Talk:Critical views of chiropractic/Archive 2

Critical views of chiropractic

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Snowed in

I'm in the midst of a snowstorm and intend on occupying myself on this article. I propose converting Matt's section on Controversies within the profession to External Links at the bottom of the article, and will write a narrative paragraph on controversies. Nancy Sculerati MD 12:09, 16 March 2007 (CDT)

Just a quick look in, I think your into is looking great. It was my section by the way, don't blame Matt for it, and do what you will with it.Gareth Leng 12:12, 16 March 2007 (CDT)

I blame you both for everything, but somehow I can't stop myself from collaborating with you. :-) Nancy Sculerati MD 14:28, 16 March 2007 (CDT)

That's because you know you love us:) Good work today! I have a problem in that third paragraph in the lead:

• Why should Chiropractic be less cohesive in underlying views than Physical therapy or Nursing? Unlike the founding philosophies of these other relatively recent health professions, Chiropractic was originated by an individual who disdained the germ theory of disease [1], and had no reverence for scientific research. However, just like these other professions, the development of Chiropractic has increasingly emphasized educational excellence in professional schools, with a heavy focus on science in the classroom. Overall, this has resulted in a wide range of individual practice styles in current chiropractors: a range that includes those that reject basic tenets of biological medicine, at one extreme, along with those who reject the notion of vertebral subluxations blocking innate intelligence, on the other.

I think I know what you are trying to say, but think we are going over the edge when we make the statement:

• Chiropractic was originated by an individual who disdained the germ theory of disease [1], and had no reverence for scientific research.

No reverence for scientific research. Keeping in mind the times and the state of the scientific community at the time, he was not that far off. There are several sources that discuss his theories, if he had no reverence for it, he wouldn't have even discussed it. I think we might be able to say that he "lacked a proper education in science" or "lacked the resources", etc.. Thoughts?

"Disdain for the germ theory". Do we know this? We could just as easily say "after he was jailed, he cloaked his discovery in vitalistic mystic cultism to protect it from scientific medicine." Maybe we could say both byt saying something like: "Whether out of true disdain for the germ theory or perhaps out of an effort to protect his discovery from scientific medicine by cloaking it in a vitalistic and mystic cult like apparel, ..." Thoughts? --Matt Innis (Talk) 22:05, 16 March 2007 (CDT)

I sent you the full text of the following article:CHIROPRACTIC ANTIVACCINATION ARGUMENTS. By: Busse, Jason W.; Morgan, Lon; Campbell, James B.. Journal of Manipulative & Physiological Therapeutics, Jun2005, Vol. 28 Issue 5, p367-373, 7p; DOI: 10.1016/j.jmpt.2005.04.011; (AN 1744481) read it please. It's there. Nancy Nancy Sculerati MD 22:41, 16 March 2007 (CDT)

Hey Nancy! Hope your sitting by a fire;) This is the same one you sent yesterday, right. I'll take a look at it again. Thanks. --Matt Innis (Talk) 22:45, 16 March 2007 (CDT)

I looked through it again and still think we are going over the line in making an assumption that he disdained the germ theory (though it could have been possible, we just don't know how he felt) or that he had no reverence for science (without a specific source). Maybe if we stated it in such a way that wasn't such a statement of fact. --Matt Innis (Talk) 22:56, 16 March 2007 (CDT)

• The acceptance of ancedotal evidence and temporal association as evidence of causality that is prevalent in the published chiropractic literature has been rejected by the professional medical, nursing, and other allied health science peer reviewed literature for at least a generation and there is concern among health science professionals that chiropractors endorse popular beliefs in possible connections between such things as autism and additives in vaccines as almost certainly true, rather than entirely speculative.

Are we saying that it is anecdotal, temporal and speculative that autism might be caused by additives in vaccines? Is state of the science on this issue secure enough for us to make this statement without clarifying it?

--Matt Innis (Talk) 22:45, 16 March 2007 (CDT)

Wait a minute. I see, there is a second part about double standards and not accepting the same quality evidence for strokes.. I see what you are saying. Chiropractic has the same critique about medicine. Are either valid arguments? --Matt Innis (Talk) 23:19, 16 March 2007 (CDT)

I notice we have lower case and upper case professions (Chiropractic and chiropractic) throughout the article. Do we want to pick one and go withit. I know that WP uses all lower case, but I think Nancy and I both are used to upper case (not sure if it is a US thing). I have gotten used to the lower case so I am okay with either, but suppose we should pick one and go with it. --Matt Innis (Talk) 23:05, 16 March 2007 (CDT)

Membership stats

Gareth, I finally found these archived on the chiro page in wikipedia and we can thank our good friend Fyslee for these. I assume this is what you were looking fo rthemm for:

Membership figures for various chiropractic associations vary depending on the source, but here is one list from the ACA, comparing to other professions:

FACTS Licensed DCs: 60,000

• ACA 18,000
• ICA 8,000
• WCA 250?? undocumented

Licensed PTs: 203,261

• APTA 66,000

Licensed MDs: 583,000

• AMA 275,000
• AOA 1,200

--Matt Innis (Talk) 22:25, 16 March 2007 (CDT)

---

No, Matt, chiropractic refers to procesures, etc- Chiropractic to the formal philosophy and profession. That is also true of nursing, Nursing, medicine, Medicine. Your changes in the text have removed the sense of it. Nursing as a profession is older than Chiropractic but was rooted in reverence for science and math. Your edits destroy the sense of what I wrote and do not reflect facts. Read about Florence Nightingale, read that paper I sent you from the chiropractic peer reviewed literature and quote me real quotes from scholarly resources to refute it. Or to support your contentions. Further, "Fyslee" is a recognized source of nothing to me. What are the actual sources of those numbers? I'm taking a break. I'm not having fun here and I need to do something positive. Nancy Sculerati MD 06:18, 17 March 2007 (CDT)

The numbers are from published membership figures from the various organisations so its a compliation of many sources not a single source, so do we really want all the sources here? . Please Nancy, remember that we're all trying to be constructive here. Matt's edits do express a fair point - in DD Palmer's day the germ theory was still very new, it's not as though he was rejecting something that at that time was very solidly understood and accepted. Anyway, go ahead Nancy and when you feel you've done your best bit to be comprehensive and neutral we can maybe be focussed in our comments and improvements.Gareth Leng 09:00, 17 March 2007 (CDT)

From what year? From what publication(s)? Dues paying members? Matt's edits are not acceptable to me - because they do not reflect the actual views of DD Palmer. Instead, they are a speculative apology and excuse for what Palmer "might" have meant. His son, BJ Palmer wrote the same kind of stuff right into the 1950's, and chiropractic opposed the polio vaccine and continued to claim that subluxations were the cause of infectious diseases. As far as chiropractic goes, this is not a topic of overriding interest to me, and I, personally, do not endorse chiropractic for the treatment of children (except in the case of say, whiplash injury) and am strongly opposed to chiropractic treating otitis media and the "crying child". I have been as open minded as I can be here, and feel as if I am carrying the load of scholarship, and am not enjoying myself doing so. Obviously, this topic is of great interest to you all, and so, please carry on. I'd prefer to devote myself to other topics for the time being. No hard feelings- but I'm not in sympathy here. Nancy Sculerati MD 15:29, 17 March 2007 (CDT)

Text here was removed by the Constabulary on grounds of civility. (The author may replace this template with an edited version of the original remarks.)

went through Gareth's rewrite

I just read through, added a couple of things. I think that this is fine.- should be approved. It actually clearly expresses criticisms, in my opinion, without being polemic and without offering constant qualifications and apologies. As I say, I expect Critical views of surgery (I'd love to write the "Cosmetic surgery" version) to be no less clear. And Matt, yes, I think that the connection between autism and vaccine additives is entirely speculative. Sometimes speculation turns out to be real, but there is no reasonable level of proof. I don't know if you have ever read some of the old medical journals- like the first JAMAs. I've read case series of honest physicians (I believe, they were, anyway- I even started getting convinced by some of the papers) who detail "500 cases" of blood letting, and go into how much it helped each one. That's ancedotal evidence and it truly is not proof. In my tremendously august opinion- of course ;-) Nancy Sculerati MD 12:45, 18 March 2007 (CDT)

Nancy, not arguing that the theory is not speculative, only that it is not chiropractic's theory, it is made by others, some even PhDs. This belong on the vaccination page mostly, though it is good to say that there are chiropractors that agree with these guys. That's all. Also, to say that DD disdained the germ theory is just not correct. The source does not say anything like that. Do you have something that does? -Matt Innis (Talk) 09:52, 19 March 2007 (CDT)

Hi Matt, are we talking about words here _ I thought I'd seen DD quoted as claiming that most diseases (95%) were caused by subluxations. At the time plenty of people - Hahnemann and the homeopaths, frankly claimed that germs were innocuous, symptoms of disease but not causes. The word disdain is unneccessary, but surely he did reject it.

The autism link to vaccines is certainly not specific to chiropractic, and was first made I think by an MD (I agree that it was speculative, but it was a speculative explanation of a reported association beyween triple vaccines and autism that was not supported by a later large study, i.e. a mistaken speculation but not a random speculation). I think the criticism here however is not that this is part of chiropractic, but that some chiropractors offer health advice in areas outside their scope of knowledge and practise.

I think we need to sit and look at this article again after a day or so. I think it's clear and straight, we must think carefully about whether it is neutral; best to sleep on it a bit.

Gareth Leng 10:09, 19 March 2007 (CDT)

Yes, we are talking the word. DD did feel that it was a reduced resistance of the host that allowed germs to take over. This is not different enough to call it disdain, which evokes a sense of contempt. If anything DD was skeptical. Nothing unusual about that.

To lump all vaccines in one and say many chiros disagree is misleading. The DPT would evoke much less disagreement than i.e. chicken pox vaccines. Because the risks to the population are far less for chicken pox if they do not get the vaccine than polio for example. Allowing the patient a choice for which ones they want is what the language of the ICA and ACA is saying. -Matt Innis (Talk) 10:59, 19 March 2007 (CDT)

Hopefully, the word disdain will be changed. The Canadian study showing that an equal number of chiropractors favor, as are against vaccination is included. Still, a stance against vaccination has been an feature in chiroprasctic, as has been the acceptance of risks such as autism that are not accepted by the health sciences. That's clear from the chiropractic literature, among many sources. It certainly should never be implied here that every chiropractor is against all vaccines. Nancy Sculerati MD 11:08, 19 March 2007 (CDT)

Thank you. Agreed, I think those are all valid and basically true. There are even issues regarding thimerisol or mercury that all antivaccination advocates state - agree some chiropractors (or groups) are right up there with them. The reason I am uncomfortable is because we give no rationale for why they would be against it. I feel we need to at least mention something that shows that they are not just saying this just to be obstinate. We do say out of their no drug policies (or something like that), but perhaps a little more to slarify the supposed reasoning. --Matt Innis (Talk) 11:27, 19 March 2007 (CDT)

No one is implying obstinancy and it is not reasonable to present a speculative association here. That can go in an article on vaccines, and be linked. Or it can go in the Chiropractic article. Or we can include an external link to the chiropractic view in the text. This is the Critical Vieew of Chiropractic, and without being unfair-that's what it needs to emphasize, it's not "The debate about the critical view". But it should be fair and neutral and in no way be otherwise. my 2 cents Nancy Sculerati MD 11:40, 19 March 2007 (CDT)

We still seem to use upper case and lower case differently. It really should be consistant for all the professions. --Matt Innis (Talk) 15:00, 19 March 2007 (CDT)

Had a go, may not have got it all right. The logic I've tried to follow is that Chiropractic as a noun standing for the profession is capitalised but when it stands for the practise it is not, and as an adjective is not.Gareth Leng 05:36, 20 March 2007 (CDT)

Let's start at the beginning- is it true that the points under theory are debated extensively? No, those are the combined consensus views of medicine and biological science. No consensus view in any of those fields believes that chiropractic has demonstrated efficacy above placebo in anything other than certain types of back pain, or that the population is not at risk for infectious diseases if the immunization rate goes too low, etc. Why is this couched as a question-a debate? I don't think that's a reflection of mainstream science or medicine. Perhaps additional scientists and physicians- and chiropractors, should be involved here before we approve this article. I am overall, quite uncomfortable with it. I do not have the time at the moment to go through it line by line and be forced to extensively debate each line, but even from the start-as I have stated above, I think that the critical view is weakened to a point that renders it distorted. sorry.Nancy Sculerati MD 08:07, 20 March 2007 (CDT)

I've redrafted the Intro accordingly.Gareth Leng 09:34, 20 March 2007 (CDT)

For Approval

I've moved the section below down from earlier, just to keep us focussed. Are we close to Approval? I think so, barring minor tweaks of style etc. Clearly Nancy is concerned that the critical view has been distorted, and that is not the intention of anyone, so this should be correctable. However, what is essential is that the article have a neutral tone. First, the article should not appear to be expressing the opinions of Citizendium editors, but only coolly reporting opinions of others, so we must not seem to be endorsing criticisms. Second, the article must be fair to those who are being criticised, in that their response to any criticism must also be reported neutrally.Gareth Leng 08:43, 20 March 2007 (CDT)

As Nancy has said, we need more eyes on this article to move it towards approval. Can I ask for structured views to aid improvement. This article is not an "attack" article or a critique, that would be inadmissable. Rather, is is a neutral reporting of critical views about chiropractic. The article must avoid either promoting or denigrating those criticisms. It must instead seek to explain clearly what those criticisms are and attribute them to verifiable notable authorities. If the counter arguments are not self evident, as Larry has proposed, they must also be given, and also been given neutrally, and represented fairly (i.e. with the best case that can be made).

Accordingly, can I ask for opinions on the following specific points

1) Are the criticisms described clearly? Is it obvious what the criticisms are, what their basis is, and who has made them?

2) Are the sources of criticism clearly noteworthy in context?

3) Are the criticisms fair - i.e. legitimate criticisms of chiropractic in general, not criticisms of failings of individual chiropractors

4) Are they presented neutrally, i.e. is it clear that the criticisms are just being reported, and are neither endorsed nor denigrated by Citizendium or its editors?

5) Are counter arguments either self evident or fairly represented, and adequately attributed where appropriate?

6) Is the tone "sympathetic"? i.e. can it be read by either chiropractors and physicians as an honest and direct neutral account of criticisms, but given in a way that does not by its tone invite offence to either? i.e. is it professionally civil?

7)Have any significant areas of criticism been omitted or under-represented?

I suggest that these are the key issues on which to proceed towards Approval. I don't think that every point of argument necessarily needs attribution, but reasonably disputed points should be. Comments? Gareth Leng 07:23, 15 March 2007 (CDT)

As part of the executive of Citizendium I care very much about its success. But, hard as it is, an appearance of neutrality has to be based on cold facts and not on arbitration. There is more to neutrality than simply the consideration of chiropractors and physicians- there is the neutrality of information as used by patients. Having taken care of children in various English speaking parts of the world, including Africa and Micronesia, and having spent most of my professional life caring for children (and adults- but frankly, the adults make their own choices and its the welfare of the children that drives me) of people from literally all over the world of all social classes whose parents often speak English as a second or third or" n" language, things here have to be plainly worded. Very plainly worded. I do not believe that anyone here is purposefully being slanted- but much of the world holds the US as a standard in health care and hopefully, someday all of the world will see Citizendium as the standard in reliability in free information, and so-consider, the following quoted line of a major criticism, for example: “That the chiropractic philosophy to avoid using drugs can be dangerous to some patients if they discontinue to take drugs that have been prescribed for serious conditions.” It’s stretching it to qualify this both by “some” patients and “serious” conditions. Although physicians disagree about drug herapy, and drug therapy regimens can be changed by another physician-although not all drugs prescribed may be vital – this sentence implies that the consensus view of medicine and science is that it’s ok for a chiropractor to advocate that a patient discontinue drugs prescribed by a health care provider some of the time for serious conditions and anytime at all for conditions that are not serious. That quote can be taken as the consensus concern is only about some patients with serious conditions, and not all the others, since literally-that is what it says. In short, this article does not seem neutral to me, as a physician, it even fails to discuss the consensus view of medicine and biology that the entire theoretical basis of chiropractic is not only "unproven" but that no attempt -despite chiropractic claims of having an excellent education in science in its schools- has ever been made to prove it, because it is speculative in nature- instead of being hypothesis driven- it is driven by a line of inquiry that asks- couldn't it be true? That line of inquiry has been rejected by both mainstream medicine and science Nancy Sculerati MD 09:42, 20 March 2007 (CDT)

Hmm. I didn't see this phrasing as being needed for neutrality but for accuracy.

“That the chiropractic philosophy to avoid using drugs can be dangerous to some patients if they discontinue to take drugs that have been prescribed for serious conditions.”

Two words here are in contention

1) the word "some" where the implied alternative is "all".

2) the word "serious" where the implied alternative includes "not serious"

Not including these words is therefore equivalent to asserting

“That the chiropractic philosophy to avoid using drugs can be dangerous to all patients if they discontinue to take drugs, even drugs that have been prescribed for non-serious conditions.”

This I consider to be non-neutral because it makes physicians and scientists appear to be sensationalist, alarmist and illogical. The words were not inserted to make chiropractic sound better, but to make the criticism more sound.Gareth Leng 11:38, 20 March 2007 (CDT)

On the article, what does the article actually say it present - it quotes a critic as declaring that "the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners" and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques"

Honestly, I don't see how we could put these criticisms more directly.Gareth Leng 11:53, 20 March 2007 (CDT)

(put in at same time as above-edit conflict)yes, accuracy is very important. And the main word that is probably a problem in the sentence quoted is "dangerous". Poor choice (and not mine ;-)). How about just saying it straight, without the dangerous, which is the alarmist and sensational nidus of the sentence, The idea is that, As Chiropractic philosophy advocates all medication as unnecessary to health and does not diagnosis discrete medical conditions, there is concern that discontinuation of drugs prescribed by physicians and other health science clinician on advice of those chiropractors that do advise patients to solely follow chiropractic care causes harm. Not so elegantly worded- but in concept, accurate. I think at first review, anyway. Nancy Sculerati MD 12:03, 20 March 2007 (CDT)

Not mine either, I think this is Matt trying very hard to put the criticism as strongly and clearly as he can.Gareth Leng 12:40, 20 March 2007 (CDT)

(now that I have read latest edit that conflicted with the placement of the above text) " and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques" Just put it in simple terms and not such academic termds. rationalism? empiricism? pseudoscience? These are terms understood only by extremely educated people and, as for example arguments in the article on pseudoscience show right here on our site, are not clearly agreed upon even by them. An intelligent person who has a secondary school education should be able to follow this article plainly- that's all. It's awfully hard to write that way but this subject needs to be discussed in that manner, doesn't it? It's not a technical subject and it has relevance to the general public. Nancy Sculerati MD 12:17, 20 March 2007 (CDT)

OK, I've reworded. It's very important that the wording is absolutely true to the meaning and context of the original, so Matt please comment on whether my rewording is accurate here - it's a referenced attributd criticism and we must be careful that it is understood that we are simply paraphrasing the criticisms of others, not expressing our own opinions hereGareth Leng 12:40, 20 March 2007 (CDT)

The opinion of physicians is so basic here that I think that expecting it to be stated explicitly is unrealistic. A basic tenet of the physician-patient relationship is that the physician prescribed medications in the best interests of the patient and that the patient is free to be non-compliant but expected to discuss that with the physician, or another physician. That is such a basic idea that virtually every ad or opinion piece in the United States that is directed at the public says: discuss this with your doctor-ask your doctor if this is right for you, and in the United States, that word doctor-in lay language not legal language, is equivalent to physician. That's the reason that the "Truth in Health Care advertising bill" is being sponsored, to make it clear that a Doctor of Optometry is not just the same as a physician, etc. The ideas I am expressing are not just my personal opinion, but they are a very moderate-as they should be-summary of the medical view. Although I have my own views about otitis media, for example, I am not pushing them. I say plainly that to physicians, it is outrageous that a chiroprctor calls himself or herself a doctor and tells patients that the medicines their doctor prescribed are really just a profit ploy by the pharmaceutical companies and are better discontinued- when that happens. Chiropractors are not trained in medical diagnosis or examination, that is not to say that they don't offer effective treatments or do not have clinical training in chiropractic. What I am trying to convey here is that the views I am offering, far from being very exterme, are -on the physican side-very, very moderate. When I suggest that we work with them it can only sound self-serving, since they are my views, but I think that it is not reasonable to expect that if I find the article unacceptable that it will be acceptable to the mainstream American physician. I'd like to find a way that is not offensive to chiropractic for this article to be acceptable and it will lie in just plainly and clearly laying out the critical view - in language that an ordinary person can understand. That's not easy, but that's all. No acid. Just straight. Nancy Sculerati MD 15:43, 20 March 2007 (CDT)

Meaning of neutrality

Here the issue I think is what is the meaning of Citizendium policy on neutrality? For me, it is that Citizendium articles should not seek to promote any particular opinion, but should be confined to reporting opinions, including dissenting opinions. Those opinions should not be presented in a way that implies that the editors endorse some opinions but not others; the editors should remain neutral. Neutrality does not mean giving equal space to different views, but does mean treating all with polite respect, and giving sufficient evidence for the reader to understand who holds those opinions and the basis on which those opinions are held. Gareth Leng 11:45, 20 March 2007 (CDT)

Space, when limited, is generally apportioned based on our best estimate of the breakdown of opinion among the "constituency" of the article, with special weight given to expert opinion--which, here, would consist particularly of doctors who study and comment seriously on chiropractic (since they are the sources of the "critical views") as well as chiropractors who reply to them. Just uploaded this last night: CZ:Neutrality Policy. --Larry Sanger 12:28, 20 March 2007 (CDT)

I'm pretty sure we've followed this, in expressing primarily criticisms raised by expert opinion on the medical scientific side - except that we have a potential problem in that it's hard to find criticisms clearly verifiably attributable to expert opinion. In other words, in fact most of the clearly expressed criticisms actually come from chiropractors, it's very hard to find anything as clear and forthright from any other serious source.Gareth Leng 12:35, 20 March 2007 (CDT)

The law suit endorsed by the AMA in the late 70's was forthright, and at that time very likely reflected the view of the medical profession in the US as a whole. After that was lost in court there has been less published, but the available facts: for example reports that the faculty of medical schools (as Matt had referred to) threatened to strike if chiropractic was incorporated, suggest that these views are not irrelevant today. I will try to find statements by societies and organizations of physicians, nurses and other health science professionals. That might help. Nancy Sculerati MD 14:56, 20 March 2007 (CDT)

Act of congress? Misleading advertising

Currently, there is a bill in the US Congress(5688) [1] that is being fought by chiropractic.[2] This bill is apparently sponsored by several MDs who are congressmen, entitled the "Healthcare Truth and Transparency Act". Nancy Sculerati MD 15:12, 20 March 2007 (CDT)

actually-maybe it's already law? Nancy Sculerati MD 15:17, 20 March 2007 (CDT)

rewrote start of article

I rewrote the start of the article to plainly list the criticisms. I thought that the article could go-section by section, over each one. I am sure that we can arrive at a reasonable presentation of this topic, and expect that there will be lots of "back and forth" before we are satisfied. I do not want to proceed further until we have some accord on these criticisms- as they represent an outline of the article. so-is it agreeable in concept to modify the article in this explicit way, to put the criticisms up front and then go through them? 2) Are any of the listed criticisms disputed by other authors? Are any major current criticisms omitted that should be included? and 3) can we discuss the wording of each of the listed criticisms felt to be legitimate? write them out here on the talk page? Then we can go through them one by one and try, together, to come up with a fair presentation of each. Unless you think that plan is a poor one- in which case, please speak up. I just want to add that the criticisms-such as advertisement, would be presented with the history of how that practice waqs banned by physicians for physicians, and why that might influence criticism- and similarly for each of the complaints made particularly by physicians. The thesis being that physicians (particularly in the US) are very sensitive to charges of "quackery" and "lack of scientific evidence"because they themselves had to change their own preferred behavior over the years to comply with these raised standards in medicine and are particularly upset if others claim to be "just as good"but do not follow suit. The first "quacks"that the AMA drove out were physicians. The homeopaths apparently didn't hire a good enough lawyer, and I expect the AMA was pretty suprised when the chiropractors did. That by the way, was a feeble attempt (the only kind I have) at humor- but that's the best I can do. That's the point I was trying to drive home with the Flexner Report stuff in the chiropractic article, that many of the AMA's arguments against chiropractic had been used to purge sects of medicine from the profession. I think that all of this can be fairly presented without making any side look either angelic or demonic. The points are to be made in a dispassionate manner of reporting the views and presenting sufficient history and science such that the views can be understood in context. Nancy Sculerati MD 17:31, 20 March 2007 (CDT)

Full circle again

Hey guys, sorry I haven't checked in, but things got crazy in real life for a little while. I see I missed some of the fun. I do have some input (of course), but let me first say that it seems that Gareth is doing a good job at presenting the chiropractic viewpoint in a neutral manner, so I don't think I have to add much to the article. Having said that, I think this article is accomplishing nothing but making everyone involved look bad. My father always taught me not to pick on someone smaller than you because you lose either way. Either he beats you up and you look like a wimp, or you beat him up and you still look like a bully. It seems that the more we beat up on chiropractic the more we look like wimps or bullies. There is no winning here. Everybody loses. Including CitiZendium. If we come out looking any other way but neutral, the loser will be CZ. So I don't think anybody should expect to feel "good" about this article either way. The best we can feel is neutral. I have felt neutral about this article a few times, but seem to go around in circles a lot. I think the problem for all of us is with the list in the intro. When people look at a bulleted list, they see a list of what they think are "facts". It does not matter what was written in the sentence above and below. Unless we can make those sentences neutrally stated, it won't be neutrally stated. I could once again try to rewrite them, but that would only go the other way. I'm not sure that a list is a good way to present these arguments. It cannot present it in an ubiased fashion. It probably wasn't a good idea in the first place. My input here is mostly to make sure you guys have the chiropractic viewpoint right. I have no idea what the MD viewpoint is, but I am getting the feeling that it is based on a distorted view of what chiropractic is. The only cure for this would be verifiable sources, so I'll try to give some of those. I'll try to keep up. --Matt Innis (Talk) 22:40, 20 March 2007 (CDT)

Gareth's revision of intro

Much better. Putting the crticisms as questions might also work. Nancy Sculerati MD 04:15, 21 March 2007 (CDT)

I am concerned that the chiropractic response to the criticisms is not adequately presented, and how that should be done. It seems to me that the force of the chiropractic defense against many of the criticisms is expressed in the words of the judge in the Wilk case. The following is close to verbatim from the judge's opinion.

" In the 1960's, the American Medical Association (AMA) became concerned that medical physicians were cooperating with chiropractors, and formed as an objective, "the complete elimination of chiropractic". The AMA discouraged physicians from cooperating with chiropractors in patient treatment, research and educational activities such as sharing clinical research data. Chiropractors were denied access to hospital facilities, and, for instance, medical doctors were discouraged from aiding chiropractors in interpreting electrocardiograms. As a result, four chiropractors brought an antitrust case against the AMA and others, and in 1987 a Federal Court Judge ruled that the AMA were guilty of an illegal conspiracy to suppress competition. The judge stated that evidence at the trial showed that the AMA had taken “active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractic, subvert government inquiries into the efficacy of chiropractic, engaage in a massive disinformation campaign to discredit and destabilise the chiropractic profession and engage in numerous other responses to maintain a physician monopoly over health care”

I think that this probably covers the chiropractic rebuttal, which is that chiropractic research has been starved of funds, and that they have been actively prevented from integrating into hospital based medicine by a medical profession tht itself has been very selective and dishonest in its use of evidence in order to suppress a serious business competitor.

It is not our place to decide the argument, only to report it. I'd suggest that, if we mention AMA comments from before the Wilk case at all, then we must include this account of the Judge's opinion.Gareth Leng 04:54, 21 March 2007 (CDT)

I think that's a good idea. There may be some text needed to talk about "physician as business" and "academic medicine", to put that in perspective, and as I have not read the entire opinion, there may be other aspects that should also be mentioned- but as some of the AMA's allegations are included in the "critical views" reported, that opinion seems like a good balancing point. Nancy Sculerati MD 06:54, 21 March 2007 (CDT)

What do you say we consolidate these into one on vaccines and maybe one on medically prescribed treatment:

• that the rejection of universal vaccination in favor of "personal choice" puts the general population at risk for epidemics if the immunization rate falls too low.
• that the rejection of vaccination by some chiropractors can expose their pediatric patients to risk of preventable illnesses like whooping cough (pertussis) and lockjaw (tetanus).
• that the care of the patients with conditions that have never been shown to be efficaciously treated by chiropractors is not warranted if these chiropractors advocate the patient forego medically recommended vaccinations and medically prescribed treatment because such care exposes patients to proven risk without offering proven benefit.

--Matt Innis (Talk) 08:11, 21 March 2007 (CDT)

Also, if we want to stay with this list of crticisms, then the article sections need to reflect each point. I am not sure where to discuss each of the points so that it adequately covers the topic. Either we need to make the list reflect the article or the article reflect the list. --Matt Innis (Talk) 08:46, 21 March 2007 (CDT)

Matt, shortening the list because the listed criticisms are not important or are not truly those voiced by the notable critics is one thing, but shortening the list just for the sake of lightening the critical views is another thing. This article should be accurate and, overall, give a sympathetic rendering of the critical views of chiropractic. It will also have to give a counterbalance, but just as the article on Chiropractic emphasizes the chiropractic perspective, this article properly emphasizes the Critical views perspective. Isn't that correct? So- lets go through it and, as you say make the article reflect the list and see what we come up with. If we do a really good job, then a thoughtful physician or other health science expert who is critical of the profession should feel that the major views have been covered clearly rather than obscured, and the thoughtful chiropractor should feel that yes, these are the criticisms, not reported as Objective Truth but reported as what is, in fact, argued by notable critics, but mention has been made of alternative views and links have been provided for further evaluation of those views. I don't know how far to go in balance- for example, would it be reasonable to have another article entitled "Defense of Chiropractic against critical views" and put the weight there on defense, with mention of the critics rebuttal? My point is that all of the articles have to strive for neutrality, but neutrality does not mean suppression of critical views. Shortening the list-unless done because the items on the list are not legitimate, is suppression of critical views. Better to air them. That's the topic here. Nancy Sculerati MD 09:42, 21 March 2007 (CDT)

I don't think Matt's point was to suppress criticisms, only to consolidate them where they are repeated in several places. But I'm happy to go with Nancy, as I think there are some subtle differences in the criticisms. Anyway, I've for the moment inserted the "chiropractic response to the AMA" for consideration, it may not be the best place for it (comments?) and I'll add the reference to the opinion, it's all available on line. With this I'm ready to approve, and I sense we are about there.. it would be good to do this before the launch as after it there will be other things pressing. I've already tagged a "to approve" on the draft Chiropractic.Gareth Leng 10:07, 21 March 2007 (CDT)

Yes, I don't think I am disagreeing with anything Nancy is saying. Just noting that vaccination is one crticism of chiropractic and we seem to be spreading it out over three points. Thought maybe consolidating was appropriate. I understand how you might think I was trying to make the list shorter, so I won't begrudge you that. Personally, to me it's not the length of the list, but the quality that counts. Also, if this article is done properly there should be no need for a "defense of chiropractic criticisms" article. --Matt Innis (Talk) 10:12, 21 March 2007 (CDT)

On is another article needed; no this article needs to be balanced; we report the views, all relevant notable views, sufficiently for them to be understood. If we've omitted a major criticism, it's an omission, but if we've omitted a major rebuttal on an important point, it's a failure of balance. The issue we've been struggling with is how to show the chiropractic response without in the process misrepresenting the criticism. I hope we've got there.Gareth Leng 10:15, 21 March 2007 (CDT)

Gareth, of course this article needs to be balanced.Please reread my statement above:This article should be accurate and, overall, give a sympathetic rendering of the critical views of chiropractic. It will also have to give a counterbalance, but just as the article on Chiropractic emphasizes the chiropractic perspective, this article properly emphasizes the Critical views perspective. Isn't that correct? So- lets go through it and, as you say make the article reflect the list and see what we come up with. If we do a really good job, then a thoughtful physician or other health science expert who is critical of the profession should feel that the major views have been covered clearly rather than obscured, and the thoughtful chiropractor should feel that yes, these are the criticisms, not reported as Objective Truth but reported as what is, in fact, argued by notable critics, but mention has been made of alternative views and links have been provided for further evaluation of those views. Still, the emphasis here is on Critical Views- and just as the Chiropractic article allowed a sympatheic rendering of chiropractic without arguing every point made in an "equal time" sense to critics, this article should do the same for critical views. Do you want to write the rest of it and reformat it- that's fine with me. Preferrable even, please go ahead. Nancy Sculerati MD 10:22, 21 March 2007 (CDT)

I think the article as it stands is fine; there's no call for equal space or anything like that, I'm just reiterating Larry's point, made above, that

"...in any article that details criticisms of something, it is essential that published or common replies be detailed as well. That is a very straightforward and obvious application of the neutrality policy."

As I've said, I'm happy about the present article, because I think it is clear what the responses to the criticisms are, and that we haven't endorsed but just reported both criticisms and responses. Gareth Leng 10:29, 21 March 2007 (CDT)

I cannot approve the present article because it states that each of the points will be discussed in a section, and the whole article needs to be reformatted to do that. Once that's done it needs to be polished and copyedited. I am not happy when after I write what I believe to be something reasonable fair and balanced for a rough draft it is implied that the article now is bullying and a disservice to Citizendium. I can understand that this is a sensitive issue, especially to a chiropctor-after all, look at the title of the article. But I am also sensitive to criticism and my motivation to volunteer my time to intensively work on this article is affected by it. I am not interested in playing the part of the "bully" here, but feel an obligation to see that mainstream medical views are fully covered. So please proceed to get it into shape yourself, put the sections in order, make sure each one has a cogent argument and do the copyediting. Clearly it is not there yet.Nancy Sculerati MD 10:41, 21 March 2007 (CDT)

We're fine. It's just that when we changed the lead, we created more work for ourselves. There are a thousand different ways to say the same thing. Let's stick to one and keep refining it until we get it right. And Nancy, I do hope you don't think I am calling you the bully, I said "we". If we look like we are bullying, CZ looks bad, because we are CZ. --Matt Innis (Talk) 12:45, 21 March 2007 (CDT)

Please look at Matt's comments under "Full Circle Again", and take the time to understand that these were made in response to my rewrite, and comments about it (under "rewrote start of article" just above "Full Circle") on the talk page. Nancy Sculerati MD 12:09, 21 March 2007 (CDT)

I'm sorry Nancy, I thought it was this guy that put the list in. My apologies, that is why I was wondering why we were fighting so hard to keep it? --Matt Innis (Talk) 12:43, 21 March 2007 (CDT)

Communication is a wonderful thing. :-). Nancy Sculerati MD 13:02, 21 March 2007 (CDT)

Think your additions are all good except this:

" the lack of proof that ....that there is a direct innervation of nerves that pass near the vertebrae to many of the areas of the body claimed to be affected by spinal adjustments"

If any do claim this then they don't know the science. Spinal nerves directly innervate I think every organ, and do so quite extensively (not just muscles, and I think both efferent and afferent), and I don't know of any exceptions. There is certainly an extensive spinal innervation of the liver (see e.g. la Fleur et al. Polysynaptic neural pathways between the hypothalamus, including the suprachiasmatic nucleus, and the liver. Brain Res. 2000 Jul 14;871(1):50-6. PMID 10882782), the GI tract and all reproductive organs including the uterus and gonads. It's not speculation but established fact (in animal studies anyway).Gareth Leng 08:14, 22 March 2007 (CDT)

Yes. Think that would be a nice addition. That is why Anthony Rosner of the FCER says it is too early to let go of the concept of subluxation. Though I did notice that Rosner is being replaced by Reed Phillips [3]. Thats the Phillips that we cite in the chiropractic article along with Mootz. They are the new breed of scientific chiropractor. Looks like another step in the toppling of subluxation;) --Matt Innis (Talk) 09:53, 22 March 2007 (CDT)

Gareth, having a little trouble with this one: what is particular to Chiropractic is that chiropractic treatment offers a feasible alternative to vaccination. I read the article fromt he WCA on this, too. I'm not aware that chiropractic actually considers itself as a feasible alternative to vaccination. I have heard the usual rhetoric for chicken pox or measles (to make sure they are healthy, then bring them over to somebodies house that has chicken pox, etc.) Suggesting that getting the disease is the best form of immunity. I assume probably the same with the flu vaccine. I don't think this works with hepatitis:) They certainly don't want to suggest they use dirty needles:) --Matt Innis (Talk) 10:47, 22 March 2007 (CDT)

Hi Matt, what I'm alluding to is the claim that chiropractic strengthens the immune system and so provides a natural way to resist infection. I've seen this in direct relation to vaccination in WCA literature, want me to chase it?Gareth Leng 12:18, 22 March 2007 (CDT)

Wow, if there is someone suggesting this, I have no intention of defending that. Let's at least make sure we attribute that one to the ones responsible for making a stupid statement like that. If I were the AMA, I wouldn't give them any credence either;) I did see that the article that you have referenced talks of Steve Perle, DC. I do know that he is apparently involved in a lawsuit with the WCA concerning an earlier criticism of their "scientific methods"[4]. The straight/mixer battle rages on! --Matt Innis (Talk) 21:51, 22 March 2007 (CDT)

Vaccination

Obviously we need to get this right and fair, and all I can do is look at the web and the literature. In its official statements the WCA a) casts doubt on the safety and effectiveness of vaccination (see this [5] and b) promotes chiropractic care as a way of boosting natural immunity. However I know the WCA is a small, extreme organisation. There's a very interesting review by Campbell JB et al. in Pediatrics 105 No. 4 April 2000, p. e43 [6] Chiropractors and Vaccination: A Historical Perspective. It states, about anti vaccinationist chiropractors "Although the precise numbers of these vocal antivaccinationists remain uncertain, it is apparent that their views do not represent those of practising chiropractors in general. Several chiropractors, possibly members of the quiet majority, have felt compelled to contribute scholarly works that clearly demonstrate a provaccination stance"

?? Have we got it right in the article?Gareth Leng 05:35, 23 March 2007 (CDT)

You see now, perhaps better, why the official statements of the responsible Chiropractic organizations can be legitimately criticized. If a subgroup -we are not talking about an individual, but an official professional organization, makes claims like WCA does-it is up to the parent organization to make a statement - either to support vaccination (with a clause about risk, nobody would do anything else) or to reprimand the group somewhere public for these statements. When the only statement made by the big organizations about vaccination is the "personal choice" rhetoric, that's a problem. I can't think of an example in Medicine at the moment, but the truth is that no profession likes to alienate its own members, and generally sticks together. But I do know, that when it gets to a certain point- even a profession such as Medicine says something. If they don't, then professional credibility is lost. Here, I understand Chiropractic's young, not so well organized - but I assure you there are patients who listen to the WCA because they want to believe that stuff and because it all falls in with folk logic. In light of Chiropractic's long past history of anti-vaccination, just trying to sound reasonable about minimizing medications and risk, is avoiding the issue. The truth is that the same promotion of chiropractic as being a way to strengthen host immunity so that "dangerous" vaccinations can be avoided has been made continuously, by at least somebody official in the profession, for a hundred years. That is combined with the acceptance of risks like autism from vaccination being referred to as actual or probable fact throughout so many publications even in the chiropractic mainstream- it's a problem. It's a problem that could be solved if the statements from the chiropractic organizations showed more gumption. Nancy Sculerati MD 15:39, 23 March 2007 (CDT)

restoration of reversed comment

Can I add the small point that in my own country, Australia, Chiropracters do not have a high or aggressive profile as anti-vaccine activists. David Tribe 17:19, 23 March 2007 (CDT)

Note that I stand by my comment, just retracted it because it might be seen as unconstructive. My general stance is that weak , ill-founded ant-vaccine attitudes should be subjected to strong scrutiny (and I support that general thrust here). I was just trying to find a fair representation of where Chriropractic is placed, but my comments are merely anecdotal David Tribe 02:03, 24 March 2007 (CDT)

responding to comment-even though reversed

Come on David-get in here. I point out that David Tribe made a comment here about Australia and the lack of anti-vaccinationists in chiropractic there-and then erased it. David, you may have erased it because you saw that we argue in the article that the USA, since it has the largest (by far) representation of the profession and the most crtiticism of it is our focus here. But I wonder- in Australia, are there specific laws or reguations that have already taken care of this? Don't get me wrong- I love the freedom of the USA, in fact, the community that I personally am most comfortable in is Manhattan where personal freedom gets taken to a level -on a practical basis- that's particularly high grade, but-in Canada, for example, the health service actually made a rule specifically stating that since Chiropractic offers no recognized aid to immunity chiropractors are not allowed to discuss vaccination with their patients. I wonder if that's the sort of thing that's also been done in Australia. Again, Matt, we cannot write these articles and rely only on how you practice or how you were trained. The WCA may only be a small organization, in terms of dues paying members, but it strikes me that people who have such extreme beliefs, unless they lean on the fascist side of things instead of the new age side of things, tend not to be strictly organized dues paying members of any organization. The number of members is not a critical measurement of influence, anyway. I notice the WCA advertises meetings in many journals/magazines and lists lots of speakers. What kind of registration do they get for those meetings? For example, tenured faculty in surgical departments (I blush modestly, even though my career is over now, unfortunately) are not by any means numerous as compared to all physicians or all surgical specialists- but when they give talks or write papers that influence is much larger than their numbers might suggest. I know Gareth that you have suggested that looking into these things is "original research" but I don't see it quite that way. God knows reading those old chiropractic Palmer green books seemed like original research to me - but it's not like we are coming up with some new theory here. We are just trying to figure out a very legitimate subject that has not been carefully analyzed. I don't see why we can't look up published data like meeting registrations, course syllabi and such where we can find them. Otherwise- how can we write accurately? The world needs honest articles about these subjects. Who else is going to write them? All I can say, is so far- it's been nearly nobody or exactly nobody. As much as I resisted getting dragged into this- I really want to know the answer. Nancy Sculerati MD 18:07, 23 March 2007 (CDT)

This has certainly been a learning experience for me and quite frankly it is because I never thought about it that seriously. That is why my first impression was that this is a vaccination issue, not chiropractic. After reading Nancy's good work, it occurs to me that it is a chiropractic issue simply because they have a position of authority that requires a certain amount of responsibility. So I am behind Nancy as far as bringing this to the front, especially since it could quite possibly be THE reason that Medicine stopped respecting chiropractic as a health profession in the 1950s. It was a missing piece of my puzzle. Having said that however, if we are going to bring down the weight of this argument on this page, I agree with Gareth that we need to bring out the OTHER side of the story in the same sympathetic way. In other words, we cannot appear to be making value judgements on the weight of the arguments - just state them and attribute them properly and let the chips fall where they may. This is going to be tough for both Nancy and I to swallow - maybe even Gareth, but it is our responsibility to the article to present it neutrally. Unfortunately, this may mean that we create a long article on vaccination as we look at the pro and anti arguments. It may be that we have to build the vaccination article first and then bring parts of it back here. Thoughts?

I just saw David's comments in the history and, while Nancy, you make the very good point that we cannot build this article based on my practice or impression of chiropractic, it is just as important that we can't build it on your single impression as well. Opinions such as David and Gareth are valuable. I am not totally convinced that things are that different in the USA and am still reserving judgement on that issue for now. It could also be that your vision of chiropractic is skewed as well. This is not a statement about you, but if I am not convinced and I have read every post made on this wiki concerning this subject, how do we expect chiropractors who just read the article to buy it. They are going to have the same reaction as me. That is why we have to continue to dig this stuff out of the sources if we are going to make claims of such. If we attribute the information to the sources, then the weight of the sources should help us decide on the validity of the claim. I think we are doing that, but it is a slow process and it won't be finished by Sunday. --Matt Innis (Talk) 22:14, 23 March 2007 (CDT)

---

You are losing me, Matt. First, this is "Critical Views of Chiropractic" and it simply reports the critical views, it's just a fact that one critical view of chiropractic by clinical health scientists has been about a perceived anti-vaccination stance. That is true in the USA, and that's the way it is stated in the article. Second, my contributions to the article have all been carefully sourced - and are not my opinions. I have been the one here spending many hours daily reading the literature. My concern about anti-vaccination and chiropractic originally comes from having parents relate their experiences, but none of that is written here, let alone the articles. That's the concern that has pushed me to actually read every expert review and legitimate source of information that I can find. There is no doubt that in Canada what I have written is fact (that Canada put a stop to it), and there is no doubt that not just the WCA, but that the ICA Council on Pediatrics take an anti-vaccination stance, or at least lean towards that stance as much as one possibly can in the USA without landing in jail. In other words- nobody is going to publish outright things that are against the law. I don't think that you need fear we are going to go overboard here, we want neutral articles. I am going to copy some statements from the ICA below. Nancy Sculerati MD 06:55, 24 March 2007 (CDT) Below are the publications on vaccinations available from the ICA, the only ones listed on their website for the council of pediatrics. In other words, I did not select the anti-vaccination ones from a group of articles on vaccination, these are the only references provided by the website of one of the largest organization of chiropractors' pediatric group. Period. scroll to bottom of this link [7] I am trying my best to be neutral, and I have been looking for statements from chiropractic organizations in the USA to counterbalance these. Help me, please. I can't find them. When I say we can't go by your personal experience Matt, I mean you say that in your school Logan, this was not advocated, and that you practice differently, but that is no counterweight to this stuff. The ICA claims to be one of the largest organization of chiropractors in the world.You posted that it has 8000 members. If I've got that wrong, correct me, please. I am struggling to learn here, and I want to be accurate. Please read the stuff below, word for word, and check the link.

Vaccination [ BACK TO TOP ] Shaken Baby Syndrome or Vaccine Induced Encephalitis? By Harold Buttram, M.D. and F. Edward Yazbak, M.D. In November 1997 little Baby Alan, 10 weeks old, died from complications following 6 vaccinations (including Dpt, Hib, OBV and hepatitis B) given on one day. His father, Dr. Alan Yurko, was accused of Shaken Baby Syndrome, found guilty of murder, and is now serving a life sentence without parole. During the extremely short trial, the possibility that the baby’s complications may have been vaccine-related was never mentioned – why? This paper will help you understand what can happen when a baby, with the medical conditions that Baby Alan had, gets the DPT vaccination and how mis-diagnosis can result in tragedy. (Reprint available in Pediatric Articles, Volume 4)

The Vaccination Myth: An Exercise in Logic By Robin C. Hyman, D.C. The author suggests that the Outside-In, Below-Up approach of the vaccination theory is in direct philosophical contradiction to chiropractic’s Above-Down, Inside-Out healing veracity. He provides logical arguments aimed at disproving five basic vaccination myths regarding their safety and effectiveness. (Reprint available in Pediatric Articles, Volume 4)

Immunization: A Closer Look By Ashley Cleveland, D.C. and Bradley David Eck, D.C. Immunization has been heralded by the medical establishment as the sole force responsible for declining rates/disappearances of certain formerly problematic human diseases. Likewise, there are those who recognize a stretch of logic in assuming a direct cause and effect relationship between mass immunization and falling rates of infections, and who point to serious adverse reactions in children following the administration of childhood vaccinations as an indication that this medical intervention may not be the savior of humanity. The picture here is clouded by politics, power, and personal tragedies, and it is time to take an honest look at the issues surrounding the health of our children and those policies that determine the care they receive. (Reprint available in Pediatric Articles, Volume 4)

Chiropractic Attitudes Toward Immunization By Viera Scheibner, Ph.D. This article is a commentary on a “Survey of American Chiropractors’ Attidue to Immunization.” The authors of the survey believe that there is scientific value to vaccinations even though the survey showed that a significant number of chiropractors are anti-immunizations. Dr. Scheibner’s evidence is otherwise – vaccines do not immunize; the harmful side effects can lead to degenerative diseases later in life; all facts documented in the medical literature but ignored or excluded from safety calculations by the proponents of vaccines. (Reprint available in Pediatric Articles, Volumes I, II & III)

David and Gareth's opinions are as worthless as yours and mine :-), what's important about our opinions is how we use our impressions to formulate ideas and back them up with review of available literature. Again, in Canada I expect that a citizen does not have an impression that chiropractic is anti-vaccination and there is a law in Canada that accounts for this. Is there a similar rule in Australia? Your impressions are important but I can't find statements among chiropractic organizations here in the USA that back them up, can you? If you can we can use them and that would be great. I'm on your side, not against you. Nancy Sculerati MD 07:25, 24 March 2007 (CDT)

Agree with above statements with 4 minor variances. 1) This article is separate from the chiropractic article only because that article is too long. It still must be presented neutrally - consider it just a section of the chiropractic article. I think we both really understand that, but may have trouble getting that across to each other. 2) You have convinced me that vaccination belongs in this article in a big way. But we have to present it in a neutral way - meaning that the only way it can be neutral is to describe the vaccination debate neutrally (not only whether chiropractors make a certain stand). In other words, we have to carefully dissect the pro and con arguments for vaccination and attribute them to the proper sources. Unless chiropractors just make this stuff up, we have to find out who is saying it, then the weight of the arguments will decide if these chiropractors are standing on any type of firm ground or not. Surely associations are not making statements based on opinion. I understand pressure from it's memebers, but where are they getting their information? 3). The source that we have concerning vaccinations is from Canada. Are you saying that you think the USA is different? My NC state law does not allow me to discuss medications either. I assume that includes vaccinations. What chiropractors might believe and write about in their papers where they should be welcome to talk about anything they want. It is their reputations that are being put on the line. Are there not MDs who write about antivaccination? 4). You are right, we are all just as valuable here. I'll look at your link you provided now. --Matt Innis (Talk) 08:31, 24 March 2007 (CDT)

We'll make sure that this article is reasonable. I'll understand what you are getting at better as we actually write it in. Meanwhile, could you look at the Chiropractic/draft? I think the pictures that Gareth suggested, the one of those you pick, could go in a couple of later sections of the article as it has no illustrations. I think that the Chiropractic draft is better than the approved for several reasons, and I think we should approve it now. I took off the approval template, and I don't really know how to put it back. Could you look it over and do that Matt-when ready? Thanks Nancy Sculerati MD 08:36, 24 March 2007 (CDT)

Nancy - I looked at your link and see that you were just pointing to the excerpts that you quoted. I see that they are being presented in the chiropractic pediatrics web page, but I'm not sure what conclusion I am supposed to draw from it. Are you saying that the full articles may have been misquoted? exagerated? or something that the association might be misrepresenting the authors? I do think these are the "reasons" this group of chiropractors may be using in their antivaccination stance, but they aren't the ones making the statements. It's those sources that we want to investigate in the antivaccination debate. I'll take a look at the chiropractic draft now. --Matt Innis (Talk) 08:46, 24 March 2007 (CDT)

I am saying that the only references offered on vaccination by this group are anti-vaccination or at least very critical of vaccination and that, along with what they say on their other pages about their "drugless" approach to the comprehensive care of children, which they offer, is not a modern health science view of pediatric care, but consistent with the same old story of the old school of chiropractic. Also these references have been critiqued in the article Gareth and I both cited from Pediatrics, please get them and read them and send them to us. I don't have access to them full-text. Meanwhile, I looked at the ACA website, and they clearly do not publically advocate comprehensive care for children in the same way at all. Nancy Sculerati MD 15:55, 25 March 2007 (CDT)

Looking for Vaccination articles in Chiropractic pediatric web site

Hey all, found this one online Shaken Baby Syndrome and vaccines]. I'm still looking for the rest, but start with this one. --Matt Innis (Talk) 17:57, 6 April 2007 (CDT)

The web site referenced Vera Shreibner [8] which looks like could be a source for a lot of anti-vaccination stuff from her [9]. Notice the whale.to web site. I think this is a strong antivaccination web site or ring or something so we are getting close. There ought to be a lot of infromation from here to make the WHY defense. It will take me some time to read over it all. I am wondering if this should be in the Vaccination article and this page links to it. Or in a Criticism of vaccination article and we link to it. Do you think we could write a good neutral article there? It was very controversial on WP that I never looked at, but saw some of the fallout with lots of banned users. --Matt Innis (Talk) 18:11, 6 April 2007 (CDT)

Let's get tis article done, you can put anything in other articles for now-but I'd like to get this out of the way and approved. Nancy Sculerati 18:26, 6 April 2007 (CDT)

Okay, here is the bulk of information for antivaccinationists [10]. The question is how we want to get this article done. So we could either 1) just mention the antivaccination stance and point to a neutrally written vaccination article which would mean that we trim down some of the provaccination written information from this article or 2) we could add the antivaccination info in order to illustrate the WHY in this article. I think we should put this into a vaccination article along with the provaccination stance that is already in this article. See what I mean. I think this criticism is bigger than chiropractic. --Matt Innis (Talk) 19:17, 6 April 2007 (CDT)

I am not interested in writing an anti-vaccination article at this time. I say do whatever you have to do to feel that you can approve this article, without having to write another article first.Nancy Sculerati 19:19, 6 April 2007 (CDT)

Okay, I will rewrite the areas that I think this article is not neutral. Give me some time, then you can revert it. --Matt Innis (Talk) 19:28, 6 April 2007 (CDT)

I placed the ToApprove box on top with one week as the target date. We can always change it. --Matt Innis (Talk) 22:20, 6 April 2007 (CDT)

Final? changes

Am going through afresh. Stopped at the point that these concerns have become no less acute since the court case... Actually this is not what the AMA said, as I recall their defence to the case was that they had already withdrawn the boycott because of improvements in chiropractic education and practise for which they took credit - in effect they argued that their campaign had done a service in forcing higher standards. The judge rejected this defence on the grounds that she did not believe that the AMA were sincere and that they were still encouraging an unofficial boycott. Anyway I thought it right to note that the AMA recogbnised that standards had improved since the court case.

"Chiropractors however can point to evidence that they have significantly upgraded their standards of education and research independently of Medicine, and without public funding; Significant improvements in chiropractic standards have been acknowledged by the AMA, who indeed claimed that this was a positive outcome of their campaign."Gareth Leng 08:04, 10 April 2007 (CDT)

Cut this " For example, the common cold, chiropractors may give an adjustment and send the patient home for rest and fluids, while a family doctor might prescribe an antibiotic with the rest and fluids." Seemed to give mixed messages. Is this a criticism of doctors who give antibiotics to treat viruses? If so its a valid criticism, or has been in some cases, but not really appropriate here - needs explanation and too tangential.Gareth Leng 08:07, 10 April 2007 (CDT)

Cut this: "For those chiropractors that remain skeptical of Medicine's intentions, this lack of evidence ensures that Medicine will not adopt these principles as their own." Seems like a counter attack not a defence, and not understandable to the uniyitiated.Gareth Leng 08:30, 10 April 2007 (CDT)

OK, I think we've put a lot into this and should move on; I vote approve.Gareth Leng 08:46, 10 April 2007 (CDT)

Welcome back Gareth! Okay, in the beginning of this article, we promised to answer these questions:

• What is the evidence that supports or refutes them? What aspects of chiropractic practice and medical practice have combined to produce these particular complaints? Why is there controversy within the chiropractic profession about at least some of them? Chiropractors appear to respond to these allegations differently depending on their particular professional orientation. Each point is discussed in this article.

Your suggestions to cut this:

• "For example, the common cold, chiropractors may give an adjustment and send the patient home for rest and fluids, while a family doctor might prescribe an antibiotic with the rest and fluids."

and this:

• "For those chiropractors that remain skeptical of Medicine's intentions, this lack of evidence ensures that Medicine will not adopt these principles as their own."

These are probably the two most important reasons all chiropractors continue to do what they are doing. I didn't place them as a defense, rather as explanations. I'm not sure that giving an adjustment for a virus is any better than giving an antibiotic, or worse, but it is what drives the chiopractors thinking that causes the controversy with those that criticise. If some are not initiated to the idea, maybe we should illucidate for them instead. And one of BJ's fears was that Medicine would overtake chiropractic as they did Osteopathy. This is a very real concern for chiropractors and directs how they act as well. Something about wolves and deer;) Would you be anxious to prove what you do if it would be taken away from you. You get the idea - cloak it in mysticism. There are chiropractors that do not want this stuff proven, because they know it would be the death nail for chiropractic as an independent profession. Most of the criticisms thrown at chiropractic are designed to get them to fall in line. The battle among chiropractors is whether to do so, with 25% saying yes, 25% saying no and 50% watching to see how these issues develop. If chiropractic goes too fast, a branch will break off and keep perpetuating the vitalistic concept. The question is where that 50% goes.

Are you sure you can't just reword some of that to make it fit better? --Matt Innis (Talk) 09:17, 10 April 2007 (CDT)

• ""...while a family doctor might prescribe an antibiotic with the rest and fluids. The family doctor does not first " The problem here is this - an antibiotic is not a sensible prescription for the common cold, in the past many have indeed done exactly this, and it might have some benefits in pre-empting opportunistic infections. But for the common cold, definitely no. (agree Nancy?). So what is your point - that some doctors have sloppy prescribing habits? Its true of course but I dont think this is what you were saying. I think you were saying that some doctors make innocuous prescriptions to reassure the patient and let nnature and sensible advice do the job of healing. This I think is very true. You might have been saying that doctors don't investigate the cause of symptoms, but treat according to habit and their experience. This is also very true. But which of these things were you saying here?

Gareth Leng 09:47, 10 April 2007 (CDT)

That chiropractors consider their treatments as a better option than alternatives because they have no side effects. --Matt Innis (Talk) 11:05, 10 April 2007 (CDT)

How about "In practice, family doctors do not routinely investigate the causal basis of their patients' symptoms, but usually prescribe treatments based on their clinical experience of what has been effective in similar cases in the past. Thus for a patient who has signs of a respiratory infection, a family doctor will not normally wait to investigate whether the infection is viral or bacterial, but will advise the patient to rest and drink plenty of fluids, and may also prescribe an antiobiotic. The doctor in these cases judges that the antibiotic will do no harm and might do some good. The chiropractor will give the same advice, but does not prescribe drugs; he or she may give the patient an adjustment or sell them a dietary supplement, also judging that their treatment will do no harm but might do some good."

Remember, the criticism here is that chiropractors practice outside their scope... The rebuttal is that chiropractors feel they can handle these things just as easily as medicine, their education does allow for it and just because their approach is different does not make it wrong. We can't just make a criticism like "that chiropractors are not trained in the diagnosis of medical diseases, and so are not competent to act as comprehensive primary care health care providers" without allowing some defense. I am not sure we handle it well. I don't buy that the family doctor does not give antibiotics to almost every patient who presents with a cough or a sneeze without even making an attempt to differntiate bacterial vs virus. And that is okay. But don't condemn chiropractors for not doing it. I know I'm pounding on this, but if this article is not going to be a farse for just throwing darts, then we have to deal with the real arguments and real defenses. I haven't seen any other article do it. I'll breathe now.--Matt Innis (Talk) 11:21, 10 April 2007 (CDT)

No, not a dartboard, it's a question of understanding that's all. But isn'y what you've just said exactly what I've said - that in practice what they do they do from experience not after scientific testing? Here it is again, with one word goneGareth Leng 12:03, 10 April 2007 (CDT)

"In practice, family doctors do not routinely investigate the causal basis of their patients' symptoms, but usually prescribe treatments based on their clinical experience of what has been effective in similar cases in the past. Thus for a patient who has signs of a respiratory infection, a family doctor will not wait to investigate whether the infection is viral or bacterial, but will advise the patient to rest and drink plenty of fluids, and may also prescribe an antiobiotic. The doctor in these cases judges that the antibiotic will do no harm and might do some good. The chiropractor will give the same advice, but does not prescribe drugs; he or she may give the patient an adjustment or sell them a dietary supplement, also judging that their treatment will do no harm but might do some good."

This is good, but that is not all. The critique is that they are not capable of being primary care docotrs. In other words this complaint is a myth. Chiropractors are capable of handling these patients. They can order the blood work, they can determine if it is bacterial, they can refer the questionable ones out, they can diagnose bronchitis, they can send a patient to an oncologist just as easy as the family doctor. They can be primary care, that is what the critique is. Chiropractic is part of the health sciences. --Matt Innis (Talk) 12:21, 10 April 2007 (CDT)

"For scientifically minded physicians, the lack of proof that nerve conduction is actually affected by chiropractic manipulation means that DD Palmer's theories remain speculative. For those chiropractors that remain skeptical of Medicine's intentions, this lack of evidence insures that Medicine will not adopt these principles as their own."

Again, what are you saying here? Are you saying that chiropractors don't want to see evidence because Medicine will claim chiropractic for themselves? Or are you saying that Medicine uses this as an excuse not to take chiropractic seriously? If the latter it could be "Chiropractors believe that their own experience of the efficacy of chiropractic for their patients is sufficient justification for retaining Palmer's explanations. Those who are skeptical of Medicine's intentions believe that if retaining these concepts ensures that Medicine will not absorb Chiropractic, then this is no bad thing." Gareth Leng 09:58, 10 April 2007 (CDT)

This view has been expressed by many chiropractors Gareth, and it is a business view. It has nothing to do with truth or theory, it has to do with market niche. Nancy Sculerati 10:02, 10 April 2007 (CDT)

I agree they see it as a matter of survival for the profession; Medicine will give chiropractic to the physical therapists and there will be no patients left, the schools will fold and DC's will go the way of the dinosaur. HOWEVER, if chiropractic is deemed unscientific, then Medicine can't use it. They leave chiropractic alone. This is what they think. So, for this group of chiropractors, there is no rush to prove it. Now, if there comes a time when Chiropractic has grown enough to stand on its own two feet, it can be uncloaked - remove Innate, investigate it all you want, but continue to give the credit where credit is due. The debate would consider whether now is the time or not. Those that don't trust Medicine, don't want to, others think they should. --Matt Innis (Talk) 10:37, 10 April 2007 (CDT)

Further, many family doctors (and even specialists such as myself) DO prescribe rest and fluid, and many chiropractors sell bottles of high priced vitamin supplements as a major part of business - but since these are not regulated as drugs, its still "drugless healing". Nancy Sculerati 10:05, 10 April 2007 (CDT)

Yes, but this is another group of chiropractors - mixers. Straights won't sell vitamins, they agree that herbs are just as toxic for you as drugs. Instead they will adjust, tell you to go home and rest. The difference is that chiropractors are not goign to tell you to take something for the fever as they consider it part of the bodies natural defenses rather than something that needs to be treated. --Matt Innis (Talk) 10:42, 10 April 2007 (CDT)

OK, happy with that: how about "Chiropractors believe that their own experience of the efficacy of chiropractic for their patients is sufficient justification for retaining Palmer's explanations. Those who are skeptical of Medicine's intentions believe that if retaining these concepts ensures that Medicine will not absorb Chiropractic, then is no bad thing for the future of Chiropractic as an independent profession."Gareth Leng 10:12, 10 April 2007 (CDT)

Hi Nancy, I've revised the wording of the other sentence above re common cold in light of your commentsGareth Leng 10:18, 10 April 2007 (CDT)

Thanks, I'll look. Here's another issue re: "Those who are skeptical of Medicine's intentions believe that if retaining these concepts ensures that Medicine will not absorb Chiropractic, then is no bad thing for the future of Chiropractic as an independent profession". It has nothing to do with medicine's intentions again, it has to do with market niche. Try: "If retaining these concepts ensures that Medicine will not absorb Chiropractic, then the future of Chiropractic as a viable profession may depend on them". Nancy Sculerati 10:24, 10 April 2007 (CDT) Sorry, I am not writing well, I'm tired today. do you see what I mean?

Whew, I've been all over this page. Please look through it from Final? to catch up with my comments on each of your responses. I am not there yet, again, and realize that I am throwing you for another loop, and may not be clear in my discussion, but this article takes us in so many directions, I have to consider all theories and groups and considerations in order to be fair to all of them. --Matt Innis (Talk) 12:03, 10 April 2007 (CDT)

OK, with Nanvy's comment above I'm inserting this, feel free to take out again or modify. "Chiropractors believe that their own experience of the efficacy of chiropractic for their patients is sufficient justification for retaining Palmer's explanations. Some chiropractors also believe that retaining these concepts are important for the future of Chiropractic as a viable, independent profession, believing that this will ensure that Medicine will not absorb Chiropractic."Gareth Leng 12:11, 10 April 2007 (CDT)

--Matt Innis (Talk) 11:05, 10 April 2007 (CDT)

And, consolidating the above (I think), the following:

"In practice, family doctors do not routinely investigate the causal basis of their patients' symptoms, but usually prescribe treatments based on their clinical experience of what has been effective in similar cases in the past. Thus for a patient who has signs of a respiratory infection, a family doctor will not normally wait to investigate whether the infection is viral or bacterial, but will advise the patient to rest and drink plenty of fluids, and may also prescribe an antiobiotic. The doctor in these cases judges that the antibiotic will do no harm and might do some good. The chiropractor will give the same advice, but does not prescribe drugs; he or she may give the patient an adjustment or sell them a dietary supplement, also judging that their treatment will do no harm but might do some good, and are a better option than drugs because they have fewer adverse side effects."

Added Matts comment but with one proviso, we cannot say that adjustments have no side effects it, or at least you can say it but I wn't believe it; if an adjustment works by altering spinal nerve traffic then it surely will have side effects; they may be mostly unnoticed or innocuous, but to say it has no side effects to me is like saying it does nothing. Happy with fewer side effects. Again I'm adding the above in, just to move things on.Gareth Leng 12:18, 10 April 2007 (CDT)

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Revise

OK I see there's a problem herefor both of you, that you both seem to feel the arguments personally. Me, I'm a cold-hearted soul anyway. Where's the truth as I see it? Nancy is right in that the article has become very repetitive and seemingly arguing round in circles. Matt is though right in that the article was actually not fair and balanced; it gave full voice to criticisms but did not represent the rebuttals effectively. One problem, is the tone in which the criticisms were voiced, when words like quackery are used, this reflects the vehemnece of the criticism but not the content - how do you reply to this? One way is to reflect the corresponding anger of chiropractic (Medicine, Malice and Monopolies) - this is the understandable anger, cynicism and resentment of what is seen as arrogance, ignorance and self interest cloaked in high-sounding ideals yet riddled with double standards. Do we start to express this? Matt's rather gentle efforts to do so are seen by Nancy as distractions, that mislead the reader. Mislead how?

Nancy's worry I think is that these issues get in the way of evaluating the criticisms coolly. The answer then must be to state the criticisms as coolly as possible, and remove the emotive language from the criticisms, giving no need and no excuse for emotive language in rebuttal.

The criticisms must be made clear. They must not appear to be endorsed by us; we are only reporting criticisms. Whether we feel they are valid or not is not the point.

Similarly the response must be as clear as possible. The same applies. They must not appear to be endorsed by us; we are only reporting rebuttals. Whether we feel they are valid or not is not the point.

We must therefore be careful to use reported speech, assigning views to people other than ourselves, and never here state anything as fact, only as referred opinion.Gareth Leng 04:33, 11 April 2007 (CDT)

Anyway, I've gone through the article again in what is quite a major revise. I don't think I've actually lost anything significant, though I have removed repetitively stated points.Gareth Leng 05:14, 11 April 2007 (CDT)

look at archives

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Gareth, I think your edits were quite neutral. Nancy, just because this article is named "criticisms" does not give us license to "assume" the criticisms are true. It is our duty to present them and their defenses if necessary. That is what we have done. If the defense happens to look better than the criticism, maybe the criticism is unwarrented. That is what the reader should decide. Also, saying the same thing ten times doesn't make it more true. You can disguise it several ways, but the meat of it is the same and that is why the list that you represented today is to vague and repetative. Previously it was simple and direct and allowed simple and direct responses. When you complicate as you have, it unfairly buries criticisms among the assertions that can't be defended in any rational manner. I am not happy with your changes. Just look at the list now. It repeats itself endlessly:

• That an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model, and advocate expansion of market base into the care of the well child.
• That this same subgroup by encourages parents to believe that all vaccinations have much higher risks and much less proven benefit than any organized health science or biological science group accepts.
• that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
• that Chiropractic argues that such coursework in "medical diagnosis" qualifies its practitioners to be fully qualified to make medical evaluations, and to rule out signs of serious disease.
• that the theoretical basis of the key chiropractic concept of vertebral subluxation is not scientifically sound.
• that rejecting universal vaccination in favor of personal choice puts the general population at risk of epidemics, and might expose pediatric patients to the risk of preventable illnesses.
• that, in the USA, chiropractors are not trained in medicine, nursing, or health science, and so are not competent to act as comprehensive primary health care providers. However, an organized subgroup of chiropractors openly make that claim and are no protest is made by the organized profession.
• that the care of patients with conditions that have never been shown to be efficaciously treated by chiropractors is not warranted.
• that Chiropractic accepts a level of self-promotion in advertising that is unprofessional and misleading.
• that although chiropractic has been shown to be effective for a limited set of conditions that are associated with backpain, this efficacy is generalized to "muscloskeletal conditions", a phrase without specific meaning that does not include the conditions, such as myasthenia gravis, multiple sclerosis, or rheumatoid arthritis, that any reasonably knowlegable layman might assume to be such a condition.

--Matt Innis (Talk) 08:04, 12 April 2007 (CDT)

If you read the article carefully I hope you will find that I have not removed or watered down any criticism; some things that were stated twice are now only stated once. The additions to the list of criticisms that you have made I don't object to, except to note that they are not in fact criticisms; they are statements of fact that are not disputed and are also apparent in the article. Your additions for instance mean that in the list vaccination appears twice, formerly it appeared as a criticism of chiropractic, now in addition to this criticism is a simple statement that some hold the beliefs for which they are criticised. If we compare the wording "not adequately trained to diagnose" to "not trained in nursing, medicine or health sciences" and ask which is the sharper criticism, I would say without hesitation that the former is, the latter statement is a mere truism with about as much objective force as to criticise physicians because they are not trained in chiropractic. The former wording goes to the heart of what in their training is missing.

Far from watering down the criticisms I hae been trying to do the opposite, to render the criticisms rational. I do not believe that I have ever removed any criticism except some that would make those who made them look foolish (e.g. the claim that peripheral organs do not receive a spinal innervation), nor have I watered them down except by excluding the type of words (quackery) that merely repeat gratuitous insults. Equally, neither I nor Matt have included in the rebuttal the counter-assertions that are made by chiropractors, for example that academic medicine in the USA is ethically compromised by its extensive links with the pharmaceutical industry, and that it is their opposition to the use of drugs that really underlies the stance of academic medicine.

Here as always, what I try to write are not my opinions; they don't matter. We have broken far away from Wikipedia conventions here in writing criticisms on our own authority as experts rather than depending on the published words of others, giving voice to what may be said privately but which is not said publicly in the authoratative peer reviewed literature, but I am not going to be drawn into forming and expressing my personal opinions. This article may not work, and if so no article of this type will work. That, I think, would be a shame, because yes I would like to see a critical views of Medicine article too, provided it too is written coolly and objectively. However, as for your links, actually, what is not said in this article? What do you want said that is not said? If I knew what you thought was missing I would try to say it for you, but say it, and let the response be said too.

I don't know whether you think that expressing a criticism coolly is to water it down. In my opinion, an argument expressed coolly and rationally has far far more force than one that uses emotive language; to say that a criticism is vehement doesn't make it any wiser, but suggests on the contrary that is driven by emotion not reason.Gareth Leng 08:14, 12 April 2007 (CDT)

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First new criticism

• That an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model, and advocate expansion of market base into the care of the well child.

If we want to leave a statement such as this in, "as a business model" opens any comments regarding this crticism to the medical "business model". "Expansion of market" becomes Medicine protecting it's market share. Do we want to go there? --Matt Innis (Talk) 10:20, 12 April 2007 (CDT)

I have several problems with the phrasing. It's not even clear to me that this is a criticism. It's true that an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model, and the only sense in which this is a criticism to me is the connotations of "business model" - and I guess not everyone sees anything wrong with a business model for health care; certainly private hospitals here have business models. The second half again isn't really a criticism, the implied criticism I guess is that there is no need for preventative care. My objection is that this really doesn't seem like a criticism unless you choose to read things into the words.Gareth Leng 11:04, 12 April 2007 (CDT)