chiropractic while acknowledging areas of relative weakness - in the sense that the scientific foundations are deficient because more research is needed, not because the foundations are implausible or dogma based.Gleng 11:46, 7 July 2006 (UTC)

So, can we agree that we could contend that- for back pain related research - the body of science for physical therapies and conventional medicine is essentially on the same footing as chiropractic, though all may lack some quality? It is the claim for health related benefits of chiropractic that lacks sufficient evidence, as the body of quality science available is insufficient to draw conclusions about specific diagnostic or treatment methods. --Dematt 13:06, 7 July 2006 (UTC)

I think that's fair, though I'm conscious that we're getting into OR and our interpretations here, so it would be best to agree that this seems a fair reflection and find some authoratative statement backing it - one reason I've been stressing the report above is to see if we can use this as authority for what is said here. Personally I think this report was a well informed and balanced overview, might be a bit out of date now, and not specific enough about chiropractic, but it's the clearest and most responsible acount of the confounding effects of the placebo effect that I've seen. Overall it's sympathetic to chiropractic while keeping an objective distance, and not shy of stating where the potential problems areGleng 14:07, 7 July 2006 (UTC)

Okay, thanks Gleng, just had to get it straight in my head as we work our way though this. I appreciate your knowledge as well as your candor. Feel free to keep me on track during this process as I am sure my bias will occasionally rear it's head:) --Dematt 18:11, 7 July 2006 (UTC)

"Adjustment" claim

The following self-glorifying (?) claim in the article is problematic:

"The chiropractic adjustment differs from other manipulative techniques in its precision and accuracy in correcting vertebral subluxations."

• It makes an undocumented claim:

... that it is more precise and accurate than "other manipulative techniques," when in fact an adjustment can be performed precisely or imprecisely, accurately or sloppily, and other manipulations performed by other professionals can be performed just as precisely or imprecisely. Skills vary among chiros and among other professionals, but only chiros call it an "adjustment," regardless of whether they've done it well or not. This does not deny that it should naturally be the case that more chiros are skilled at it than the number of those skilled at it in other professions, since it is the hallmark skill of chiropractic.

• It does not differ for the reason claimed, but for another reason:

... it is performed for another reason than other manipulations - it is performed to correct vertebral subluxations. Other manipulations performed by other professions (and reform chiros) are performed for other reasons. Only those who believe in vertebral subluxations perform "adjustments" to correct them.

The defining difference is the intent. The sentence should be reworded or deleted. I favor rewording it, since this difference in intent is crucial to an understanding of chiropractic, and should not be left unsaid. -- Fyslee 14:42, 8 July 2006 (UTC)

I beg to differ. Historically, manipulations were given to a general area, where as the adjustment was given to a single, specific vertebrae.--Hughgr 18:42, 8 July 2006 (UTC)

I understand what you're saying, but the facts (not the same as "intention") say otherwise. Historically that may be so, but nowadays manipulation can and often is directed at a specific movement segment (I assume you are referring to such), at very specific angles, but in fact it is impossible to limit the effects of an adjustment or manipulation only to that segment, although an attempt to do so will help to limit it to the local area. A failure to attempt such limitation will result in a general mobilization of the area (which will still do the job in most cases.....;-). -- Fyslee 22:33, 8 July 2006 (UTC)

Wow, this is basically the same conversation we are having on the VS page. Down to the minute:) I'm moving it here so we can work on it together;

Hey guys, Fyslee made a much needed edit;

• It could be said the one thing that separates the chiropractic adjustment from other manipulative techniques is the aim toward specificity.

  It could be said the one thing that separates the chiropractic adjustment from other manipulative techniques is the aim toward specific treatment of subluxations.

When I read the original sentence, I thought it was talking about the difference between what is claimed to be the more generalized osteopathic manipulative techniques that "crack" them all vs the claim to adjust just the specific subluxation necessary. This new sentence seems to say that they only treat subluxations. Is that what we meant? And is that what we want? And if so, maybe we can add the comparison with the osteopath. --Dematt 22:33, 8 July 2006 (UTC)

My edit summary:

"undocumented assumption reworded to accurate description"

I attempted to resolve a problematic wording by replacing it with something that was at least accurate, even if it might have changed the originally intended (and undocumented) assumption (meaning). Maybe I interpreted it incorrectly. I hoped to create a wording that could stand up to scrutiny. The original was lacking - in my opinion. -- Fyslee 22:44, 8 July 2006 (UTC)

I have to agree with Fyslee. Either his statement should stay or we need to document that the DC's technique is different and more specific. Otherwise, we state that DC's think that their technique is different and allow appropriate discussion to the contrary. Is this a fallacy that DCs are led to believe by their instructors; is it a fallacy that DCs lead their patient's to believe for some reason; is it a fallacy that DCs want other professionals to believe as a proprietary or legal protection; or is it true.

I think there are times when it is accurate to say that the adjustment is more specific. For instance, with HIO that only adjusts the atlas or Gonstead technique that only adjusts the major subluxation in the specific direction of fixation there is no doubt about specific adjustments to specific vertebra. I would imagine that the actual statement came after BJ narrowed treatment to HIO. However, by that time, diversified technique had already been circulating (Langworthy incorporated lots of techniques at ASC), the adjustments tend to be more generalized and will move more than the intended vertebra. We can say DD noted that the difference was using the short lever for the adjustment, but even he began to adjust different vertebra with different methods, probably a lot borrowed from osteopathic and bone-setting techniques.

So maybe it's a little of all these things. If we use one sentnence, it would be more accurate to use Fyslee's version. Or we have to expound and document. If there are some facts out there, lets see them.--Dematt 03:47, 9 July 2006 (UTC)

In regard to Dematt's first paragraph above, I think we could answer "All of the above." It can be very precise, it can also be a delusion, and it can also be a sales gimmick. It depends on the situation, the chiropractor, the school, etc. All of the above are definitely true at times, but just as certainly not always.

One can make a rock solid case for one thing: the (only?) absolutely defining difference between the chiropractic "adjustment" and joint manipulation is the intention - to correct vertebral subluxations (VS). Only chiropractors have a patent on this concept, as well they should.

One cannot make a solid case for degree of accuracy or precision, since that depends on the skill of the one doing it. This is true among chiros themselves. There are MDs, DOs, and PTs who are just as skilled at doing precision manipulating as any DC. Certainly not as many, but they do exist. Yet they don't do it to correct VS, and they do it only in the presence of symptoms, whereas many DCs perform adjustments based solely on the DCs own determination of the presence of a subluxation. It is this type of asymptomatic treatment that raises the hackles of skeptics, and is specificially singled out by many insurance companies as non-coverable. It lessens the credibility of the whole profession, to the detriment of many sincere and highly skilled DCs.

I originally saw the first version of the sentence in question as a blatant attempt at putting one-upmanship into the article, but I let it ride for awhile. When I saw that it was still there without being dealt with as a clearly POV sales trick, I decided to attempt to at least make the statement accurate in some sense, without starting a debate over the original intent. Better to let it die a quiet death....;-)

I certainly would have no problem with an added sentence explaining that chiropractors are trained to perform specific adjustments with great accuracy, but it shouldn't be written *as if* they are the only ones who can do it specifically and accurately. That is actually becoming less true all the time, in keeping with the increased training many PTs are receiving in manipulative techniques. Since the article is about chiropractic, and not about MDs or PTs, they don't need to be mentioned, or any comparison made. That would avoid any one-upmanship problems. It goes without saying that the greatest number of skilled joint manipulators are to be found in the chiropractic profession.

One thing to keep in mind - a joint cares not about the intention of the manipulator. As long as the manipulation/adjustment is performed properly, some relief should occur. The chiropractic intention (correcting VS) has its greatest effect on the mind of the patient and on the chiropractor's own sense of having done a good job. Fantastic placebo effect and marketing technique (which is constantly being misused by practice builders to manipulate patient's minds). The joint couldn't care less who did it or why. -- Fyslee 14:48, 9 July 2006 (UTC)

So the who and why only become important when considering when and how much and how often.--Dematt 11:49, 10 July 2006 (UTC)

Well.....taking into account that my statement is rather simplistic, yes. Of course there can be other factors to consider, but from a purely physiologic sense, without the psychological/placebo aspects, a joint in need of a manipulation/adjustment should respond positively. -- Fyslee 16:57, 10 July 2006 (UTC)

And your statement allows for an important philosophical difference among manipulators. If we consider just objective straights, they would manipulate different vertebrae at different times for different reasons and possibly more often than PT's, MD's and even some (or they would argue, most) DC's. So the difference may not be so much the specificity of the manipulation as much as the specific purpose. I.e., if your purpose is to reduce pain, 10 visits with some exercises and IBU might do the job, but if your purpose is to "affect dyspepsia with or without spinal pain" it may take 30 visits and stay away from the IBU. Thus, Fyslee's statement of manipulating the vertebral subluxation is probably more accurate as it encompasses this concept without regard to other manipulators and their skills and purpose.

Just to add my two bits, it has been my understanding that the manipulation was to a general area, whilst the chiro adjustment was to a specific, single vertebra with a specific line of correction. But perhaps that not as accurate now as it once was. I have no problem with the current wording. but I'd just like to show a quote I found that shows why I've thought this.

"Yes, there are osteopaths, a few orthopedist, and some physiotherapists who "manipulate" the body, including the spine. But because of their general dirth of training, because of their tendancy to non-specificity in their manipulations, because they see manipulations limited to musculoskeletal problems, and because they tend to lack a meaningful, practical grasp of the hierarchial arrangement of the body's systems, their manipulations are unable to approach the clinical results of chiropractors. That of course could change with time...The concept of analyzing and correcting the full spine, as a functional unit, would not rest well with allopathic thinking." (vs. only manipulate area with pain) V. Strang, 1984 Essencial Principles of Chiropractic--Hughgr 19:02, 10 July 2006 (UTC)

Putting together all that, how about:

• Chiropractic's contribution to the field of manipulative therapies is the concept of applying a precise adjustment to a specific affected vertebra rather than the generalized maneuvers of the early osteopaths. Though other healing arts have recently begun to develop their skills in this area, the use of spinal manipulation in an attempt to correct the theoretical vertebral subluxation remains solely a chiropractic endeavor.

--Dematt 19:38, 10 July 2006 (UTC)

I like it. Levine2112 21:06, 10 July 2006 (UTC)

Very good. -- Fyslee 14:35, 11 July 2006 (UTC)

Cool, I'll put it in and see what happens:) --Dematt 14:43, 11 July 2006 (UTC)

Sorry, I didn't see this discussion before my edit. However, the statement "...other healing arts have recently begun to develop their skills in this area..." presupposes that they need to, which may not be generally accepted. — Arthur Rubin | (talk) 17:32, 11 July 2006 (UTC)

No problem. That's a good point. Keep thinkin' :) --Dematt 18:10, 11 July 2006 (UTC)

I've just tried to salvage the most important point. -- Fyslee 19:03, 11 July 2006 (UTC)

I took the extra mile:) --Dematt 19:35, 11 July 2006 (UTC)

Research funding

Always an issue with research, I figured it best to add at least paragraph describing the nature nature and state of chiropractic research funding. The most info that I could locate was from the Cherkin/Mootz report Chiropractic in the United States Training, Practice, and Research <-- PDF. However, the data presented in this report is only accurate as of 1997. Updates and revisions for encyclopedia accuracy is appreciated as always. Levine2112 17:27, 10 July 2006 (UTC)

Good, thanks Levine! I keep going back and forth trying to decide how to address research funding. I feel like there should be something in the history that mentions the AMA role in restricting research efforts and the monetary effects of schools being private instead of public. If you come up with anything, that would be great as well.--Dematt 21:07, 10 July 2006 (UTC)

I am looking around for this and more current data about the state of chiropractic research funding. Levine2112 21:09, 10 July 2006 (UTC)

Also, from Wilk vs. AMA,

"Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country." Interesting, eh.--Hughgr 22:01, 10 July 2006 (UTC)

Wow, that says a lot. --Dematt 22:04, 10 July 2006 (UTC)

archive?

Could we archive this, its getting really long. Thanks.--Hughgr 19:45, 11 July 2006 (UTC)

Done, hopefully to everyone's satisfaction. -- Fyslee 20:15, 11 July 2006 (UTC)

Thankyouverymucha :)--Hughgr 23:34, 11 July 2006 (UTC)

Muchos Gracios Amigos! --Dematt 03:41, 12 July 2006 (UTC)

Mange tak! Levine2112 03:50, 12 July 2006 (UTC)

Det var så lidt. Da nada. -- Fyslee 09:45, 12 July 2006 (UTC)

Inappropriate Utilization of cervical manipulation

Hi folks,

I added a few lines discussing Rand's finding that cervical manipulation is used inappropriately. Please review. Abotnick 03:05, 20 July 2006 (UTC)

My first comment is that you wrote: "the Rand corporation reviewed chiropractic usage of neck manipulation", but the reference you are pointing to doesn't specify "chiropractic". Did the actual Rand study only include "chiropractic" usages, or is this one of those case where they are also including a blind masseur and an Indian barber's use of neck manipulation? (See Terrett AGJ: Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. JMPT 1995;18:203) If it was not limited to chiropractic then it isn't really relevant to this article and should be removed.

Second, note that the number may be incorrect or misleading. Here in a summary of the RAND report the numbers are different and you can get a clearer picture of the story. The panel demonstrated clear agreement on 40% of the indications and clear disagreement on 2% of them. Regarding the appropriateness of cervical manipulation or mobilization for the indications 43% of the indications were rated inappropriate for the intervention with 41% ranking as uncertain and 16% considered appropriate. Levine2112 03:21, 20 July 2006 (UTC)

The NCAHF link in the article doesnt' work, and the rand ref is only a cover page, so there's not much info. Do you have the report Abotnick? What needs to be answered with this discussion is whether or not the "whole" spine works as a functional unit, or is it just individual motion segments.--Hughgr 18:06, 20 July 2006 (UTC)

I made some changes. See what you think. I may have changed too much, so feel free to change it back.--Dematt 18:28, 20 July 2006 (UTC)

L>:My first comment is that you wrote: "the Rand corporation reviewed chiropractic usage of neck manipulation", but the reference you are pointing to doesn't specify "chiropractic".

L>Did the actual Rand study only include "chiropractic" usages, or is this one of those case where they are also including a blind masseur and an Indian barber's use of neck manipulation? (See Terrett AGJ: Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. JMPT 1995;18:203) If it was not limited to chiropractic then it isn't really relevant to this article and should be removed.

According to the NCAHF reference it was a multidisciplinary panel which included chiros. I don't see any reason why it would be irrelevant.

>TDiI - The panel included chiros. But was the study only about chiropractic adjustments or did it include other people performing neck manipulation? Levine has a good point - is is the same point that Terrett made in his study - that studies about neck manipulation have been wrongly attributed to chiropractors. If this study wasn't exclusively about the proper usage of neck manipulations as performed by chiropractors, then it is of very little value here other than to mislead readers. This portion of the article asked the question: Is the chiropractic adjustment safe? However, this RAND study doesn't help answer that question. It asks: Are neck manipulations safe? Neck manipulation can be and are unfortunately performed by practioners with less precision skill of a chiropractor. I think Terrett noted that this study included manipulations performed by a Kung Fu healer or something wierd like that! Using this RAND study to answer the question "Is chiro safe?" would be like using a study that included heroine addicts to answer the question "Are syringes safe?" I hope you all see my point. TheDoctorIsIn 20:42, 21 July 2006 (UTC)

L>Second, note that the number may be incorrect or misleading. Here in a summary of the RAND report the numbers are different and you can get a clearer picture of the story. The panel demonstrated clear agreement on 40% of the indications and clear disagreement on 2% of them. Regarding the appropriateness of cervical manipulation or mobilization for the indications 43% of the indications were rated inappropriate for the intervention with 41% ranking as uncertain and 16% considered appropriate. Levine2112 03:21, 20 July 2006 (UTC)

I'm secondary referencing here. Does anyone have access to the original study? The low back pain study they referenced pulled records and I'm assuming that this was done also so it is not just indications. If that is true then it isn't comparable to Levine's 40% study.

The NCAHF link in the article doesnt' work, and the rand ref is only a cover page, so there's not much info. Do you have the report Abotnick? What needs to be answered with this discussion is whether or not the "whole" spine works as a functional unit, or is it just individual motion segments.--Hughgr 18:06, 20 July 2006 (UTC)

Link is fixed.

Abotnick 19:11, 20 July 2006 (UTC)

Abotnick, I'm not sure I'm reading the same thing you are in the referenced article. Am I missing something? --Dematt 19:25, 20 July 2006 (UTC)

Dematt, I found some more information on the Coulter study. They did use clinical scenarios. I don't think that it was a reflection of chiropractors actual practices which since they are subluxation based are probably even worse because they don't rely on a valid diagnosis.

See below.

http://www.ptjournal.org/Jan99/v79n1p50.cfm

"Another approach to evaluating the risks and benefits of MCS is to summarize the opinions of experts in the field of manual therapy. The RAND group evaluated the risks and benefits of MCS by assessing the clinical opinions of a 9-member panel that consisted of 4 chiropractors, a primary care physician, a neurosurgeon, an orthopedic surgeon, and 2 neurologists.11,174,175 Ratings were made on a 9-point ordinal scale (1=inappropriate application of MCS, 9=appropriate application of MCS). For 736 "clinical scenarios," the panel indicated that only 11.1% of the scenarios were appropriate for the application of MCS, whereas 57.6% of the scenarios were ranked as inappropriate.174 Coulter174 noted that for almost all the scenarios evaluated, the use of mobilization was rated more favorably than manipulation." Abotnick 15:30, 22 July 2006 (UTC)

I see what you're saying and I broke the group down into 4MDs, 4DCs and 1 MD/DC because I think it is relevant in this discussion. Because we are trying to use research to back up conjecture, I think we need a good reference for the last sentence, then we got it. Other than that, the paragraph could theoretically use a rebuttal type statement that takes out any particular POV and allows an uneducated reader to draw their own conclusion.--Dematt 13:36, 24 July 2006 (UTC)

My problem still remains that this study was about cervical manipulation performed by other practitioners than just chiropractors. For all we know (this is just a hypothetical), 100% of the manipulations performed by chiropractors were deemed appropriate in this study, while the other practitioners accounted for the misuses. I don't see how this study is really helpful to an article exclusively about chiropractic (and not exclusively about cervical manipulation). I recommend expunging it or making the point clearly within that this study wasn't limited to chiropractic cervical adjustments alone. For a clear snapshot of the implication of what RAND research has shown specifically about chiropractic, check out this link on RAND. Levine2112 15:58, 24 July 2006 (UTC)

I agree with the concern about whether chiros performed the manipulations. I am also concerned that I don't know what the list of conditions were. For instance, perhaps the list of over 700 conditions were things like vaginitis, hemorroids, ingrown toenails and then headaches. Then I would agree cervical manipuation may be appropriate for only 11% of those. Without knowing what was on the list, the numbers are meaningless to those who "really want to know":) If the paragraph stays, the next sentence needs to address these. --Dematt 17:25, 24 July 2006 (UTC)

I performed some editing to this section in question. I still think it should be expunged outright due to its lack of chiropractic specificity and thus being a source of confusion, but if it is going to stay it should be more along the lines of how I edited it to be. As usual, I am open to alternatives. Levine2112 18:20, 24 July 2006 (UTC)

BTW, I have a similar objection to the research behind our footnote #2 which is linked to one of ur intro paragraphs. While this meta-analysis talks about chiropractic, the research is dealing with spinal manipulation in general and includes in his research manipulation performed by other types of practiitoners than just chiropractors. We really can't validly use this research to say anything about chiropractic specifically; certainly we can't use it as scientific evidence that specifically refutes chiropractic. Levine2112 17:04, 24 July 2006 (UTC)

Levine, I find it interesting, given their conclusion, that they say, "We do, however, note that the absence of evidence is not the same as evidence of absence of an effect. None of the reviews conclusively demonstrates that SM is ineffective."

Also, relating to "inappropriate cervical manipulations", does anyone have a comment on evaluating the whole spine as a functional unit, vs. one motion segment?--Hughgr 19:24, 24 July 2006 (UTC)

Conleydc changes

Conleydc, Welcome! It is good to have some new ideas here on the chiropractic page. You had some good input, but got a little carried away:) Please don't take it hard that I reverted your changes. Some of them were not bad, but when you deleted large volumes of text, you inadvertantly deleted other points of view(POVs). While they may not be your POV, they represent months of work by countless numbers of editors that represent as many POVs. Overall the compromised text covers all our POVs. While your POV is important as well, please feel free to add whatever you like (though be prepared for some cross examination), but try not to delete text without discussion. Looking forward to your input!! --Dematt 14:20, 24 July 2006 (UTC)

RfC on National Association of Chiropractic Medicine

I am beginning an RfC on National Association of Chiropractic Medicine, and would lke to get input from others as to whether it should or should not be referenced in the article.

It is my view that it is not a source worthy of reference since it does not publicly reveal it’s membership numbers or names, does not hold elections for officers like real groups and associations do. I could not find any information about regularly held meetings, or any scientific seminars that it sponsors for the chiropractic profession for continuing education credits.

All I could find is a one-page website with three of the four links at the bottom to websites that are privately owned and operated by Stephen Barrett that solicit donations. Therefore I am skeptical about this so-called ‘Association’ and its inclusion in this article.

Even though it is a chiropractic group, Fyslee, who, curiously is a physical therapist, seems to know much about it. I am assuming good faith that he or Artie Rubin can provide this needed data, as they felt strongly enough to ensure the inclusion of the several references to NACM. I had asked for this information in the past, but nothing was produced.

Lacking verifiable data, perhaps we should consider removing it. Would anyone care to comment? Steth 02:29, 26 July 2006 (UTC)

Assuming what you say is accurate - that it does not publicly reveal its membership numbers or names, does not hold elections for officers like real groups and associations do, and that it is not a ligitimate organization with any sort of majority or significant view - I would have to concur that any reference to it should be expunged... and perhaps its own article should face the test of an AfD. Levine2112 05:43, 26 July 2006 (UTC)

I was the one who added it to the "reform section", but those are valid points. All I know is what they (whomever they are) say in their website. If we can't prove that it is a real organization then it shouldn't be included.--Hughgr 05:47, 26 July 2006 (UTC)

I believe what I wrote to be accurate, as I couldn't find any information anywhere about this. In previous talk pages, Fyslee explained that if the names were revealed, it's members would be in great physical danger (presumably from angry chiropractors) and that these attacks have taken place. I asked him to elaborate to prove this, but he was not forthcoming. Either way it should be considered for exclusion from the article.

I think you are right Levine, the article should be brought under scrutiny with an AfD. Maybe others can provide some insight. Steth 10:53, 26 July 2006 (UTC)

I would like to give anyone else an opportunity to provide the data on NACM. Otherwise I will go ahead and remove the references as I think that is the correct thing to do for unverifiable additions. Can anyone provide this information? Thanks Steth 16:59, 26 July 2006 (UTC)

Hi Mccready, I noticed recent changes to the Chiropractic article you have been making lately. Regarding the NACM, I have been seeking information regarding their legitimacy. Do you have some new information that would qualify them as a legitmate "association"? You know, like the list of members, officers, something about elections, seminars, or official recognition. I have been trying to locate this information, but have been unsuccessful in this endeavour. If you have this information, please share it with us so we can evaluate it. Thanks,Steth 11:37, 28 July 2006 (UTC)

Vandalism?

Mccready, take a chill pill. I think you woke on the wrong side of the bed. You know better, please be careful. --Dematt 12:22, 26 July 2006 (UTC)

Vandalism is too strong a word perhaps, but a reasoned approach is always better, with extensive use of the talk page. Jefffire 12:24, 26 July 2006 (UTC)

Deleting things because the "article is too long" is IMO poor justification, and inevitably leads to POVish deletions. Removing otherwise good information from WP is imo a far worse "sin" than exceeding nominal article length. Better to seek consensus and perhaps split the article in such cases. - Jim Butler 19:03, 26 July 2006 (UTC)

Here, here. McCready, we finally got this article running smoothly with editors of all POVs. Please respect. Levine2112 06:50, 27 July 2006 (UTC)

Revert war

1. Top should say "vertebral subluxations" and differentiate from subluxations 2. Article too long - the bits I've removed should be on other pages. 3. There is definitely dispute about chiro effectiveness (despite levine's and others religous adherence to the line) and this needs to be flagged. 4. There is good commententary that chiro is a pseudoscience and this needs to be tagged. If you want a solution to this, best to tackle the points one by one, eh? Mccready 07:01, 27 July 2006 (UTC)

Some of your points are good enough, just take it one at a time, and discuss serious and larger edits here first. -- Fyslee 08:01, 27 July 2006 (UTC)

You've reverted good edits. Which points do you disagree with?Mccready 08:17, 27 July 2006 (UTC)

I disagree mostly with (2). Even if the article is too long, and the rest of the editors can be convinced of that, the decision of what to do with the article and the information still needs to be made by the editors working together, not just by one editor who edits too boldly. That only leads to revert warring and bad feelings.

The other points do need looking into, especially the first one about "vertebral subluxations." I'll do that one right now. -- Fyslee 10:37, 27 July 2006 (UTC)

I have no trouble with 3 of the points noted above. However, if we must include such a strong stance on science, then the article will have to be longer due to the necessity to explain the metaphysical, hypothetical and religious aspects of chiropractic. And then you would have to explain that most DC's don't really practice that anyway, because 90% treat low back and neck pain, apparently effectively and with high patient satisfaction. I think we're looking at a vicious cycle that from a philosophical POV appears as pseudoscience, which is what some would like to see, but others see as dogmatic stubborness in an effort to protect a theory until science proves it. That could be argued ad infinitum on this discussion page, but all it will do is continue revert wars for the next ten to thiry years (which is how long it will be until the science is finished). It seems that the only reasonable solution is to either use compromise wording or go ahead and take out all mention of science and flag it now. Any thoughts?--Dematt 15:57, 27 July 2006 (UTC)

The article is long, but it's a big topic. Doesn't matter anyway, not a paper encyclopedia. The "bits" your removing are information that contradicts your POV, but are relevent to the article. Please don't remove them. I doublt someone would be confused about a "subluxation" on the "Chiropractic" page. There is already a disambig. page and the chiro sublux page makes the distinction. And finally, discuss your "bold" changes on the talk page first. --Hughgr 17:24, 27 July 2006 (UTC)

(2) Long articles can be split; that's better than deleting material. Kevin, we had this discussion on talk:acupuncture where (intentionally or not) you kept deleting stuff that was counter to your POV.

(3) Re debate over effectiveness, using NPOV, perhaps we can just say something like "most scientists see evidence" and cite it.

(4) On pseudoscience: under NPOV it is fine to say in the article that some people say chiro is pseudoscience. However, using the category advances that POV to the exclusion of others. This has come up with acupuncture and related topics, and I see a real problem with some editors trying to impose the views of skeptical advocacy groups, a/o the deprecated WP:SPOV, and refusing to consider the implications of NPOV violations. Please read WP:CG, which cautions the possible POVishness of using cats and says when in doubt, don't do it. The cat is also misleading to readers, esp. in light of the fact that some scientists find evidence for chiro's efficacy. Even under WP:SPOV, category:pseudoscience is unjustified unless there is scientific consensus that chiro is pseudoscientific. "Good commentary" that chiro is pseudoscience is fine to cite in the article with NPOV wording, but in no way suffices to justify using a category, which by definition is without qualification. Thanks, Jim Butler 04:52, 28 July 2006 (UTC)

The stuff I've deleted as too long should go in other articles - so put it there if you wish. You'd have to be a diehard to delete the RAND stuff I put in Paul - talk about good faith!!! I haven't got time to muck around again so I'm reverting. Apologies to anyone whose since made good edits but now you know how it feels. Mccready 08:21, 28 July 2006 (UTC)

Kevin, please engage the issues that editors have raised here. Reverting without discussion is contrary to WP:DR, which is WP policy. Please abide by that and don't escalate. Thanks, Jim Butler 08:37, 28 July 2006 (UTC)

Section "Changing political and healthcare environment"

The bulk of the verbose section "Changing political and healthcare environment" does not seem to relate to the topic. Only at the end, the section makes a small connection with the topic. I suggest the section be summarized into 2 or 3 sentences, and the irrelevant material removed. Any objections? -Pgan002 00:18, 28 July 2006 (UTC)

• Misplaced Pages controversial topics