Talk:Chiropractic

Concerns of Bias in the Lede and within the Article

There is a heavy concern of bias in the lede and the article, one gives the minority a dominant voice and one that overstates certain points in terms of prejudicial spacing in the article (that does not follow MEDMOS) and heavy use of Edzard Ernst at key points in the article that have been usurped by existing studies or newer, secondary sources.

Many studies of treatments used by chiropractors have been conducted, with conflicting results.[9]

Many studies of treatments used by MDs have been demonstrated as well, with conflicting results. What specifically is the argument? Joint manipulation studies? Effectiveness, cost-effectiveness? Safety?

Systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception for the treatment of back pain.[10]

Several studies has shown that manipulative therapy is has effectiveness in upper and lower extremity MSK conditions, including systematic reviews. There is an evidence-based resource that precisely looks at the evidence for what conditions DCs treat and what is the evidence for their interventions most commonly used in clinical practice? http://clinicalcompass.org/category_ccgpp/scientific-studies. How has this source been omitted the whole time?

A critical evaluation found that collectively, spinal manipulation failed to show it was effective for any condition.[11]

Why does an outdated study that has been usurped by new evidence on the same topic make it to the lede?

The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[13]

Untrue, manipulative therapy has proven effectiveness in chronic LBP in maintenance care conditions

The evidence suggests that spinal manipulation therapy is safe[14] but the rate of adverse events is unknown[15] as there is under-reporting.[16]

The sentence begins with the conclusion, the adverse rates are known in some instances and the citation does not state there is under-reporting it suggest that it may be under-reported.

There is controversy surrounding the level of risk of stroke from cervical manipulation.[17] It has been suggested that the relationship is causative,[18] but this is disputed by many chiropractic proponents of this treatment modality, who believe the association between chiropractic therapy and vertebrobasilar artery stroke is unproven.[19]

The arrangement of the paragraphs suggests that it safe, then the body is essentially about the risks of cervical manipulations which are very low according to the data, and the opposition to the conclusion that there is a causative link is already discussed in the literature which is to say, there is no conclusive evidence of that claim and this is maintained by the research that was done by chiropractic and other health scientists.

It overlaps with other manual-therapy professions, including massage therapy, osteopathy, and physical therapy.[21]

This point, which fails to appear in the MT, Osteopathy and PT articles, is not central to any significant degree, and chiropractic is considered the leader in manual methods in health care as demonstrated by this lay article demonstrating how the WHO and the WFC collaborated on this regard (http://www.canadianchiropractor.ca/content/view/1307/38/).

D.D. Palmer founded chiropractic in the 1890s, and his son B.J. Palmer helped to expand it in the early 20th century.[23] It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, **and consider vertebral subluxations to be the cause of all disease;**

Please show citation to be cause of all disease

For most of its existence it has been at odds with mainstream medicine, sustained by pseudoscientific ideas such as subluxation and innate intelligence[25] that are not based on solid science.[10]

Ernst again prevails as the dominant 'voice' despite the fact there is no proof that he speaks for the medical profession or any scientific 'consensus' and is also critiquing the minority viewpoint of the profession and not the mainstream or dominant viewpoint of the majority of the profession.

Despite the general consensus of public health professionals regarding the benefits of vaccination, among chiropractors there are significant disagreements over the subject,[26] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[27]

Yet again, the minority viewpoint is being used as a means to discredit the majority position which, in fact is more complex and involves the argument of the freedom of choice when considering mandatory, blanket vaccinations. Also, there are other elements not described in the critique such as the effectiveness of certain vaccinations such as the Tamiflu Debacle (http://www.digitaljournal.com/life/health/tamiflu-research-questioned/article/382174).

The American Medical Association called chiropractic an "unscientific cult"[28] and boycotted it until losing an antitrust case in 1987.[29]

What is the relevance of the statement that the AMA once called Chiropractic an unscientific cult and only giving the AMA viewpoint which was found guilty of conspiring to contain, eliminate and destroy the chiropractic profession as per Will et al 1976? Does this sentence belong in the lede as well, highlighting how the Journal of the AMA now recommends chiropractic care for LBP (http://jama.jamanetwork.com/article.aspx?articleid=1681414)

Chiropractic remains at a crossroads, and that in order to progress it would need to embrace science and not ideological dogma.[31]

This concluding sentence infers that the majority of chiropractors and/or their institutions do not embrace science, the dogma is perpetuated by a minority of practitioners. This is also a rather poor use of an source, merely an opinion piece rather than a preferred secondary or tertiary source.

DVMt (talk) 23:42, 26 April 2014 (UTC)

Good points, DVMt (talk)! There sure is a strong need for a revision of sources and reassessment of bias in the article. I think you made the point really clear. Currently there's a lot of opinionated views present. Jayaguru-Shishya (talk) 09:01, 27 April 2014 (UTC)

All the text in the lede is well sourced and on Wikipedia we WP:ASSERT the text according to what the source says. The text in the lede is a summary of the body. The text in the lede is sourced. For exmaple: ""Straights" tend to rely exclusively on spinal adjustments, to emphasize innate intelligence, and to subscribe to the notion that subluxation "is the leading cause of disease in the world today."42[1] The text in the body is also sourced. For example: "“Innate intelligence” evolved as a theological concept, the representative of Universal Intelligence (=God) within each person.36 D.D. Palmer was convinced he had discovered a natural law that pertained to human health in the most general terms. Originally, manipulation was not a technique for treating spinal or musculoskeletal problems, it was a cure for all human illness: “95% of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints.”37"[2] QuackGuru (talk) 16:27, 27 April 2014 (UTC)

Precisely Quack, "originally" manipulation was done to cure 'disease' but this is no longer the case, as you alluded, its primarily for spinal or musculoskeletal problems. The source you are using from is from 1998 and has been usurped several times since then, most notably in Haldeman's 2005 text "Principles and Practice of Chiropractic"(http://www.amazon.com/Principles-Practices-Chiropractic-Scott-Haldeman/dp/0071375341) which is the current "modern" or contemporary practice of chiropractic by the mainstream of the profession. This is notable in 2 ways, first, First, Haldeman and the chiropractic profession pioneered World Spine Care (http://worldspinecare.com/) which is brings together a multidisciplinary group of doctors and therapists to help treat spinal disorders in 3rd world countries and has such notable sponsors as Elon Musk of Tesla and endorsements from the WHO, North American Spine Society, and other leading spine care organizations. This article severely minimizes the spinal MSK focus of chiropractors and puffs up the controversy which is management of non-msk which represents 10% of those who seek chiropractic care. Also, the "minority" group which represents the fringe of the profession totals at 19% according to the latest research on the topic as per this article " Less than 20% of chiropractors (18.8%) were aligned with a predefined unorthodox perspective of the conditions they treat. Prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use and vaccinations were strongly associated with unorthodox group membership (X(2) =13.4, p = 0.0002).CONCLUSION: Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices. Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession's factions is important to the anticipation of care delivery when considering interprofessional referral. Less than 20% of chiropractors (18.8%) were aligned with a predefined unorthodox perspective of the conditions they treat. Prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use and vaccinations were strongly associated with unorthodox group membership (X(2) =13.4, p = 0.0002).http://www.ncbi.nlm.nih.gov/pubmed/24512507.

To summarize: Outdated sources with heavy bias on Ernst, controversy, heavy emphasis on the "unorthodox" or fringe of the profession re: subluxation/joint dysfunction, professional identity, practice characteristics, etc.. and virtually no emphasis on modern practice such as emphasis on spinal and musculoskeletal conditions, advancements in research and professionalization over the last 25 years, no mention of Haldeman, Janse and other historical and notable chiropractors in contrast to the exclusive focus on DD and BJ at this article. In plain words, the weight of the article is drastically shifted to the past and focuses a lot of the founders, the fringe of the profession, gives Ernst and his collaborators undue weight based on the criticism of the unorthodoxy of the profession. There is no mention of chiropractors being permanent members of the medical staff at the Olympics as of London Games in 2012, and the fact that medical director at Team USA was a chiropractor. The article's tone, weight, emphasis is directed to the past and to the fringe, which destroys the credibility of the article in the first place. Even comparing the Wiki version to NCCAM (branch of NIH), WHO and other mainstream, reliable and credible sites demonstrates the dramatic differences in tone, language, emphasis, etc. http://nccam.nih.gov/health/chiropractic/introduction.htm DVMt (talk) 01:07, 1 May 2014 (UTC)

I could go on, but there is agreement from Jaygaru from my earlier post, the majority of which was not addressed.

The book is currently used in the article.[3][4] I updated the body with this source. The lede does explain that "mixers", are the majority, and are more open to mainstream views. There is an article for Sports chiropractic. QuackGuru (talk) 18:27, 1 May 2014 (UTC)

D VMt (talk), I'm impressed, you made pretty well the point in your last post. I think the time is ready to start fixing the strong bias in this article. Whatever recent changes user QuackGuru (talk may have made recently, I can't really see how they'd have fixed the problem. Also dear QuackGuru, as much as you might love editing these articles non-stop (please see the new thread below), could you please keep your editing undisruptive? Thanks. Jayaguru-Shishya (talk) 11:02, 2 May 2014 (UTC)

Thanks for your comment Jayaguru. I agree and will make some proposals soon, the most important is getting the article to follow proper MEDMOS. Quack, you have not addressed my key points again, despite my repeated attempts to get a meaningful dialogue established to improve the article. As you mentioned, there is a sports chiropractic article (which is not given it's proper diligence and weight in the main article) but I was using it as an example of how MSK-related chiropractic is given the short shrift at the expense of the non-msk 'controversies'. DVMt (talk) 11:22, 2 May 2014 (UTC)

Chiropractic overlaps with several other forms of manual therapy, including massage therapy, osteopathy, physical therapy, and sports medicine.[21][52]

The CON was only a brief mention. See Talk:Chiropractic/Archive_18#Scope_of_practice_comments_on_sports_chiropractic.

On Wikipedia, we summarise the mainstream research. The sources cited are being done appropriately and neutrally. For example, the author Ersnt is serious mainstream researcher. The results should not be rejected; editors were giving the weight it is due. There is nothing extremist or flawed about the research per WP:MEDRS. Ernst's work is critical of CAM, and he gets criticized back; there is nothing surprising about this. Obviously, the article represent serious research that should not be ignored by any neutral summary of chiropractic. It is irrelevant whether you personally disagree with Ernst or other researchers. Removing the summaries will not bring justice to a serious encyclopedia. What is being portrayed is according to WP:V. and WP:NPOV. QuackGuru (talk) 17:00, 2 May 2014 (UTC)

With all due respect Quack, I am familiar with the rules and spirit of WP. There is another editor who shares the same concerns as I, and we're going to make proposals to improve the article. The most glaring aspect is WEIGHT given to mainstream or orthodox chiropractic (spine and MSK) which as you saw, represents 81% of the practicing DCs. Since we all agree that the mainstream view within chiropractic orthodoxy is spinal and MSK focused, that should play a large voice as this is why chiropractic is today. The article is dramatically geared towards the past. Ernst's view is actually the outlier, given his results haven't been independently replicated in studies that didn't directly involve him. Also, Ernst view, as you mentioned has been repudiated and his research questioned and is highly controversial himself. You also imply that Ernst's POV is synonymous with the "medical" POV or speaks for the medical profession. I challenge that inference and claim. I can present numerous instances of present-day MD-DC collaboration for spinal problems (https://d2oovpv43hgkeu.cloudfront.net/newsroom/Dr-Mike-Kates-story.pdf) international collaboration with the WHO Bone and Joint Decade, which affiliated with World Spine Care as I mentioned previously. The chiropractic profession is also behind the World Spine Day (http://www.worldspineday.org/world-spine-day/about-wsd/) a means to create awareness for spinal health. The readers of the article need to understand not only how it was back in the day (pre 1980s) but how it is today. This encyclopedia already has its fair share of problems with fleeing editors and questions of reliability and very apparent in articles like this that are a generation behind and where the 4/5 of MSK is obliterated by the 1/4 quackery. How about chiropractic scientists (DC PhDs) working in mainstream universities such as this initiative in Canada? http://www.canadianchiropracticresearchfoundation.com/research-chairs--professorships.html. DVMt (talk) 23:48, 2 May 2014 (UTC)

Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

Posadzki P (2012). "Is spinal manipulation effective for pain? An overview of systematic reviews". Pain Med. 13 (6): 754–61. doi:10.1111/j.1526-4637.2012.01397.x. PMID 22621391.

We are not going to add junk sources or replace high-quality sources. It's not about Ernst's POV. It's about the sources are reliable despite who the author is. QuackGuru (talk) 04:18, 3 May 2014 (UTC)

Why would you assume that 'we' are going to add junk sources? You didn't address my key point was that Ernst POV = medical profession mainstream POV. Also, the Posadzki source is exactly the type of source that is misused. There is no study that confirms his findings and they way it's being used at the article to present 'the other' POV is giving one study far more weight than the majority of others which contradicts the findings (i.e. manipulation for pain, as these new review suggests (http://www.ncbi.nlm.nih.gov/pubmed/24436697), (http://www.ncbi.nlm.nih.gov/pubmed/23339721). I've raised a key point 3 times, and you seem to be ignoring it, so I'll as you directly: If we agree that the mainstream and majority of chiropractors practice in a manner that is spine/MSK based (81%) then why doesn't the weight or tone of the article reflect that? DVMt (talk) 17:48, 3 May 2014 (UTC)

"Collectively, these data fail to demonstrate that spinal manipulation is an effective intervention for pain management."[5] The source written by Posadzki is reliable and not misused.

The sources written by Ernst also are reliable. The sources (http://www.ncbi.nlm.nih.gov/pubmed/24436697) and (http://www.ncbi.nlm.nih.gov/pubmed/23339721) are both in the article. QuackGuru (talk) 20:59, 3 May 2014 (UTC)

Cost effectiveness

We have a great list of concerns here by DVMt. One being "The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[13] Untrue, manipulative therapy has proven effectiveness in chronic LBP in maintenance care conditions". We have a 2008 review that supports this statement [6] "Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown."Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:13, 3 May 2014 (UTC)

The sentence in the lead however is not a great summary of this section [7] Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:35, 3 May 2014 (UTC)

The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[13]

This sentence in the lede is specifically about maintenance of chiropractic care. Most of the other sources are about spinal manipulation in general. QuackGuru (talk) 20:52, 3 May 2014 (UTC)

Yes I am aware of that. I am just wondering if we should summary the overall cost effectiveness in the lead. Not sure why maintenance chiropractic care was single out. Maybe we could have "spinal manipulation may be effect for certain condition but not others" Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:57, 3 May 2014 (UTC)

Done. See diff. QuackGuru (talk) 21:26, 3 May 2014 (UTC)

Thanks looks good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:00, 4 May 2014 (UTC)

Semi-protected edit request on 29 April 2014

108.225.17.38 (talk) 05:43, 29 April 2014 (UTC) I just read your article on chiropractic and I must say, as a chiropractor that specializes in neurological disorders, I find it most disturbing. May I ask where you found your undocumented essay on chiropractic? I personally find it slanted and invite you to interview me as well as others, about the true work of chiropractors. Our main focus is on the care of the nervous system and we have many credits to date, most recently, working with autistic children and those diagnosed with ADD and AHDD. Which, by the way, are a direct result of drugs. No, we are not Mainstream, nor do we choose to be, when Mainstream is about drugging our society, and most of all, our children. We choose to keep our patients healthy and allow them to live their best life possible, instead of drugging them to the point that they forget what their life was all about.

Not done: as you have not requested a change.
If you want to suggest a change, please request this in the form "Please replace XXX with YYY" or "Please add ZZZ between PPP and QQQ".
Please also cite reliable sources to back up your request, without which no information should be added to any article.
We never "interview" anyone - only report what has already been published in reliable sources that are independent of the subject. - Arjayay (talk) 07:41, 29 April 2014 (UTC)

Disruptive editing by user QuackGuru

I have been observing the editing style of a certain user, QuackGuru (talk), for quite a while now. Out of the 500 last edits on this article's page, 244 has been carried out by the same user (which is 48,8% of all edits). The editing is really disruptive, as there might be even up to 10 different edits in a row from the same user with immature edit summaries, such as "nonsense", "total nonsense", etc. There is no question why the articles have so strong opinionated bias.

Also the user is clearly more interested in pushing his own opinions rather than building a well-balanced, neutral point of view article. For example, in the narrow field of alternative medicine articles, QuackGuru is clearly switching between different wikitags according to whatever best might suit his personal views:

1. The user adds a {{copyright violation}} tag[8].
2. The user changes it to a {{citation needed}} tag[9].
3. As this didn't work out with the other editors either, now he changes the tag into {{POV-statement}}[10].
4. Finally, user Paavo273 reverts the latest attempt of QuackGuru by stating: "...Remove POV tag that replaced one or more other tags. See talk...."[11]

This applies to all the alternative medicine articles (Traditional Chinese Medicine, Chiropractic, etc.) Overall, the editing is aggressive in both terms of reverts and misuse of wikitags, as well as it is fragmented and hard to follow.

Therefore, I'd like the user to stop the disruptive editing and respect the other contributors as well. Wikipedia isn't one man's project. Should there be any difficulties with the technical side of editing, please get familiar with WP:SANDBOX[12] where he can practice editing without causing a nuisance to the other users. Jayaguru-Shishya (talk) 10:52, 2 May 2014 (UTC)

Quack has been banned before from alt-med articles and chiropractic as well for the same editorial behaviour that you describe. These style of editors have driven away several health professionals who want to improve the article due to the drama and gerrymandering behind the scenes. There does seem to be an ownership issue and a lack of balance in the edits that would reflect true neutrality. DVMt (talk) 11:10, 2 May 2014 (UTC)

The content was word for word the same as that on page three of this WHO document [13]. Thus yes there was a copyright concern and QG tagged it. He then fixed the concern by paraphrasing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:22, 3 May 2014 (UTC)

There seems to be different interpretations of when copyvio is applied and to which research it is applied to at this article, another form of inherent bias that dominates the article. I disagreed with his edit and so does Jayguru. The main point was the fact that nearly 50% of the recent edits are by QG and they increase the fringe viewpoint which dominates at the expense of the spine and MSK. More of the same. Myself and other editors currently and in the past have had grave concerns with respect to what gets 'highlighted' at the article and it seem like the unorthodox fringe practices which constitute less than 20% gets the most weight. For instance, spinal joint dysfunction /subluxation section presents the fringe viewpoint but does not address any of the scientific research with respect to the biomechanical, histological, anatomical, physiological and neural (neuromuscular) that looks at the subluxation/joint dysfunction in a MSK context. Also, Ernst' viewpoint and critique of joint dysfunction/subluxation is arguably fringe since the ICD-10 recognizes the subluxation complex as a diagnosis. (http://www.icd10data.com/ICD10CM/Codes/M00-M99/M99-M99/M99-/M99.13). Note that it's under the MSK section of the 2014 ICD-10, which is a reliable and internationally accepted medical diagnostic compendium. The MSK viewpoint is under-represented again. DVMt (talk) 18:17, 4 May 2014 (UTC)

The source you provided that recognizes the subluxation complex as a diagnosis is unreliable.

You originally added the WP:COPYVIO to the lede on November 21, 2011.

Another account also added the copyvio to the lede on March 20, 2014. What a coincidence!?

You claimed you disagreed with my edit and so does Jayguru. What recent change to the text you disagree with. Please provide a diff. QuackGuru (talk) 18:34, 4 May 2014 (UTC)

The source is perfectly reliable. Just the fact that you give your opinions here as facts does not change it. More facts, less opinions. Jayaguru-Shishya (talk) 11:31, 5 May 2014 (UTC)

...and after the {{copyright violation}}? Then you went through two more wikitags, seeing if any of them might suit your own, opinionately driven purposes. Jayaguru-Shishya (talk) 11:31, 5 May 2014 (UTC)

Using someones elses words regardless of attribution is a "copy and paste" concern. We must paraphrase. There is no if or buts about this. We have already had the APA send us a cease and desist notice for using the DSM criteria to closely. I have meet with WHO and they do not seem interested in releasing their content under a CC license at this point in time. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:20, 4 May 2014 (UTC)

We can deal with the issues you see one by one if you wish. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:21, 4 May 2014 (UTC)

No. 244 edits out of the last 500 has been carried out by the one and same user, QuackGuru. This means that nobody will post 244 different posts discussing every single edit at the Talk Page; the problem is the user himself. Jayaguru-Shishya (talk) 11:40, 5 May 2014 (UTC)

The ICD-10 is just a classification system and is neither here nor there with respect to if Ernst is a reliable source or not.Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:42, 4 May 2014 (UTC)

The primary issue is the weight given to the fringe/unorthodox aspects of chiropractic vs. the mainstream/orthodox aspects. IOW, the non-MSK vs. the MSK emphasis. It's pretty clear there is a specialized focus in this particular domain of medicine, which is clearly cited. Regarding, Ernst, the dispute is not if it a reliable source, it's a) the weigh given to it, in that it is implied that Ernst's POV is the equivalent and synonymous of the medical profession. The relevance of the ICD-10, and by extension the WHO, is that is not only a reliable source, an organization and a credibility that trumps any individual researcher, especially one as controversial as Ernst. Despite the fact that evidence-based chiropractic (spine/MSK health) has been on the radar now for 10 years, with guidelines (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839918/) and textbooks (http://www.amazon.com/Evidence-Based-Chiropractic-Practice-Michael-Haneline/dp/076373571X) and evidence-based resources (http://clinicalcompass.org) yet the attempts over the years to discuss and highlight the mainstream materials has been effectively censored. Ironically enough, Ernst is in complete denial about EB chiropractic, it seems like there is some serious cognitive dissonance. "http://edzardernst.com/2013/08/evidence-based-chiropractic-is-an-oxymoron. The collaboration between the medical and chiropractic professions have increased dramatically as well, with specialized focus on spine and musculoskeletal care. Hospital based chiropractic services are beginning to be offered (http://www.stmichaelshospital.com/programs/chiropractic/), (http://sunnybrook.ca/content/?page=sjr-patvis-prog-chiro), for spine, MSK conditions, which reflects also change in attitude and culture in recent times amongst the profession. Ernst' current POV is actually fringe, in that he is intolerant of the the chiropractic profession under any circumstances (including spine/MSK), which is essentially bigotry. He is also aiming his critiques traits that are specific to a faction (unorthodox) but the article fails address this and provide proper context. If we agree that the mainstream and majority of chiropractors practice in a manner that is spine/MSK based (81%) then why doesn't the tone and weight of the article reflect that? DVMt (talk) 00:16, 5 May 2014 (UTC)

We look at the effectiveness section and 5 out of the 6 bullet points are about MSK issues. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:05, 5 May 2014 (UTC)

Did not address my concern. Are you suggesting that 81% of the article is focused on the MSK aspects of chiropractic and the weight is representative to the majority group? Unfortunately it seems like there is more stonewalling going on, as I cannot get a straight answer. The pseudoscientific aspects dominate, so does their viewpoint despite representing less than 1/5 of practicing DCs. There was also no rebuttal of any other of my concerns and points I addressed in my previous comment addressed to you. Please address my concerns and the points that I have raised above, thank you. DVMt (talk) 02:20, 6 May 2014 (UTC)

See Chiropractic#Effectiveness. Ersnt is only one of many sources in the article. The section is current with lots of reliable sources. QuackGuru (talk) 03:22, 5 May 2014 (UTC)

Ernst is the only critical source being used, if he does represent the 'medical mainstream opinion' there must be other papers that replicate his findings and agree with his POV? The dominant voice of the article belongs to a skeptic MD whose obsessive critique of chiropractic (note the 64 article found, http://www.ncbi.nlm.nih.gov/pubmed/?term=Ernst+E+%5BAU%5D+and+Chiropractic) undermines his credibility so much that his conclusions simply aren't be reproduced by other researchers that aren't affiliated with him. DVMt (talk) 02:20, 6 May 2014 (UTC)

I believe we can overcome the strong bias in this article. It's not really good if we give one critique dominate over the wider concensus in the field. Jayaguru-Shishya (talk) 11:31, 5 May 2014 (UTC)

Yes, agreed. The article is a sham, and it's troublesome that politicking here trumps common sense. The is a gross misrepresentation of the facts, the factions, the identity, the research, the evidence, the contributions to health care (in the MSK arena and the research into joint and spinal manipulation). I'm going to create a new section for a neutral lede that doesn't trivialize and minimize the effectiveness of manipulation for MSK conditions and has far greater weight on the adverse events despite being considerably safer than the alternatives (opioids, acetaminophen, NSAIDs) whose side-effects are strangely missing from the article. DVMt (talk) 02:20, 6 May 2014 (UTC)

Besides from being banned earlier for editwarring alternative medicine articles, user QuackGuru has also been warned by administrator EdJohnston from editwarring the very alternative medicine articles here: [14]. He has been warned by another administrator, Tiptoety, as well here: [15]. "...Hi QuackGuru. Please consider this your only warning for edit warring... //// ...I'll also note that if you continue to edit war on Pseudoscience related articles, I will impose a 1RR restriction your account per the discretionary sanctions..." It is clear that the user is still continuing the same disruptive way of behaviour. Jayaguru-Shishya (talk) 11:40, 5 May 2014 (UTC)

See WP:TALK#USE and WP:TPG#YES. If you have a problem with content, then go after the content. Article talk pages are not for you to whinge on about perceived ownership or any user behavior, or to quote " Keep the discussions focused upon the topic of the talk page, rather than on the personalities of the editors contributing to the talk page.". You do not have to comment on every single edit QuackGuru has made, you just have to discuss what in the article you disagree with and how it should be changed. Cannolis (talk) 12:33, 5 May 2014 (UTC)

Yes agree with Cannolis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:28, 5 May 2014 (UTC)

QG is has a long hx of disruptive editing. Some feel that he deserves a barnstar. Others disagree. QG has made this article incredibly difficult to edit for 6 years now, driving away a plethora of talented editors in the process. There are 2 concerned editors here and it doesn't seem like our concerns are being taken seriously, at least by the admin. I'd prefer a neutral party admin to 'oversee' the the article and the behaviours of the editors. There's a COI there.

Signing your comments might be a good start. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:45, 9 May 2014 (UTC)

New Lede Proposal

Chiropractic is health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual and manipulative therapy and its role in joint dysfunction. Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe.[1] The majority of mainstream health care and governmental organizations classify chiropractic as traditional/complementary alternative medicine[2] Most people who seek chiropractic care do so for primarily for low back pain and other neuromusculoskeletal complaints.[3] Though chiropractors have many similarities to primary care providers, they are more similar to a medical specialty like dentistry or podiatry.[5]

Chiropractic was founded in 1895 by magnetic healer, D.D. Palmer, in Davenport, Iowa, United States. Chiropractic theory on spinal joint dysfunction/subluxation and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's historical vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation. Far reaching claims and lack of scientific evidence supporting spinal joint dysfunction/subluxation as the sole cause of disease has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system.[4] Today the monocausal view of disease has been abandoned by the profession [59]preferring a holistic view of subluxation that is viewed as theoretical construct in a "web of causation" along with other determinants of health.[6]

Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction,[5] the manipulable lesion remains inextricably linked to the profession as basis for spinal manipulation.[6] In 1963 the American Medical Association formed a "Committee on Quackery" designed to "contain and eliminate" the chiropractic profession. In 1966, the AMA referred to chiropractic an "unscientific cult" and until 1980 and held that it was unethical for medical doctors to associate themselves with "unscientific practitioners".[38] The 1987, the AMA was found guilty of being engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." [37] In the 1980s, spinal manipulation gained mainstream recognition[39] and has spurred ongoing collaboration into research of manipulative therapies and models of delivery of chiropractic care for musculoskeletal conditions in the mainstream healthcare sector.[40][41][42]

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain,[7] and other neuromusculoskeletal disorders[3] Manual therapies appear to be as effective as standard medical care, exercise therapy and physiotherapy in the treatment of low back pain [8][9], and may be effective for non-specific neck pain, [10][11][12] headaches,[13][14][15]and extremity conditions.[16][17] Although serious injuries and fatal consequences can occur[18]and may be under-reported,[19] spinal manipulation is relatively safe[20] when employed skillfully and appropriately.[1] There is ongoing research investigating upper cervical manipulation and incidence of stroke.[166]

No refs are listed so hard to judge. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:44, 9 May 2014 (UTC)

Comments

This proposal eliminates a lot of the bias and neutralizes the tone. It focuses on the primary MSK role and presents evidence of NMSK management of DCs. Unlike the current version which omits that the AMA tried to destroy chiropractic and was found guilty of restraint of trade, this new version presents the history (1963 to the present which shows the changing relationships of the medical and chiropractic professions. At some point in time one of the most critical sources, that states that the monocausal (one cause, one cure) approach has been abandoned has conveniently disappeared. DVMt (talk) 23:32, 7 May 2014 (UTC)

The first sentence is the same WP:COPYVIO you originally added to the lede on November 21, 2011 using the WHO source. There is no reason to repeat past mistakes.

• World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). ISBN 92-4-159371-7. {{cite journal}}: Cite journal requires |journal= (help)

The second sentence is not a summary of the body: Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in North America, Australia and parts of Europe.[1]

The lede says: Chiropractic is well established in the U.S., Canada and Australia.[21] This is a summary of the body that says: Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[21][16]

The WP:LEDE should summarise the body. Your proposal is not a summary of this article. For example, a good summary of Chiropractic#Cost-effectiveness is:Spinal manipulation may be cost-effectiveness for sub-acute or chronic low back pain but the results for acute low back pain were insufficient.[13] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[14] Cheers. QuackGuru (talk) 23:53, 7 May 2014 (UTC)

No disagreement with the research added? Good. You're pointing out technical details, which can be ironed though at a later point. We're just establishing a narrative and principles. We're going to cover the past and present in an equal manner, we're going to present the mainstream of chiropractic as the majority group with the dominant voice, while acknowledging and delineating the fringe. The criticism of Ernst are directed specifically to a faction within the profession that has x,y,z practice traits and x,y,z beliefs. Besides, he is an outlier in his views, especially in his "conclusions" on the safety, effectiveness and cost effectiveness of joint and spinal manipulation". Tuchin (2013) provides a much better source to discuss chiropractic and stroke (http://www.medscape.com/viewarticle/809688_4). The AMA is on board with DCs for LBP management and that's a huge event in the profession's history. LBP is the #1 reason why patients present to chiropractors and the #1 leading cause of disability in the world (http://www.webmd.com/back-pain/news/20140325/low-back-pain-leading-cause-of-disability-worldwide-study). Residencies are coming to the US in Veterans Affairs under primarily a MSK role (http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56655). We agree that ICD-10 is a reliable source, and that subluxation complex is listed in the MSK section and biomechanical lesions. We also see it is in Medicare and there is a specific PARTS criteria. There is the mainstream view of the subluxation within chiropractic and there is a fringe view. We present the 'mythical' version here but actually the one that is currently being studied with respect to spinal biomechanics, neuromuscular responses. How can Wikipedia's entry of Chiropractic be legitimate and reliable if exclusively relies on a fringe narrative that excludes the dominant themes within the profession today by the mainstream group? Is the mainstream, majority group primarily NMSK focused? Yes or No. As one wiki editor to another, I ask of you to please answer my question. I'd ask that you bring citations to support your claim. Cheers. DVMt (talk) 04:42, 8 May 2014 (UTC)

Great work! I think this helps us to overcome many of the problems discussed earlier. Also a great summary of body WP:LEDE. There are, however, a lot to fix in the body itself, but I'm confident we can manage that. Jayaguru-Shishya (talk) 14:47, 8 May 2014 (UTC)

Thanks! I am awaiting for a direct answer to my question to Quack re: the mainstream of the profession being primarily MSK based. I understand for some it may cause cognitive dissonance but we need to be objective about what the literature is stating in terms of practice characteristics and educational training. Speaking of which, here is an interesting video about the education chiropractors along side medical physicians (https://www.youtube.com/watch?v=O7wUJXo25JE). DVMt (talk) 15:21, 8 May 2014 (UTC)

Your proposal is similar to old text that was in the lede that was not a summary of the body. You claim your proposal is a new proposal but it looks like you trying to go back to a version similar to an older version. We should not go backwards and restore text that does not summarise the body.

For example, A Cochrane review found very low to moderate evidence that spinal manipulation therapy was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.[12][17]

Another example, A critical evaluation found that collectively, spinal manipulation was ineffective for any condition.[11][18]

We should keep the most current Cochrane review (PMID 23169072) along with other reviews (PMID 21952385) about the effectiveness in the lede.

The current text in the lede passes WP:V and summarises the body.

Your proposal includes: Manual therapies appear to be as effective as standard medical care, exercise therapy and physiotherapy in the treatment of low back pain...

Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M (ed.). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Rubinstein, SM (2012 Sep 12). "Spinal manipulative therapy for acute low-back pain". Cochrane database of systematic reviews (Online). 9: CD008880. PMID 22972127. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

That is WP:OR and does not summarise the body. QuackGuru (talk) 16:47, 10 May 2014 (UTC)

Mainstream chiropractic and spine/MSK focus

Quack has refused to answer my question Is the mainstream, majority group primarily NMSK focused? Yes or No. despite repeated attempts to communicate with him/her, and considering the problems that are also occurring at the acupuncture page with similar editing practices, I'm going to take this question to a different venue. This is eerily similar to what was done when there was continual censorship and deletion over the inclusion of the fact that chiropractic was a 'health care profession' despite have several reliable sources that stated the obvious. The issue of weight, tone, npov with respect to this topic has been steadily increasing over the years and now it has hit a tipping point. NPOV tagging will seek remediation to discuss this critical issue. DVMt (talk) 21:03, 9 May 2014 (UTC)

This is in the lede: It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[8]

The lede makes it clear that the "straights" are the minority and the "mixers" are the majority that are more open to mainstream views. QuackGuru (talk) 21:06, 9 May 2014 (UTC)

You have still not answered my question directly. Is the primary, dominant, mainstream group NMSK focused, yes or no? DVMt (talk) 21:11, 9 May 2014 (UTC)

Perhaps you can take a look at this: "Back and neck pain are the specialities of chiropractic but many chiropractors treat ailments other than musculoskeletal issues." This is currently in the lede. There's a COI there? I'm not sure what you are talking about but of course I have received numerous peer-reviewed studies by e-mail from you know who. QuackGuru (talk) 02:06, 10 May 2014 (UTC)

I'm afraid Wikipedia isn't interested about your personal emails, QuackGuru. Anyway, you have been asked a question and it seems that you are avoiding it at all costs. So what is your answer? Enough with your pointless blabber about the lede and your endless fire of links, just answer the question okay? Jayaguru-Shishya (talk) 12:55, 10 May 2014 (UTC)

"Back and neck pain are the specialities of chiropractic but many chiropractors treat ailments other than musculoskeletal issues.[10]"

The text in the lede answered the question. The specialties of chiropractic are back and neck pain but many chiropractors treat ailments other than musculoskeletal issues. QuackGuru (talk) 16:01, 10 May 2014 (UTC)

You still have not answered the question yourself QG. Your refusal to answer my question (https://en.wikipedia.org/wiki/Wikipedia:IDHT#Failure_or_refusal_to_.22get_the_point.22) is a perfect example of being tendentious and a breaking the spirit of collaborative editing. Most shockingly, you just admitted to being canvassed and de-facto meat puppet for Edzard Ernst. Congratulations. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints (http://www.ncbi.nlm.nih.gov/pubmed/11313611). Why are you, and the article, so focused on the 10% as opposed to the 90% of MSK based treatments, majority of whom are for LBP? Is that what Ernst wants you to do? DVMt (talk) 17:22, 10 May 2014 (UTC)

I don't have a personal opinion about who is the majority group but there is text in the lede and body that says back and neck pain are the specialities of chiropractic. That is a dated primary source (http://www.ncbi.nlm.nih.gov/pubmed/11313611). See WP:MEDRS. QuackGuru (talk) 17:34, 10 May 2014 (UTC)

That makes really clear the point what you just said DVMt. Given the fact that QuackGuru is constantly refusing to answer the question, it is reasonable to make the conclusion that he doesn't have a say in the matter and we can continue editing the article in order to remove the current strong bias in the article. Thanks. Jayaguru-Shishya (talk) 13:50, 11 May 2014 (UTC)

I'm not asking you about your opinion I'm asking you about the facts. Secondary sources are of course preferred when they exist. When they don't we can use a primary source, especially given this context which is not making a judgment on the efficacy of a medicine/therapy/intervention, but rather to highlight practice characteristics. So, the 10.3% source is perfectly valid, and reliable in the context that it is being used. So, now we have several facts: 1. Roughly 90% of chiropractic patients are for musculoskeletal disorders, primarily low back pain. 2. The mainstream, or orthodox group in the profession, representing 81% of the profession, practices primarily in musculoskeletal medicine, most of which are spinal disorders. 3. The majority (73) of chiropractors see themselves as conservative spine care specialists.. Here is another question: How long have you been a meat puppet for Edzard Ernst? You are pushing and unduly weighing his research. This is a serious concern. DVMt (talk) 22:23, 10 May 2014 (UTC)

I replied to the dated text you want to add/restore that contains WP:OR among other problems. See Talk:Chiropractic#Comments. I previously told you the primary source fails MEDRS. The proper place to discuss alleged COI (WP:COI) is at Wikipedia's Wikipedia:Conflict of interest/Noticeboard. Cheers. QuackGuru (talk) 02:38, 11 May 2014 (UTC)

I disagree. Jayaguru-Shishya (talk) 13:50, 11 May 2014 (UTC)

Quack, doesn't come even close to failing MEDRS. Still dodging my questions I see. More proof of the chiropractic profession and MSK focus "These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system." http://www.ncbi.nlm.nih.gov/pubmed/11805694.

"Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research."[19] That is definitely a study and thus fails MEDRS.

We don't need to include a theory from an older source from 2002[20] when we have newer information currently in the lede and body that is straight-out assertive. QuackGuru (talk) 07:03, 12 May 2014 (UTC)

It's not theory, it's practice. You're again trying to omit reliable sources that specifies to what extent fringe practices are (IOW, non MSK). 9/10 DCs primarily treat MSK issues since 9/10 patients present to the for MSK issues, most prevalent, spinal pain. You again point to Ernst, which is outlandish behaviour as you admitted to being in contact with him (COI and meat puppetry, possibly) but he is representing the fringe opinion. The "straight out" assertive component is rather bogus, as I've demonstrated above. You, and other enablers, including an admin, have deliberately stymied any discussion that centres on the current practice characteristics of the profession, such as the primary focus on spinal disorders and seeking to become the primary care spinal clinicians. I've tried in good faith with you here, but your editing behaviour seems to be congruent with this [21]. I'll repeat this again. Roughly 90% of chiropractic patients are for musculoskeletal disorders, primarily low back pain. 2. The mainstream, or orthodox group in the profession, representing 81% of the profession, practices primarily in musculoskeletal medicine, most of which are spinal disorders. 3. The majority (73) of chiropractors see themselves as conservative spine care specialists.. We assert facts, QG. You just can't censor the ones that you don't like. DVMt (talk) 00:13, 13 May 2014 (UTC)