Talk:Chiropractic

Comparing the osteopathy article to the chiropractic article.

The article on chiropractic and the article on osteopathy are written surprisingly differently (especially the lead), despite them having very similar historical philosophies and modern-day applications. They are both considered pseduoscience, yet the osteopathy page is written with NPOV, and the chiropractic page is not. To cite a specific example, pseudoscience is the 4th word in the chiropractic article, but is not mentioned until the second sentence of the second paragraph in the osteopathy article. The article on osteopathy reads like an encyclopedia article, while the chiropractic one reads more like a tabloid article pushing an agenda.

The lead for the chiropractic page needs serious revision in how it is written. The agenda is apparent when reading it, but when compared to the osteopathy article, it is glaring. Jmg873 (talk) 13:58, 7 April 2021 (UTC)

Seems to me that we need to put the word "pseudoscience" into the first sentence of the osteopathy article, Yes? -Roxy the sycamore. wooF 14:09, 7 April 2021 (UTC)

I think it's quite an overstatement that all of osteopathy is generally considered a pseudoscience, and its article supports that. Parts of osteopathy have historically been considered pseudoscience, but currently much of osteopathic training and practice has moved into the mainstream, being regulated by the same medical boards and being practiced alongside other physicians. It's not uncommon for osteopaths to be in the same practice and performing the same tasks as other physicians; that's not the case for chiropractic. I'm not denying the historical issues with osteopathy, but considering the current level of training and acceptance in the medical field, comparison with chiropractic as a profession or comparison of how equivalent the two article should be is not well-founded. Any changes need more extensive discussion and consensus on the talk pages of both articles. Sundayclose (talk) 14:26, 7 April 2021 (UTC)

Comment. Osteopaths are not physicians. -Roxy the sycamore. wooF 14:29, 7 April 2021 (UTC)

Osteopaths are physicians. Chiropractors are not physicians. Let's move on from sweeping conclusions about titles and focus on the actual nuts and bolts of the professions. So far I've seen very little discussion of that. Sundayclose (talk) 17:43, 7 April 2021 (UTC)

Sundayclose, you are conflating osteopaths in the rest of the world with osteopathic physicians in the US. Wikipedia makes this distinction by having an article on each topic. The osteopathy discussed in the article strongly parallels chiropractic. I encourage you to read more about osteopathy (rather than US DOs), you might be surprised how similar chiropractic and osteopathy are. Roxy the dog, changing the osteopathy article may be the right solution, but I believe it reads far more NPOV than the chiro article does; it still distinguishes that OMTs application is largely pseudoscientific, but in a far more appropriate way. Like I said, it reads more as an encyclopedia article (as it should), where the chiropractic article's lead does not.Jmg873 (talk) 15:34, 7 April 2021 (UTC)

I am familiar with osteopathy outside the U.S., and I disagree that I have inflated osteopathy. Most healthcare professions vary by country, including physicians of the traditional Doctor of Medicine and Bachelor of Medicine, Bachelor of Surgery varieties. Additionally, the Osteopathy article is not confined to discussion of the topic outside of the U.S., so it applies worldwide. This needs a clear consensus for either article that is changed. That's the way things work on Wikipedia. Sundayclose (talk) 17:35, 7 April 2021 (UTC)

I am familiar with Osteopathy outside the US, and you have inflated these quacks hugely. This needs a clear consensus for either article that is changed. That's the way things work on Wikipedia. -Roxy the sycamore. wooF 17:54, 7 April 2021 (UTC)

I'm glad you agree that clear consensus is needed for either article. Now please. Move on from name-calling the professions and discuss the actual issues at hand. Sundayclose (talk) 18:02, 7 April 2021 (UTC)

WP:OTHERSTUFFEXISTS -Roxy the sycamore. wooF 18:05, 7 April 2021 (UTC)

Randomly linking guidelines accomplishes nothing. Please stop wasting our time with empty non sequiturs. It is WP:DISRUPTIVE. At this point, you have presented nothing of any real substance in terms of the issues. Until you or someone else does, I'm finished here. Sundayclose (talk) 18:11, 7 April 2021 (UTC)

Jmg873, yes., In the US, DO's split off from chiropractic and took on a reality-based medical education. Not so true of osteopaths in other countries, though. Guy (help! - typo?) 20:13, 7 April 2021 (UTC)

This is the point I am making. That article is about the osteopaths in other countries, which practice similarly and have similar beliefs to chiropractors. However, the article reads with a markedly different tone. Jmg873 (talk) 13:18, 10 April 2021 (UTC)

Jmg873This article is indeed riddled with NPOV violations because there is a cartel of anti-pseudoscience activists controlling the article. They think they're doing the flying spaghetti monster's work by inserting their bias into any article tangentially related to pseudoscience, and then spending way too much of their free time gatekeeping the article in the talk section. I won't mention any names, but a few of them can be seen posting here quite frequently. In a few cases, they have revealed themselves to be unfit to edit this article by asserting their subjective bias in the face of an overwhelming amount of evidence to the contrary (see the "physician status" discussion above). Thankfully, it seems that neutrality won the day on that issue, but every sentence I read in this article makes me cringe. It's like watching fox news in the daytime, but worse. Esoteric10 (talk) 09:20, 11 July 2021 (UTC)

Yes, yes, we get it. You want the article to be more friendly towards pseudoscience, and you think you can scare away editors who oppose that by telling them that you have found them out and noticed that they are anti-pseudoscience, as if there were anything wrong with that. Well, that will not work. The rules agree with us: WP:FRINGE.

To succeed, you must first overturn the rules. When you have succeeded in making opposition to pseudoscience illegal, then your reasoning will work. Until then, you will need to switch to a different tactic. But I suspect that one will not work either. --Hob Gadling (talk) 19:42, 13 July 2021 (UTC)

Hob Gadling Two problems with what you've said here. First is the subjective standard used to lump things into "fringe theories". The topic at hand, Chiropractic, has both fringe elements and evidence-based elements that are widely accepted as legitimate within the broad medical community. To lump the entirety of "Chiropractic" into this category is lazy and disingenuous at best, and malicious at worst. For example, if you seek chiropractic care for a torn rotator cuff, you will likely undergo orthopedic shoulder testing, possibly be sent for an MRI, and receive an accurate diagnosis. Similarly, if you seek care for radiating arm pain due to a herniated cervical disc, you'll likely receive ortho testing, an x-ray, and cervical distraction - all of which are accepted by the broad medical community as part of the standard of care for this condition. After reading this article, you would have absolutely no idea that this is part of chiropractic practice. On the other hand, yes, you will have chiropractors who crack your neck to 'treat' your migraines. This also needs to be treated appropriately as fringe. The second issue with what you've said is addressed in the third paragraph of WP:FRINGE. Even if we were to lump the entirety of chiropractic into the "fringe theory" category doesn't give free reign to ignore NPOV, which you're apparently endorsing.Esoteric10 (talk) 00:38, 15 July 2021 (UTC)

Although you claimed there were "problems" with what I said, you completely ignored what I said. I talked about your attempts of scaring away people who disagree with you, and changed the subject completely. Alright. But you are wrong about the other subject too.

Fringe is not subjective. Not if you make a difference between reliable and unreliable sources.

"Fringe" does not mean always being wrong. Every fringe promoter also says things that are based in reality. Otherwise they would fail to attract followers.

If there are chiropractors out there who don't use any of the crazy stuff, then why do they call themselves chiropractors? Shouldn't they invent a new word meaning "chiropractor without the crazy stuff"? Then we could have an article about that. Since they don't do that, well, it's their problem if they want to be part of a discredited group, not ours. If you want to mention those people, you need reliable sources which mention them. --Hob Gadling (talk) 08:11, 15 July 2021 (UTC)

No Hob Gadling, it's not "their problem", it's your problem for wanting to squeeze them into the same box as homeopaths and reiki healers when they clearly don't belong there. A significant portion of what chiropractors learn and do is evidence-based, and readers need an accurate portrayal, not a slant one way or the other.Esoteric10 (talk) 06:04, 19 July 2021 (UTC)

Hob Gadling, your comment seems to contradict itself on exactly the topic we are discussing: If there are chiropractors out there who don't use any of the crazy stuff, then why do they call themselves chiropractors? Shouldn't they invent a new word meaning "chiropractor without the crazy stuff"? Then we could have an article about that. Shouldn't osteopaths in the US come up with a different word? They aren't even remotely related to osteopaths in other countries. Despite having the same name, they have separate articles; Osteopathy which is primarily focused on the fringe theory and Osteopathic medicine in the United States, which is very mainstream. Both are osteopaths; this distinction seems to contradict your point. I bring that up because it feeds directly to the point I was making here in the first place. We do not treat the chiropractic article like other similar articles. This is the problem. Jmg873 (talk) 23:24, 9 October 2021 (UTC)

I just tried to think back to what was this about, back then, but actually, I don't see any connection with improving the article. Please go on tangents like that on another site. A Wikipedia Talk page is not a forum. Again: find reliable sources that say what you want the article to say, and the article can say it. Don't find them, and it cannot. --Hob Gadling (talk) 15:34, 10 October 2021 (UTC)

I thought I was clear; it's about making the page more NPOV. Let's start with section 1.4 "Pseudoscience Versus spinal manipulation therapy". Section 1 is supposed to be on Conceptual Basis of chiropractic. Sections 1.1, 1.2, 1.3 are all fine and flow very well, but 1.4 feels very forced and out of place. It is a section entirely dedicated to "here is why you should not see a chiropractor". It is inappropriate as written and certainly not appropriate where it is located. If anything, it would be better to be rewritten and to have it in its own "controversy" or "criticism" section. Jmg873 (talk) 18:48, 11 October 2021 (UTC)

WP:IDONTLIKEIT is not a reason to remove something. These are sourced facts, and you will not succeed in swiping them under the rug. What you are trying to do is the opposite of WP:NPOV. It does not say what you think it says.

You are a WP:SPA whose only purpose seems to be to remove unconvenient facts from articles about chiropractic. This a pretty common phenomenon: purging criticism from articles about pseudoscience only leads to the accounts being banned because they are WP:NOTHERE to build an encyclopedia. --Hob Gadling (talk) 07:00, 12 October 2021 (UTC)

I said move, not remove. Please try not to misconstrue my words. I am not trying to sweep anything under the rug. The criticisms in that section are appropriate for the article and should be included; I never said anything to the contrary. What I said was that I feel that they are out of place in their current location. When I mentioned rewriting them, I am speaking of, for example, the title. What does "Pseudoscience versus spinal manipulative therapy" mean? There is no discussion of the similarity/differences of anything, so why is "versus" being used? More importantly, we have a section for controversy or criticism in most other articles, why do you feel it would be bad to re-title that section as such? At no point in your most recent response have you addressed the point I made, you only addressed me. Please argue the content not the editor.Jmg873 (talk) 14:50, 12 October 2021 (UTC)

As a reader, I find that the language of this page has the opposite affect. I am not from US and not familiar with this practice, I came to this page in order to ascertain whether chiropractic is a legitimate practice. But the language of the page sounded so one sided that I didn't find it to be trusted source. The text is too intent on convincing the reader. Note that I am only here out of mere curiosity, I have never been to a chiropractor and unlikely to visit one in the future. I have even come to this page with the understanding that chiropractic is most likely pseudoscience. The page can definitely use a more neutral tone.46.1.138.132 (talk) 17:40, 27 October 2021 (UTC)

Opposite to what?

What do you want us to do, add false information in favor of something that does not work? Or remove true information that tells you it doesn't? Unless you have concrete edit suggestions, we cannot help you. --Hob Gadling (talk) 05:42, 28 October 2021 (UTC)

I was not really asking for help, just saying it as it is. This page doesn't sound like a wiki page about Chiropractic, it sounds more like an op-ed titled "Why Chiropractic is Pseudoscience". I would say it should start with the definition of the chiropractic, i.e. "Chiropractic is an alternative medical profession[2] that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially of the spine.[3] Practitioners of chiropractic are called chiropractors. Chiropractic is considered to be pseudoscientific[1] by many in the medical community." And "pseudo" shouldn't be repeated ten times within the same page, they feel forced and out of place. "Effectiveness" section does a much better job of conveying the same thought. 46.1.138.132 (talk) 16:45, 28 October 2021 (UTC)

I have sought to deal with some of your concerns with a few tweaks to the lead, as you have discovered. Other changes need more discussion, so I have started a new thread at the bottom (#First sentence in article) -- Valjean (talk) 16:50, 28 October 2021 (UTC)

Lots of Primary/OR/Synth here

Having now closely read over the current lede and its sources, we definitely have some issues with sourcing. I've tagged for now, as I suspect much of it can be properly sourced with time. Does anyone have a good recent book-length secondary source they like for this topic? Feoffer (talk) 00:49, 15 July 2021 (UTC)

You placed an "awkward" tag in the second paragraph on a sentence that isn't awkward and a "better source needed" tag on a reliable source. What is your aim here? -- Somedifferentstuff (talk) 02:06, 15 July 2021 (UTC)

My aim?? To remind myself to improve the sourcing and verbiage, and to invite others to do so in the interim.

Double negatives are indeed awkward: "chiropractic is not effective for pain, with the possible exception of treatment for back pain". We need one thought that says Chiropractic is not effective for non-back pain, we need one thought that describes its effectiveness for back pain (whatever that may be), and we ultimately need them sourced to a reliable mainstream secondary source reflecting the entire medical field's assessment, not a lone article we found in a pain management journal. Feoffer (talk) 02:27, 15 July 2021 (UTC)

Feoffer It seems to have been intentionally written this way to frame it in the most damning way possible. The source for this is also dated and not very good. One of the studies quoted in the NYT article you linked to below is much better source. It's a more recent and more comprehensive systematic review of the efficacy of spinal manipulation on low back pain. I think it's fair to use "spinal manipulation therapy" studies, even though they're not specifically referring to "chiropractic manipulation", especially since we can only rely on out-of-universe sources. These sources will tend to use the general term (Spinal manipulation therapy) vs. the in-universe term (Chiropractic manipulation therapy). I've added the reference here. I believe the reference and verbiage should be changed in the article. The evidence for its efficacy with regard to low back pain is pretty conclusive. "Systematic reviews of controlled clinical studies of treatments used by chiropractors have found some treatments to be effective, while others have been found to be no more effective than placebo. Spinal manipulation therapy has been found to be effective in treating low back pain, however there is little evidence to support its efficacy in treating other conditions." Esoteric10 (talk) 07:19, 15 July 2021 (UTC)

I welcome your support for recent edits, but I can't concur with your assertion that SMT -vs- CMT is just a matter of terminology (out-of-universe vs in-universe). The latter seems to expose a patient to risk of becoming a victim of pseudo-scientific quacks. BUT, RSes do seem to agree that chiropractors can be an effective, if problematic, deliverer of SMT. Feoffer (talk) 07:43, 15 July 2021 (UTC)

Let me again reiterate, comments about editor motivations are a dead end. It seems to have been intentionally written this way to frame it in the most damning way possible. Wikipedia is 20 years old, the people who wrote this might be long dead. Address the content, not the editors. Even if you're correct, its a conversation stopper. Let's assume we're all on the same team and trying to help our readers understand this topic. Feoffer (talk) 09:53, 15 July 2021 (UTC)

There's an excellent chapter on Chiropractic in a book edited by noted FRINGE-fighter Michael Shermer that looks promising in helping us get out of the synth/primary sandtrap. Feoffer (talk) 03:35, 15 July 2021 (UTC)

This 2017 quote from Skeptical Inquirer is very effective: "Spinal manipulation therapy (SMT) is a reasonable option for patients to try if they like the hands-on approach, don’t mind multiple visits to the provider, and prefer not to take pills. ... But I could not in good conscience refer a patient to a chiropractor. ... When chiropractic is effective, what is effective is not “chiropractic”: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers. If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider." Feoffer (talk) 03:53, 15 July 2021 (UTC)

NYTs that will be useful for summarizing the effectiveness studies, but let's not trust its conclusions over Skeptical Inquirer which explicitly disagrees with them. Feoffer (talk) 05:15, 15 July 2021 (UTC) Additional NYT summation of recent developments, along with firsthand account of negative experience. Feoffer (talk) 00:26, 16 July 2021 (UTC)

With respect, the book by Shermer, the article from skeptical inquirer, and the NYT article all very clearly fail WP:MEDRS. Generally, we prefer high-level peer-reviewed sources on this page. DigitalC (talk) 00:57, 16 July 2021 (UTC)

What's up with the moving goalpost here? If a primary source is provided, I see calls for secondary sources. If a high quality secondary source is provided (NYT article), there are calls for primary sources. If a high-quality out-of-universe primary source that meets WP:MEDRS is provided, it's challenged for not using in-universe terminology (SMT vs. CMT). If a high quality in-universe source is provided, it's rejected outright regardless of rigor because it's "in-universe". Meanwhile, as I browse the article, there are entire sections sourced from a single quackwatch opinion piece. There is a glaring double-standard here. Esoteric10 (talk) 02:11, 16 July 2021 (UTC)

The New York Times cites the systemic review articles in its text, so by all means we could supplement the sourcing with explicit references to the journals. I don't think anyone would seriously doubt Skeptical Inquirer is a RS on this topic unless we also thought another more-reputable source disagreed with its conclusions - since it warns against chiropractic treatment, I don't anticipate reputable contradictions of SI's conclusions.

Again, I'm not a source stickler, you can't get six sentences into the article before it's clear the sourcing and verbiage is problematic. We cite a study and claim "critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition." The cited study says absolutely no such thing! I understand how the error was made, but it just demonstrates why technical literature can be a poor foundation for an article when reliable mainstream sourcing can help guide us. Feoffer (talk) 05:27, 16 July 2021 (UTC)

That last contribution is an outright lie. The following bit between the exclamation points, is a quote, "these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition" -Roxy the grumpy dog. wooF 05:34, 16 July 2021 (UTC)

Are you suggesting I'm in error, that the source is deceptive, or are you calling me a liar? Those are all three very different replies. Feoffer (talk) 05:37, 16 July 2021 (UTC)

The source isn't in error. -Roxy the grumpy dog. wooF 05:41, 16 July 2021 (UTC)

Roxy the dog, my instinct here is that there is a difference between failure to demonstrate effectiveness and evaluation/finding of ineffectiveness. Is there more to the NZ Med J source to support the stronger claim? Firefangledfeathers (talk) 05:44, 16 July 2021 (UTC)

Precisely. And mind you, I'm not saying it IS effective, I'm just saying we need a better source, cause the source we have don't say that, not that I see. Feoffer (talk) 05:46, 16 July 2021 (UTC)

Which bit of these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition' are you guys not getting? I find this disturbing. -Roxy the grumpy dog. wooF 05:50, 16 July 2021 (UTC)

It shouldn't disturb you. These sources are written for a very specific audience. Like English or Mandarin or Differential Calculus nobody is born knowing how to speak this language. But this just cinches the importance of using reliable sources written for a general audience, insofar as they aren't contradicted by more reputable sources. Feoffer (talk) 05:54, 16 July 2021 (UTC)

Quick side issue, I am taking "collectively" out of our article's summary of the review study. In the study's conclusion, "collectively" serves to describe the aggregation of data from multiple papers. Our article doesn't get into the details enough, and it's unclear what "collectively" is referring to.

Roxy the dog, I don't want to be pedantic, and I am genuinely unsure if the distinction applies here. Here's a potentially re-framing question: would you be equally happy with our article saying "critical evaluation did not find that spinal manipulation was effective at treating any condition"? Firefangledfeathers (talk) 06:00, 16 July 2021 (UTC)

I believe that he quote that User:Roxy the dog is providing comes from the conclusion of the abstract. It is clearly and simply worded. I do not believe that is provides any evidence that we should be using sources written for a general audience rather than scientific journal articles. DigitalC (talk) 14:17, 16 July 2021 (UTC)

People who understand how medical science works (such as Roxy) know that if you make a good, strong, meaningful, carefully designed study to find out whether some treatment is effective against a specific thing, and there is no good reason why the treatment should be effective, and the study finds no evidence, then you can conclude that the treatment is ineffective. This is because if it were effective, the study would very likely have found it.

People who do not understand medical science do not know this. Instead, they usually think, "oh, they didn't find the evidence for it yet. It's inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again!" This is what is happening with pretty much all alternative medicine. Heaps of money is wasted on unpromising crap instead of actually promising candidates because deciders don't get it.

So, for knowledgeable people, "spinal manipulation was ineffective" is just a minor rewording, but for others, it is a distortion. Let's use WP:CIR, alright? --Hob Gadling (talk) 06:32, 16 July 2021 (UTC)

Oof, that smarts a bit. I would be more convinced (and to be clear, I am a little convinced) if the authors of the systematic review weren't clear about ineffectiveness in some contexts. Some of the systematic reviews included tests against sham treatment or a similar placebo option and are described with language like "This review demonstrates rather convincingly that SM is an ineffective option in the management of some types of pain such as neck pain; and the risks outweigh the benefits." (from this source). Yet, they hold off from saying so about all conditions.

I am with you on "science never proves anything", or similar constructions, often being the flaccid flailing of the pro-pseudoscience folk. For this case, I still think close adherence to the prudence of the published experts will do us better than interpreting more liberally because we're knowledgeable people. Firefangledfeathers (talk) 06:54, 16 July 2021 (UTC)

To those who believe that this 2011 review has somehow definitively "proven" that SMT is "ineffective" at treating any condition, let me point you to this 2018 review that pretty conclusively shows that a form of SMT (cervical traction) is effective at treating cervical radiculopathy, with significant improvements in short and intermediate-term pain and disability.. Yes, cervical traction is a form of Spinal Manipulation Therapy used by chiropractors. Here's a reputable secondary source that lists traction among the SMT techniques used by chiropractors. Not only is the current 2011 review dated and unable to support the current language, but the statement that "spinal manipulation is ineffective at treating any condition" is false. I think we need to come to terms with the fact that chiropractors do some things that aren't complete quackery, and trying to squeeze them into the same box as homeopaths and reiki healers is a pseudoskeptic's errand. Pinging Feoffer, Hob Gadling, DigitalC, Firefangledfeathers, Roxy the dog. Esoteric10 (talk) 06:28, 18 July 2021 (UTC)

Feoffer, I don't think the wording issue we're working out here is a reason to prefer "mainstream sourcing" over high-quality MEDRS, however technical. Since this talk page section is about Primary/OR/Synth, are we at least on the same page about this source being reliable and secondary? Firefangledfeathers (talk) 06:21, 16 July 2021 (UTC)

Definitely reliable, definitely secondary in the sense it's a systematic review. WP:PRIMARY is relevant to the extent that it's a source we should use "only with care, because it is easy to misuse". The biggest priority for me is to sculpt text that a vulnerable lay audience can quickly and effortlessly understand and verify. That doesn't mean excluding technical sources, it just means supplementing them with sources anyone can understand, and making sure the two jibe. Feoffer (talk) 07:15, 16 July 2021 (UTC)

Neither the NY Times nor Skeptical Inquirer would meet WP:MEDRS. Peer-reviewed secondary sources such as systematic reviews are the preferred sources. With that said, no QuackWatch shouldn't be being used to support the article either. DigitalC (talk) 14:13, 16 July 2021 (UTC)

DigitalCThe review I cited here does meet WP:MEDRS, and shows that cervical traction, a form of spinal manipulation therapy, is effective in treating cervical radiculopathy. The current verbiage in the article needs to be revised. The statement that "critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition" is demonstrably false. Esoteric10 (talk) 18:28, 21 July 2021 (UTC)

The source you are citing doesn't mention spinal manipulation or chiropractic. Firefangledfeathers (talk) 04:31, 22 July 2021 (UTC)

FirefangledfeathersThe source is about cervical traction, which is a type of spinal manipulation therapy. At least two of the studies included in the review were involving cervical traction performed by chiropractors. If this isn't a good source, I really don't know what is. There seems to be a bit of a catch-22 happening here with regard to sourcing. In-universe sources can't be used, but when a high quality out-of-universe source is provided, it's not considered kosher because it's not in-universe.Esoteric10 (talk) 16:22, 22 July 2021 (UTC)

Out-of-universe sources are fine! We were discussing one just above. I am not sure what exactly you're advocating for when it comes to use of this particular source, but your comments above suggest that you're proposing changing well-sourced language based on some WP:OR using the 2018 source. Firefangledfeathers (talk) 19:14, 22 July 2021 (UTC)

FirefangledfeathersThe current language is based on a dated source and is demonstrably false. The current language asserts that SMT is not effective at "treating any condition", which itself is misleading language, given that it's citing the findings of one review, which only means that it was not deemed effective at treating the conditions that were within the scope of that particular review. The source I provided was a more recent review for a particular condition which a form of SMT is absolutely effective at treating. How is this not in line with WP:OR?Esoteric10 (talk) 03:04, 23 July 2021 (UTC)

I prefer not to be pinged into conversations I'm already actively involved in. The 2018 source derives its reliability from being a systematic review; the individual studies do not obtain reliability by inclusion. It's reasonable to assume that the review authors are equating chiropractic traction with physical therapist traction by including both types in their review without comment. It's reasonable to assume that the review's conclusion applies to all traction, regardless of who provides it, or they likely would have excluded the chiro studies or qualified their results. But those are assumptions not verified in the text of the source. They're original research. Firefangledfeathers (talk) 04:03, 23 July 2021 (UTC)

References

Risks: Stroke, Death

The infobox currently lists death and stroke as risks.

• Death: From the information I've gathered, the risk of death from a chiropractic manipulation is extremely low, with causality not established. There were 26 reported cases of fatalities associated with a chiropractic visit globally between 1934 and 2009, (0.35 deaths per year).. Let's put causality aside and assume they were all a direct result of actions taken by the chiropractor. In the United States, about 35 million people visit a chiropractor each year with an average number of visits of 6.7. This amounts to approximately 235 Million chiropractic visits per year just in the United States. If we are extremely generous and assume the number of actual deaths are 30x greater than the number of reported cases, and assuming all cases occurred in the united states as opposed to globally, this would bring us to about a 1 in 23.5 million chance of death, which is the same risk of death as driving an automobile about 4 miles. Based on the number of actual reported cases, that gives us a 1 in 670 million risk, about the same as driving a car 1/8th of a mile. I think it's our job to give the reader an accurate portrayal of risks. Listing "death" in the infobox at the top of the page gives the impression that it's much more than a 1 in 670 million risk, and that causality has been thoroughly established. A good rule might be that when an adverse event is more likely to occur while driving to see a chiropractor than while in the chiropractor's office, it shouldn't be listed as a "risk" in the infobox.

• Stroke: Quality sources point to no increased risk of stroke when visiting a chiropractor when compared to visiting a PCP. "We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.". There is a source that points to the nominal number of stroke cases, but when it comes to causality, there is no consensus. Signs point to there being no causality, at least based on the sources I've found and referenced here (4 and 5 in the reflist), both high quality out-of-universe sources. It certainly doesn't meet the burden of proof required to be confidently listed as a "risk". This is aside from the fact that it is also extremely rare (about 1 in 4 million, based on what I've seen).

More broadly, I think the whole infobox needs to be re-addressed, as it is extremely misleading, however I would like to have a discussion regarding these two claims, since I think they're the most glaring issues. Esoteric10 (talk) 10:07, 18 July 2021 (UTC)

Are you saying we should sweep those deaths under the carpet because there are not enough of them?

If a reader wants to know if there are any risks, reads "no", and gets killed by a chiropractor, her death is on our hands if we agree to that. (I say "her" because young women never ever die of a stroke, except shortly after they had their neck vertebrae manhandled - you know, the ones where that vulnerable artery runs, which causes strokes if demolished. Isn't that very weird if there is no causal connection?)

If a reader wants to find a line of work where there is no danger of damaging people, reads "Risks: None", becomes a chiropractor and starts recklessly killing people because there is, after all, no risk, those deaths are again on our hands.

To avoid WP:RGW, I will add that those deaths are only the ones we know of. Read the writings of Edzard Ernst to find out more. The three studies you quote are WP:PRIMARY sources, all by the same chiropractor, J David Cassidy. Not very useful as evidence.

So, no. Fuck off. --Hob Gadling (talk) 12:54, 18 July 2021 (UTC)

Hob Gadling Sounds like an emotional response for what should be a discussion about the facts of the matter. You didn't address any of the major points I made. The data literally shows about a 1 in 1 billion chance of death, and we have absolutely nothing pointing to causality. What is the standard by which you'd feel comfortable calling something a risk? Do you have blood on your hands for not putting "stroke" or "death" as a risk of visiting a PCP in the infobox on top of the page? Provide some good sources. Show me a source that shows that deaths are associated with visiting a chiropractor at a higher rate than someone visiting a PCP. Further, show me something that points to causality. The studies I cited are in high quality peer-reviewed journals. Your response was to attack one of the authors? Show me a study that tells a different story. Claiming that something causes death is a pretty serious accusation. Should we slap that label on every wikipedia article about something with > 1 in 500 million chance of death, with no evidence suggesting causality? We are so far from reaching any burden of proof to confidently make this claim that I can't believe you can simultaneously claim to respect the scientific method while also holding this position. The only thing that seems to explain this is that you wish to portray chiropractors in a negative light. The hypothesis that pre-stroke symptoms prompt the visits seems perfectly plausible, and would make sense given the data showing stroke rates being very similar to PCP visits. The reality of the situation is far from what you're trying to portray, which seems to be the idea that chiropractors are out there doing mortal combat finishers on their patients. Also, WP:WQ you, too. Esoteric10 (talk) 04:02, 19 July 2021 (UTC)

we have absolutely nothing pointing to causality. This is a lie. I just told you a thing we have. I did not read beyond the lie because there is very likely nothing worthwhile in it. We are finished here. --Hob Gadling (talk) 06:21, 19 July 2021 (UTC)

Hob Gadling You wanted a non-primary source, I encourage you to take a look at this review . I noticed this has not been included in the article. It is the most recent and comprehensive analysis of the subject to date. I would like to highlight a particular part

The assumption that the cervical manual-therapy intervention triggers CAD in rare cases has been dominated by single-case reports and retrospective case series or surveys from neurologists who naturally lack substantial methodological quality to establish definitive causality [87]. These neurological case reports have probably contributed to an over-reporting of serious and catastrophic AEs compared to minor and moderate AEs, which are likely to occur more frequently [55,88]. In light of the evidence provided in this comprehensive review, the reality is (a) that there is no firm scientific basis for direct causality between cervical SMT and CAD...

I agree with Esoteric10 about removing death and stroke from the box. Based on the current scientific evidence, having those risks written there massively exaggerates the actual risk. That is to say, there is no evidence whatsoever demonstrating causation. Ernst's article that are cited here does not even attempt to demonstrate causation, as that cannot be done with case studies. If you have a specific article that demonstrate causation, please link it. I am extremely familiar with Ernst's work and I have never seen an article of his which demonstrates that spinal manipulation causes stroke. Your argument that those are the only deaths we know of is fallacious; that is an argument of ignorance. Trying to use the idea that there are deaths we don't know about as a matter of proof literally demonstrates that you do not have evidence to support your point. It is the same argument used by the seditionists in the US to claim that fraudulent votes overturned the 2020 election, despite having no evidence to support that belief. Jmg873 (talk) 06:06, 23 September 2021 (UTC)

Not being super-familiar with the subject, there's a lot of room for improvement here in conveying to the reader the risks. Text is sort of all over the place... Feoffer (talk) 08:26, 23 September 2021‎ (UTC)

Absolutely on board with you, Jmg873 and Esoteric10. Stating stroke and death in the infobox is misleading. This article definitely has a lot of room for improvement. Jebbles (talk) 10:48, 23 September 2021 (UTC)

Oh, look! Another review from another chiropractor claiming that there is no risk. Quelle surprise. I don't think this counts for anything.VdSV9•♫ 12:27, 29 September 2021 (UTC)

VdSV9, I think that your criticism of the clinical training of what appears to be a full-time researcher is not really meaningful here. First, the review is published in a peer-reviewed medical journal that meets MEDRS. Secondly, the claims make in the chiropractic researcher's review are consistent with all recent reviews on the topic, many of which published by researchers who have clinical training in medicine. E.G.: "There is no convincing evidence to support a causal link between chiropractic manipulation and CAD."[1] and "Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association." [2]

VdSV9, It is an in-universe researcher (therefore, an expert on the subject), publishing in a peer-reviewed medical journal that is out of universe (therefore, objective and unbiased). The journal would have looked for evidence of bias when reviewing the study. Your response implies that we should ignore it because it came from a chiropractor, but you ignore that this is published in a peer-reviewed medical journal. You seem to believe that an impact-rated journal with an all-medical review board would blindly publish a study without adequate review.

We have no studies which demonstrate causation. We have reviews (such as listed above) which have evaluated multiple different types of studies, including on mechanism, cohort studies, case-control studies, and found a minimal association, or no association. The injury itself is at most exceptionally rare (per the other research listed here). In fact, part of the reason it is so difficult to prove despite some fairly sizable studies is because of its extreme rarity. If anyone has a study demonstrating otherwise, please link it, otherwise we need to remove stroke and death from the infobox.Jmg873 (talk) 00:24, 8 October 2021 (UTC)

How would studying causation work? Rip at a lot of people's necks and see how many get strokes and how many die? That would not be allowed for ethical reasons. We already know, from basic anatomy, that there is a blood vessel at a place that makes it vulnerable to specific violent movements such as chiropractic manipulation of atlas and axis. We know that young women never get strokes except shortly after chiropractic manipulation of the neck. We have means, motive and opportunity. Any person who looks at this and is honest and unbiased can see that there is an obvious causal connection between chiropractic and stroke. "Causal" studies on this are neither needed nor ethical.

Medical doctors already know and accept that what they do can have negative effects. There are mechanisms in place that handle this. It is part of their professionalism. Chiropractics need to start going in this direction, and the first step is going out of denial regarding this. At the moment, they refuse that sort of professionalism, and there are journals who help them by publishing their denialism. For Wikipedia, that does not matter. Chiropractics are WP:FRINGE, and what they write is in-universe, colored by a fantasy worldview, and unreliable. --Hob Gadling (talk) 07:59, 8 October 2021 (UTC)

Hob Gadling, You have been here long enough to know that your personal opinions do not matter and this is not a forum for you to share your perspective. There have ben multiple secondary sources presented that suggest no causational relationship and a questionable association. Feel free to provide some recent secondary sources that support your claims, otherwise take your own advice from your first comment and f*** off.2001:56A:70E6:DB00:EC21:DA54:FA25:1647 (talk) 16:09, 8 October 2021 (UTC)

Hob, your argument is fallacious; it's an argument from incredulity. Your statement that Any person who looks at this and is honest and unbiased can see that there is an obvious causal connection between chiropractic and stroke." is OR. If you have a legitimate MEDRS source please share it. Otherwise, please refrain from OR. Jmg873 (talk) 05:59, 9 October 2021 (UTC)

Instead of asking for sources, you and the IP should just have a look at the sources already linked in the article in the Stroke-Death section, especially those by Edzard Ernst, arguably the foremost expert on alternative quackery in the world. He can explain to you what I wrote above: yes, there is a very plausible causal explanation. See [3]: The most serious problems, which some experts now describe as ‘well-recognized’, are vertebral artery dissections due to intimal tearing as a result of over-stretching the artery during rotational manipulation. This seems to occur most commonly at the level of the atlantoaxial joint.

The sources you have are, as I said, in-universe. They are biased towards a fringe idea and therefore much weaker than the non-fringe ones. Why don't you just read WP:FRINGE and accept that Wikipedia is not the right place for quackery PR? --Hob Gadling (talk) 06:21, 11 October 2021 (UTC)

We seem to be having difficult agreeing on the reliability of the source, so I have made a posting at the NPOV noticeboard. https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view/Noticeboard#RfC:_Neutrality_of_a_secondary_research_paper_written_by_a_chiropractor,_but_published_in_a_medical_journal. Jmg873 (talk) 21:00, 11 October 2021 (UTC)

Not only that, we also seem to have difficulties agreeing on whether what I said is an argument from incredulity and OR or rather comes directly from a MEDRS source quoted in the article. Maybe you want to acknowledge that I do have a legitimate MEDRS source which you could have found by clicking on a link in the article?

If one MEDRS source actually gives a causal explanation and another source (whether MEDRS or not) claims there isn't any causal explanation, then there is no way the article will say there isn't any causal explanation. --Hob Gadling (talk) 07:20, 13 October 2021 (UTC)

"Giving a causal explanation" is not the same as demonstrating causation scientifically and you know that; being able to explain how something could occur, is not the same as proving that it does. Jmg873 (talk) 12:54, 13 October 2021 (UTC)

And you know (if only because I told you) that it would be unethical to do a study demonstrating causation scientifically. You demand evidence that cannot be collected except by people with a moral compass similar to that of Josef Mengele. So, that objection is at least worthless and at most ghoulish. --Hob Gadling (talk) 13:46, 13 October 2021 (UTC)

References

Post-NPOV Noticeboard Section Break

I noticed this from the NPOV noticeboard. First, far too much space is being used by the anti-fringe editor here arguing from their personal beliefs, using ad-hominems against the researchers, ignoring the fact that the source has been peer-reviewed by a reliable journal, arguing from emotion and in one case telling an editor to "fuck off". I am inclined to pursue a tendentious editing charge against editors who behave in this manner. MarshallKe (talk) 13:08, 12 October 2021 (UTC)

Moving on, if we determine that the RS is on the same level as the other sources used in this article, and I as an insofar uninvolved editor believe it probably is, we should, at the very least, include its major claims in this article, even if they contradict the other sources used. I recommend something of the format A YEAR systematic review found CLAIM. I suggest separating the edit discussion from the source discussion, as the edit discussion WILL be messy and full of petty obstructionism. MarshallKe (talk) 13:08, 12 October 2021 (UTC)

When editor Esoteric10 wants Wikipedia to delete information about a deadly risk from an article about a technique (which, BTW, has neither a theoretical basis in reality nor empirical evidence in favor of it), then that editor must be told very clearly that No, We Will Not Do That. If you don't care about people dying after Wikipedia has ensured them that there is no danger - because bah, it's just 26 dead bodies we know of, that's peanuts, let's ignore them and pretend that chiropractic has a clean slate - and call people who think that 26 is bigger than zero "emotional", well, that is your problem. --Hob Gadling (talk) 14:57, 12 October 2021 (UTC)

Indeed. -Roxy the sceptical dog. wooF 15:00, 12 October 2021 (UTC)

Clearly the article improvements suggested by Jmg873 above are supported by plenty of recent, MEDRS-compliant sources ([4], [5], [6]). Seasoned editors like Hob and Roxy know full well that their opinions have no value here, so surely they would not resort to logical fallacies and unsupported opinions if there were actually sources or a policy-based rational that supported their preferred version of the article. Jmg873, I would suggest that you just go ahead and make the bold change. If Hob and Roxy want to push the issue then they will revert, but at some point their unsupported assertions will fail to be enough to prevent article improvements; just stay persistent and within the rules.2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 02:27, 13 October 2021 (UTC)

Yeah I'm pretty sure it wouldn't be staying "persistent and within the rules" to make clearly contentious bold edits during an ongoing discussion (WP:CAUTIOUS WP:TALKDONTREVERT WP:DISCUSSCONSENSUS). Not really in the spirit of consensus to decide it's not worth establishing. --Xurizuri (talk) 06:15, 13 October 2021 (UTC)

Xurizuri, you suggest that being bold would be contentious, can you clarify why you feel this way? Despite months of 'discussion', no editors have brought any sources or policy-based reasons to suggest that the changes suggested are not appropriate. How long do you think editors should be able to block improvements without providing any sources or policy-based reasoning? 2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 08:27, 13 October 2021 (UTC)

Another one who is unable to click on the source links in the article. --Hob Gadling (talk) 07:20, 13 October 2021 (UTC)

Hob, I have looked though the article and I cannot find anything newer than a couple 2010 sources by Ernst - a list of cases and a narrative review - that suggests anything with regard to spine manipulation and serious risks; however, higher-quality work has been done in the decade since. While no one has suggested removing the older works, the articles infobox currently makes a bold claim about safety based only on outdated and low quality sources. Surely you do not think that the infobox should rely exclusively on information from decade old sources that have since been contradicted by newer secondary sources? As a reminder, here are the 3 newest secondary sources (2 systematic reviews and a comprehensive review), that encompass at least 2 review cycles:

• Haynes et al 2012: "Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association."
• Church et al 2016: "There is no convincing evidence to support a causal link between chiropractic manipulation and CAD"
• Chaibi & Russel 2019: "In light of the evidence provided in this comprehensive review, the reality is that there is no firm scientific basis for direct causality between cervical SMT and CAD..."

2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 08:27, 13 October 2021 (UTC)

• User:MarshallKe - I think the source actually is the only thing that does matter, and whether to include pro-chiropractor is simple: WP:MEDRS and WP:RS/MC state it is a matter of published in reputable journals. All these Diversions into who wrote it it or spats among WP editors will not change whether a medical journal published the content. After that, the claim of risk of death is a matter of NPOV prominence by WEIGHT, and to fairly describe both sides - and please include numbers. The claim of risk seems fairly exceptional to me, but if the position is 26 deaths per zillion is something to worry about and countering positions exist, then edits should just state it. Cheers Markbassett (talk) 08:33, 13 October 2021 (UTC)

  If you set the deaths in relation to the clinical benefit, the quotient becomes quite large. See division by zero. I know from your creationist editing history that you do not care much about WP:FRINGE, but is still a guideline, and it says, When discussing topics that reliable sources say are pseudoscientific or fringe theories, editors should be careful not to present the pseudoscientific fringe views alongside the scientific or academic consensus as though they are opposing but still equal views. Have those sources received any reception, positive or negative? Remember, it has been established by a court that chiropractors "happily promote bogus treatments". --Hob Gadling (talk) 13:46, 13 October 2021 (UTC)

  This is a discussion about risk, and whether or not stroke/dissection/death should be included. Benefit/efficacy is a different discussion. Whether or not there is a benefit, does not change the risk. on a separate note, please argue the content not the editors. Jmg873 (talk) 14:41, 13 October 2021 (UTC)

  You forgot to answer the question "Have those sources received any reception, positive or negative?" and to comment on the fringe guideline. --Hob Gadling (talk) 15:14, 13 October 2021 (UTC)

  I am unclear on the point you are making about their reception. Are you suggesting that the scientific community has received these studies poorly? Admittedly, I am a relatively inexperienced editor. Perhaps I am ignorant to the relevance of this, if so, please educate me.

  Regarding the fringe guideline cited: If these were studies published exclusively in chiropractic journals and there were no similar studies in out of universe journals, I could see your point. However, the studies cited here are the three most recent reviews on the topic and are all in medical journals. As such, these are not pseudoscientific fringe views, these represent the current scientific consensus. This is evidenced by their publication in three different medical journal over 10 years of time. Different authors, different review boards, different journals; same conclusion. There seems to be consensus that these sources are MEDRS compliant, both here and on the noticeboard. Do you have any studies to present demonstrating that this is not the current scientific consensus? Jmg873 (talk) 15:42, 13 October 2021 (UTC)

  There are many thousands of scientific studies. Most of them are unimportant enough to be pretty much ignored by the scientific community at large. Wikipedia needs to select the most relevant ones. Relevance increases with reception and with the importance of the journal. If nobody has ever cited that study, then why should Wikipedia? See WP:UBO.

  WP:MEDRS is not a yes-no thing. It is a hierarchy. As jps pointed out in Wikipedia:Neutral point of view/Noticeboard, The source is still relatively new and so its reliability is suspect until other sources indicate that its conclusions are warranted. This is closely related to the reception thing. Studies are not the end product of science - after they are written and published, peers still review them and use their results or not.

  Strictly spoken, the NPOV board is not the right place for that kind of question. There is Wikipedia:WikiProject Medicine and Wikipedia:Reliable sources/Noticeboard. --Hob Gadling (talk) 06:33, 14 October 2021 (UTC)

  I disagree with some of JPS's assertions. However, I haven't written those points there because I agree with you that the NPOV noticeboard was not the best place for this; RS noticeboard would have been better. I read something on the RS noticeboard that gave me pause and caused me to post it on NPOV, but shortly after making it I realized the RS Noticeboard would have been better. If everyone agrees on the summary I put forth on the NPOV Noticeboard, I will close that discussion and re-post it at the RS Noticeboard with that summary. Jmg873 (talk) 16:42, 15 October 2021 (UTC)

As Xurizuri pointed out on the NPOV noticeboard section, why are we even including a "risks" section in the infobox at all? I took a look at several other fringe articles, including osteopathy (a nearly identical therapy) and did not any that include risks in the infobox. Why are we including these risks in a section that is too small to explain the nuance of the research that exists on it? Jmg873 (talk) 03:23, 14 October 2021 (UTC)

That question is based on the false assumption that the risk is not solidly established. Actually, The stroke risk been known for a while, based on several studies, and has been quoted a lot. In pseudosciences, we often have the situation that established facts are called into question by new studies, but then the new studies are found to contain fatal mistakes. Then there is a new study doing the same thing, and then it is found to faulty too. It would be wise to wait until the new studies have been evaluated thoroughly. --Hob Gadling (talk) 06:41, 14 October 2021 (UTC)

I will just make really clear that I meant that the benefits should also not be included in that case, because otherwise it implies there's only benefits. Which we cannot imply in good conscience - one way or another, whatever any of us believe the synthesis of the research to be, there are many reliable sources that say that these risks exist. Hob - I agree with you that a lot of the articles that say everything's fine are found to have major issues, but it is also relevant that a fair number of trusted medical authorities haven't decried it as unilaterally dangerous - this isn't the same as something like black salve or coffee enemas. There is grey area. --Xurizuri (talk) 09:55, 14 October 2021 (UTC) // Actually lmao this absolutely isn't the hill I want to die on - I edited to strike out statement. --Xurizuri (talk) 10:02, 14 October 2021 (UTC)

There are a lot of tangents that have been brought out and from multiple pages, so I want to make sure everyone is on the same page before we continue. I feel like some of the discussion about why the Chaibi study should/should not be included is spilling over here and I want to keep those discussions separated and each of them focused. I will be making a similar summary of the Chaibi source arguments at NPV Noticeboard page. This is my understanding of what has been brought for in terms of arguments, evidence and who supports each side. Please let me know if I missed anything.Jmg873 (talk) 14:32, 15 October 2021 (UTC)

Arguments opposing removal of stroke/dissection as a risk in the infobox only (not the entire article):

• The risk of stroke/dissection is "solidly established"
• proof of causation is not necessary because it cannot be proven ethically for this issue
• If we agree to remove the risk, someone visits a chiropractor and dies from a neck manipulation, the death is on our hands
• if we agree to remove the risk, someone decides to become a chiropractor and kills another person, the death is on our hands
• Those deaths published are only the ones we know about
• chiropractors are WP:FRINGE and what they write is "colored by a fantasy worldview, and unreliable"

Evidence used to support that stroke/dissection should remain in the infobox.

• Ernst, E a systematic review by Ernst of 26 case reports which concluded "[CMT is] believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death"
• Ernst, E a narrative review by Ernst concluded "causality between neck manipulation and vascular accidents is not absolutely certain but very likely"

Arguments supporting removal of stroke/dissection as a risk in the infobox only (note the entire article):

• No study claims causation, but one of the two listed says "probable"
• the 3 most recent MEDRS reviews have found little/no association and no causation (reliability of one is being discussed at NPOV noticeboard)
• Claiming death as a risk is serious and should have a high-bar
• text is sort of all over the place (i.e. confusing)
• risks are not presented in the infobox any other FRINGE articles;
• Being in the infobox gives them too much WP:WEIGHT considering the evidence for them

Evidence used to support that stroke/dissection should be removed from the infobox.

• Haynes et al 2012: A systematic review which concluded "Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association."
• Church et al 2016: A meta-analysis which concluded "There is no convincing evidence to support a causal link between chiropractic manipulation and CAD"
• Chaibi & Russel 2019: a narrative review which concluded "In light of the evidence provided in this comprehensive review, the reality is that there is no firm scientific basis for direct causality between cervical SMT and CAD..."

Editors in favor of some sort of change of the infobox thus far: jmg873, Esoteric10, MarshallKe, Jebbles, Feoffer, IP Editor 892D, Markbassett, Valjean

Editors against changing the infobox thus far: Hob Gadling, Roxy the Dog, VdSV9

Editors involved whose opinion I'm not sure of:Xurizuri

Jmg873 (talk) 14:32, 15 October 2021 (UTC)

• I am not a subject matter expert on this topic, but this article is clearly problematic. In some sentences, Chiropractic is a very scary thing that kills people, while other parts of the text suggest its mostly safe. Widespred chiropractic coverage by insurance provider and licensure from govt all points to the "mostly safe" option, but I'm no expert. The article in current form is very schizophrenic -- we need hard numbers on stroke risk any time we mention it, for example. I personally removed Death from the infobox as overkill when stroke is already mentioned. My instinct is that the current text is DRASTICALY overstating the risk of adverse events, and I think we may forget there are BLP implications here. Feoffer (talk) 21:52, 15 October 2021 (UTC)

• The issue is the infobox, not the actual risk. Let's get back to that.

I have problems with the risks being mentioned in the infobox. That type of infobox content would be more suitable for the Vertebral subluxation article, definitely not the Chiropractic article. -- Valjean (talk) 07:04, 16 October 2021 (UTC)

• I am in agreement to remove the entire risks category from the infobox. too much WP:WEIGHT Jmg873 (talk) 19:06, 29 October 2021 (UTC)

• I haven't followed the progress above very closely, but I'll pay attention now. The arguments for and against inclusion in the infobox are BS because they are focused on the risk/nonrisk argument, and not on the due weight to give such information in the infobox in this article. I see it as more relevant in the Vertebral subluxation article, definitely not this one.

Just to establish my street cred in this area, I am a major contributor to this article from its beginnings, a chiroskeptic, scientific skeptic, and have had my life threatened because of my activism against chiropractic quackery.

I am a subject matter expert due to my medical training and experience in using manual therapies, including spinal mobilization and spinal manipulation, and my deep study of chiropractic, its history, and my association with many chiropractors. I know the subject well, and I still think it doesn't belong in the infobox for this article. I have added my username to Jmg873's list above. -- Valjean (talk) 01:37, 31 October 2021 (UTC)

First sentence in article

Even for me, a chiroskeptic, the immediate mention of pseudoscience at the beginning of the first sentence is unnecessarily jarring, and we frequently get objections from readers, including from other chiroskeptics. I view their concerns as worthy of consideration, so I want to develop a less jarring version that still mentions pseudoscience in the first paragraph.

Current first sentence:

• Chiropractic is a pseudoscientific alternative medical profession that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially of the spine.

As two sentences:

• Chiropractic is an alternative medical profession that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially of the spine. It is founded on a pseudoscientific belief system.

The pseudoscientific details are explained further down in the lead and body. -- Valjean (talk) 16:44, 28 October 2021 (UTC)

Pinging those who commented in the section above (Lede should define Chiropractor & expand pseudoscience to a full 2nd paragraph): Feoffer, Somedifferentstuff, Firefangledfeathers, Esoteric10, DigitalC, Hob Gadling -- Valjean (talk) 16:44, 28 October 2021 (UTC)

Discussion

• I find Valjean's two-sentence version much better. Sounds more professional and neutral, while stating exactly the same fact. It's not necessary to give the impression that we're absolutely panting to use the word pseudoscience/pseudoscientific as soon as humanly possible. Bishonen | tålk 18:50, 28 October 2021 (UTC).
• I am agnostic on 1st vs. 2nd sentence for 'pseudoscientific'. I think the more impactful change here is from "is a pseudoscientific ... profession" to "It is founded on a pseudoscientific belief system". Valjean, did you intend to shift the meaning here? Firefangledfeathers (talk) 19:54, 28 October 2021 (UTC)
  • Yes, because it's more accurate. The profession is based on belief in several religious, pseudoscientific and unethical concepts. We examine them later. Even those who reject those ideas continue to practice as if they were true. (Why else "adjust" the spine at every visit, regardless of type of symptoms or absence of same?) The few who are truly scientifically- and ethically-minded leave chiropractic or practice like physical therapists, but without the same depth of training. -- Valjean (talk) 21:40, 28 October 2021 (UTC)
• Big improvement. "founded on" is the perfect verbiage. Feoffer (talk) 20:34, 28 October 2021 (UTC)
• I like the suggested change; much improved. The words "alternative med" are sufficient for me to cateogrize chiropractic in my mind upon reading it. Then the mention later of "founded on a pseudoscientific belief system" is enough for me to really rethink chiropractic and ponder on my previous encounters with it. But the current wording with "pseudoscientific" as the fourth word in the article is a sufficiently unreal pronouncement right off the bat that I read directly over it and passed it without a thought. Well, it does cause a thought — "Some wiki editor hates chiropractic" — and thus is rejected upon reading it. Do note that a long string of adjectives preceding a noun is not only a mouthful, but hard on the comprehension. Platonk (talk) 21:12, 28 October 2021 (UTC)
• How about built on or based on? Founded leaves the currency of the statement ambiguous. - MrOllie (talk) 21:19, 28 October 2021 (UTC)
  • I'm open to using whichever term works best. Let's see a discussion. -- Valjean (talk) 21:43, 28 October 2021 (UTC)
    • I would prefer 'based on'. 'Founded' has a timing connotation: like chiro used to be pseudoscientific but isn't any longer. Firefangledfeathers (talk) 01:56, 29 October 2021 (UTC)
      • Firefangledfeathers, I think I understand your point, and I'm in a bit of a quandary about that. The historical, pseudoscientific, foundation is unquestioned fact, and straights still cling to such beliefs. They are limited in number, but have more influence than their numbers should warrant. The current state of affairs is another matter, with most chiropractors (mixers) rejecting Innate Intelligence and, to some degree, vertebral subluxation, but they still practice with a focus on treatment of the spine as a means to improve general health, and that is nonsense. Their practice belies a continued dependence on the pseudoscientific idea of vertebral subluxation. So what to do? Do you feel "based on" works better? -- Valjean (talk) 02:19, 29 October 2021 (UTC)
        • I agree with your analysis, and I think it matches the content in the body of the article. I continue to prefer "based on", though I'm still undecided on if the change from the status quo is a positive one. Firefangledfeathers (talk) 02:25, 29 October 2021 (UTC)
          • Since there are two of you who have suggested "based on", and I'm not wedded to "founded on", I have changed it to "based on". How's it look now? -- Valjean (talk) 03:08, 29 October 2021 (UTC)

Since most comments lean toward this as an improvement, I'm going to install it now. We can still tweak it, and, of course, if there come any serious objections, we may need to do something else. At least this seems a step in the right direction, and that's often how improvements happen here. -- Valjean (talk) 01:48, 29 October 2021 (UTC)

•  Done, but feel free to discuss improvements. Nothing here is ever really "finished". -- Valjean (talk) 02:05, 29 October 2021 (UTC)

Sources

WFC definition of chiropractic compared to our first sentence

World Federation of Chiropractic's Definition of Chiropractic:

"A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."

Our lead, the part covering the bolded part above:

"Chiropractic is an alternative medical profession that is concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially of the spine."

I notice they add "and prevention" and do not use "medical", but "health", and that is significant. Many chiropractors, likely because of their historical revulsion for mainstream medicine and all things "medical" have viewed themselves and their profession as concerned with "health", not with "medicine". The reformist (and dead) National Association for Chiropractic Medicine received much opposition for their use of the word "medicine", including death threats. I once knew several of the leaders, and I too received death threats. Their attempt to reform their profession failed. Chiropractic wasn't ready to enter the scientific mainstream.

I think we should adopt their wording on those points. Here's how that might look, with wikilinks:

"Chiropractic is an alternative health profession that is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine."

Then there is this part:

"and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."

I think we can do this with it:

"and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."

Final result when put together:

"Chiropractic is an alternative health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."

Now how to incorporate that? (There might be a bit of overlinking for simple terms.) There is no requirement that Wikipedia's lead is a definition, or uses an official definition, but when we can, why not? We can just tweak it. -- Valjean (talk) 03:04, 29 October 2021 (UTC)

Describe chiropractic as it is, not as it would want to be seen by practitioners of whatever flavour. Bear in mind that the opening sentence of alternative medicine article is "Alternative medicine is any practice that aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested, untestable or proven ineffective" GraemeLeggett (talk) 05:19, 29 October 2021 (UTC)

I couldn't agree more. -- Valjean (talk) 05:33, 29 October 2021 (UTC)

I agree that there are too many simple links. I would change it to link like this:

"Chiropractic is an alternative health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation."

I removed both links to health, and removed the link to soft-tissue, as "soft-tissue" is already explained in massage. I think the text itself is a great improvement. Let me know your thoughts on the link changes. Jmg873 (talk) 18:37, 29 October 2021 (UTC)

Jmg873, I like that use of wikilinks. -- Valjean (talk) 21:00, 29 October 2021 (UTC)

I have installed the relevant part in the article. -- Valjean (talk) 21:40, 29 October 2021 (UTC)

We deal with the last part of the WFC definition ("... and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.") in a good manner, so we don't need to do anything more with this. -- Valjean (talk) 21:45, 29 October 2021 (UTC)

Manipulation of the Cervical Spine: Risks and Benefits

This research is very interesting, and is the best on the subject I have ever encountered. While it was focused on PTs, it gathered information that also included chiropractors.

• Manipulation of the Cervical Spine: Risks and Benefits

"The literature does not demonstrate that the benefits of MCS outweigh the risks."

My notes:

The graphs are interesting, especially Figure 2, where the type of practitioner was adjusted according to the findings by Terrett. PTs were involved in less than 2% of all cases, with no deaths caused by PTs. DCs were involved in a little more than 60% of all cases, including 32 deaths.

Before adjusting the numbers according to the findings by Terrett, it looked like DCs were involved in more cases than was actually the case. The revised figures made DCs look a very little bit better, but were still far too high. A casual glance at these numbers could lead to the partially incorrect conclusion, that manipulation, when performed by a chiropractor, is much more dangerous than when performed by other practitioners. No, that would not be entirely correct. They should be seen more as a reflexion of the fact that manipulation is most often performed by DCs.

Regardless of who performs the manipulation - the more it gets done, the greater the risk. Sooner or later someone is going to get hurt. It needs to be used much more judiciously, by whoever it is that uses it, than most DCs use it today. If a PT or MD were to use spinal manipulation in precisely the same way, extent and frequency that DCs do, they would be exposing their patients to the same risks that chiropractic patients are exposed to every day. The statistics would then reveal more injuries from PTs and MDs.

While the technique itself is potentially problematic, the attitude of most chiropractors towards it makes it doubly so when applied by them. In the end, the "literature does not demonstrate that the benefits of MCS outweigh the risks." That's why I gradually phased out my use of spinal manipulation, especially of the cervical spine, from my practice. I got better, safer, and more long-lasting results with mobilization combined with other treatment methods. -- Valjean (talk) 01:57, 31 October 2021 (UTC)

This article has a good list of sources:

• Chiropractic’s Dirty Secret: Neck Manipulation and Strokes

Valjean (talk) 02:06, 31 October 2021 (UTC)

I was confused by what change you were suggesting. Are you suggesting adding the statement: "The literature does not demonstrate that the benefits of MCS outweigh the risks."? If so, I think it would be better stated as "The literature does not demonstrate that the benefits of [cervical SMT] outweigh the risks." Otherwise, I would replace MCS with "manipulation of the cervical spine". Even knowing the topic, I didn't know what "MCS" meant until I opened the article. Jmg873 (talk) 01:43, 2 November 2021 (UTC)

References

Treatment of long COVID

Anecdotal evidence suggests that chiropractic lower-back atlas adjustment can restore sense of taste in people who lost it to long COVID. https://www.foxnews.com/us/houston-taste-covid — Preceding unsigned comment added by 152.130.1.18 (talk) 14:01, 11 November 2021 (UTC)

Anecdotal evidence is not good enough to go on the page. See WP:MEDRS. Nor is Fox News a reliable source of medical information. VdSV9•♫ 14:10, 11 November 2021 (UTC)

Anecdotal evidence suggests everything you want it to suggest. --Hob Gadling (talk) 15:36, 11 November 2021 (UTC)

Yes, anecdotal.... This ("lower-back atlas adjustment") also conflates the anatomy. The atlas is at the top of the cervical spine, far from the lower back. The woman's claim that a lower back "adjustment" could affect her sense of taste is utterly ridiculous. Nothing done to the lower back can affect higher up in the central nervous system. She could literally be cut in half and it wouldn't affect her sense of taste, hearing, eyesight, whatever.

The chiropractor's claim that an atlas adjustment can do it is also ludicrous, but at least anatomically within the range of possibility, in the sense that fingers pushing hard into the soft tissues of the neck could conceivably put pressure on the left or right vagus nerves. DD Palmer made the claim that his first adjustment restored the hearing of Lillard, a janitor working in his building. Unfortunately for Palmer, Lillard's later descriptions of the event indicate he wasn't totally deaf. Who knows, maybe the bump to his neck dislodged some earwax. The current repetition of these types of ridiculous claims by chiropractors just lends credence to the charge that modern chiropractic has not sufficiently divorced itself from its cultish, pseudoscientific, and religious roots to be considered a science-based profession. The chiropractor should be censored for making this type of quackish promotional statement: "With an atlas adjustment with the adjusting the first bone in the neck we can see amazing things, vision come back, hearing come back, but I never thought in a million years that I would be seeing so many patients get their taste and smell back." I am not surprised to read this. Straight chiropractors make these types of claims. -- Valjean (talk) 17:39, 11 November 2021 (UTC)

They commonly come back naturally over time, so yes, someone could attribute it to anything they drank, ate or did recently without any actual causal relationship. Relying on WP:MEDRS to support any biomedical claim avoids promoting this fallacy. —PaleoNeonate – 10:27, 13 November 2021 (UTC)

Let's test how wikilinking works here:

"The three nerves associated with taste are the facial nerve (cranial nerve VII), which provides fibers to the anterior two-thirds of the tongue; the glossopharyngeal nerve (cranial nerve IX), which provides fibers to the posterior third of the tongue; and the vagus nerve (cranial nerve X), which provides fibers to the epiglottis region. Taste fibers categorize as special visceral afferent (SVA)."[7]

"The vagus nerve is the longest cranial nerve. It contains motor and sensory fibers and, because it passes through the neck and thorax to the abdomen, has the widest distribution in the body. It contains somatic and visceral afferent fibers, as well as general and special visceral efferent fibers."[8] Note that the vagus nerve does not traverse down the body in the spinal canal, IOW it is not part of the spinal cord and cannot be affected by adjustments of the spinal bones. It leaves the brain through the left and right jugular foramina in the base of the cranium (skull).

I used to have a long bookshelf with nothing but anatomy books and atlases in English, Latin, German, Danish, Swedish, and Norwegian. They all burned in the 2018 Camp Fire. I have replaced them with one of my favorite pocket atlases that has everything: Pocket Atlas of Human Anatomy. Used copies can be ordered cheaply on Amazon and eBay. It's a goldmine with very fine illustrations of every detail imaginable. -- Valjean (talk) 18:21, 11 November 2021 (UTC)

@ IP Editor: Anecdotes are not reliable as evidence in almost any context. There is no scientific evidence demonstrating what you are describing. In fact, a large amount of the chiropractic community spoke out against this sort of thought when the International Chiropractic Association tried to promote that chiropractic adjustments promote immune function:

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system. [9] Jmg873 (talk) 18:24, 14 November 2021 (UTC)