Talk:Critical views of chiropractic: Difference between revisions

Revision as of 09:29, 21 March 2007

This should be titled critical views of chiropractic unless "chiropractic" is usually capitalized. Titles are lower-case. --Larry Sanger 17:29, 16 December 2006 (CST)

Please see quote from artocle below: "In line with a general philosophy of chiropractic to minimise use of medicines and drugs, 'traditional straight' chiropractors are opposed to childhood vaccination. Their main association, the International Chiropractors Association, is "supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health." This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy.^[1]

This is just the kind of thing that is couched so politely that it obscures it meaning. Whatever context it was in in that journal article, it is inappropriate as the message to be given in the section on vaccination here. Nobody in the medical profession believes that the use of drugs should be maximized, every reasonable physician believes that medications and drugs should be minimised in children, and what traditional straight chiropracters actually advertise and write is that "vaccines weaken the immune systm' and "are dangerous". So this, especially in an article entitled "Critical views of Chiropractic" is completely misleading. It is an apology and a defense that couches the fact that a health care professional preaches against childhood vaccinations to mothers and fathers that consult him or her, with their child, which puts everyone at risk for epidemics of infectious diseases such as measles, is somehow just a reasonable part of a philosophy of minimizing medication.

criticism of tone

This is just the kind of thing that is couched so politely that it obscures it meaning. Whatever context it was in in tha journal article, it is inappropriate as the message to be given in the section on vaccination here. Nobody in the medical profession believes that the use of drugs should be maximized, every reasonable physician believes that medications and drugs should be minimised in children, and so using the description of straight chiropracters as simply trying to minimise medications as the sole "criticism" of a view that unofficially warns against complying with mandatory vaccinations, and officially suggests that there be an amendment to the law to allow "conscientious objectors" is just not enough to actual present a mainstream view that vaccinations are important to public health, that many traditional straight chiropracters go so far as to actually advertise warnings against vaccinations and write that "vaccines weaken the immune systm' and "are dangerous". Particularly in an article entitled "Critical views of Chiropractic" a critical view that explains why vaccinations must not be optional is important. Just as I would not hesitate to write critical views of how patients are treated in suboptimal ways by American physicians as a result of a training system that can lead to depersonalization of patients, I certainly think that a discussion of foilbles within chiropractic that stem from traditional beliefs are warrented. It must not be presented that if a health care professional preaches against childhood vaccinations to mothers and fathers that consult him or her, with their child, that advocating a policy which is against the law and puts everyone at risk for epidemics of infectious diseases such as measles, is somehow just a reasonable part of a philosophy of minimizing medication. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)

There are several issues here, first this article is in development so feel free to expand, obviously this section was a stub and needs adding to.

There are problems here in that the official statements of the traditional straight organisation express support for individual waivers rather than oppose vaccination, so I haven't yet found evidence that opposition is a formal position of any chiropractic body. Obviously at least some and possibly many chiropractors do oppose vaccination, and the explanation of why they do is needed to understand why it is expected that many do in the absence of any clear evidence that I have seen that in fact they do. (I'm not doubting it, just haven't seen any survey data).

To see the wording as an apology or a defense, is something I can't see in the words. It's an explanation, and it seems that to neglect any explanation of something that raises an obvious question (why would chiropractors oppose vaccination?) would be an omission. I really see no reservation or hesitation at all in the words "This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy." This seems to me about as clear a statement as can be made?

It seems to me that any further statements about this must be made in the form of quotations from notable authorities, and I'm sure we should be able to find those.

As far as tone is concerned, I think our tone must always be polite. We can quote others who are not, but although this is a criticisms article, we are still reporting criticisms, not making them ourselves.

My personal view is that compulsory mass vaccination is an essential part of public health policy, so I am not a supporter of allowing exceptions. That's my view, and it is a conventional scientific view that for vaccination to be effective as a way of controlling disease, there must be at least an 85% vaccination rate in the population, at which point for an individual, the risks become greater for vaccination than for avoiding vaccination. Because of this, the policy has to be compulsory to be fair, otherwise a few who avoid vaccination gain benefits at the expense of the majority, and if too many avoid vaccination this puts all at risk. That's the argument, and it's a complex one to follow, and really belongs in a vaccination article not here. So what else can or should be said here except adding quotes?

I don't think an argument is strengthened by expressing it more forcefully, and think on the contrary that rhetoric merely diminishes the case. That's not merely my style preference, it's also my belief that simple, direct statements that obviously avoid anything that can be read as hyperbole or rhetorical flourish, but which are based on a conservative reading of the evidence and are expressed politely, carry more weight. "This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy" might seem like an understatement. But I think it's hard to read it and either misunderstand it, or doubt it, and hard actually for me to see what stronger statement can possibly be made that remains true. And if it's read and understood and believed - what else is there to say? We can be as rude as we like, it's not about chiropractors being upset but about whether a reader will simply be put off by what may seem like an opinionated rant. We have to trust the reader, let him see the criticisms, understand them, and draw his own conclusions; lead, not force.Gareth Leng 12:05, 14 March 2007 (CDT)

I'm not suggesting we be either impolite or rant. But the official statement of the formal organization of chiropractors cannot be the only acceptable source here for evidence of what chiropractors do. No surveys are routinely taken of health care providers by the US government or any other agency, and the data you ask for is just not available. There are many ads from chiropractors that plainly warn against medicines and vaccinations. The whole reason vaccines work in populations is because a critical proportion of "the herd" is immune and that point must be nmade in order to criticze the idea that vaccination can be a personal preference and still safegaurd the public. To simply couch that "the medical profession" feels mass vaccinations are essential and leave it at that is not helpful when there is already a general acceptance that the "medical profession" is against chiropractors. The real point is that official organizations of chiropractors not only do not condemn the statements of members that warn that vaccines weaken the immune system, but instead argue that it's simply a matter of personal preference whether on not to vaccinate your children- or should be a matter of personal preference- flies against the advancements made in public health over the last century. Look at that statement made by the organization- in the US it is against the law not to vaccinate your children, so do they support the law - No- even the official group suggests that the law should be changed to allow personal preference. That statement cannot be criticized without imparting the knowledge that personal preference removes the public benefits of vaccination for everyone and does not simply affect the person choosing not to be vaccinated - let alone the fact that it is the child who foregoes the protection but the parent who makes the "personal preference".. I just read your (Gareth's ?-the edits are not showing up except in history) and here's a point to consider- it is misleading not to explain that vaccination only works with near uniform compliance (since not every vaccinated person will actually achieve immunity) and just assume that the reader will either already know that or will carefully study another article. A couple of lines must be placed here so that the statements that are here can be understood. When I have time, I will write just that-in polite terms that can be plainly understood. This is, after all-the critical view. I am not happy that my time has to be taken up so much over alternative medicine, I would rather write about other things, but this cannot be so misleading. The tone is so formal and indirect that it cannot be plainly understood by people who are not themselves experts- that's the problem, it's not that I'm advocating rudeness-I am advocating direct statements plainly understandable to laymen, that present the critical view of chiropractic.

You know, Gareth, in the United States there is no central government health service, it's not like Sweden where records are kept on each child and a public nurse shows up and vaccinates your kid if you, as a parent, do not seek vaccination. I don't know how it is in the UK, but I suspect it's more like Sweden than like it is here, it would be a mistake to assume that the USA operates in a similar way that you are used to. In most districts (States), children cannot attend public school unless there are records of vaccination -but there are private schools where this is not true and some people homeschool, and so there are populations of unvaccinated children here. Further, some public schools are not so carefully run that kids are fully checked out, especially if misrepresentations are made by parents. This is not just a philosophical matter of the "conventional scientific" view, this is a matter of public health and safety. That's why I feel so strongly that - anywhere on Citizendium that childhood vaccination is discussed, it has to be plainly understandable to a layman. There are popular beliefs that vaccinations cause autism, destroy immunity and this all feeds in to popular conspiracy theories of government control and financial gain by doctors that is capitalized on, not just by the extreme group of chiropractors, but by Christian Scientists, other religious and political groups. Isn't Citizendium supposed to be an expert and reliable source of information? The scientific view of vaccination is not just another opinion. And it is not uniformly known that vaccination of the population is required to effect protection, it is more often assumed that it is an issue that only effects the individual being vaccinated. Furthermore-it's the law. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)

Here is the ACA's position statement of vaccination. It looks just like the ICA statement. The Assoc of Chiro Colleges didn't mention vaccination:

VACCINATION

Resolved, that the American Chiropractic Association (ACA) recognize and advise the public that: Since the scientific community acknowledges that the use of vaccines is not without risk, the American Chiropractic Association supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination. The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual's right to freedom of choice in health care matters and providing an alternative elective course of action regarding vaccination. (Ratified by the House of Delegates, July 1993, Revised and Ratified June 1998). --Matt Innis (Talk) 21:35, 13 March 2007 (CDT)

Exactly. But the reason there are laws for mandatory vaccination is that personal choice renders vaccination ineffective - if enough people choose not to immunize. That's not to say that there are not particular vaccines where the risk/benefit ratio is such that it is reasonable to make such a choice. That's not to say that immunosuppressed people or critically ill people are not exempt. But there have been cases of polio in the USA again=in the 70's, because of that kind of thinking, and more recent epidemics of whooping cough. Since not every vaccinated person developes immunity as the result of a series of immunizations, it is not only the unvaccinated child who risks polio because of "personal preference". The vaccines mandated by law are not in the category of personal preference, and although that statement sounds so benign, it's not. Who could be against personal preference? Anybody who understands the biology of vaccinations- that's who. Even the official groups of chiropractors will not endorse following the law. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)

I think you have a very good point and it needs to be made. This is the place to do it. In context of Gareths "why" question that everyone would be asking, here would be the logic (which I think our current version eludes to without saying it):

While there are chiropractors that oppose all things medical, the vast majority don't. There are a lot of fence sitters, including myself, that aren't concerned about the polio, small pox, and measles vaccines. Obviously we have some concern for diptheria, but have never personally seen anyone have a problem with it. It's the flu vaccines every year. It's the chicken pox vaccine. Hepatitis vaccines in infants. Are they really safe, do the risks outweigh the benefits? Those are the ones that keep chiropractors from jumping on the vaccine bandwagon. I think this issue will be there for awhile, because it is still out in the public. I see Texas is planning to pass a law to force vaccinate all young girls for the virus that causes cervical cancer. Do we know anything about this? Do we just trust Merck (the makers of Vioxx?). So these are the issues that chiropractors are facing. Do we say sure to vaccines just to be part of mainstream, do we make a stand against them because we don't believe in drugs at all (maybe 30 years ago, but not any more), or do we go somewhere in the middle. I think the stance that you are seeing is in the middle. Let each one decide based on the merits. Nancy makes a good point about these things being part of the process of getting children into pediatricians so that early detection is possible for other childhood things, but I would wager that those who choose not to immunize their children would go to their pediatrician if they weren't badgered to give them their shots. It is a viable critique of chiropractic's values for what they are worth. -Matt Innis (Talk) 21:35, 13 March 2007 (CDT)

references for vaccination/personal preference

Whooping cough and other infectious diseases are not just a theoretical concern. There is real evidence that "personal preference" leads to preventable illness, and when communities of people elect that preference (by law or otherwise) epidemics have been reported.

Omer SB. Pan WK. Halsey NA. Stokley S. Moulton LH. Navar AM. Pierce M. Salmon DA. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. [Journal Article. Research Support, U.S. Gov't, P.H.S.] JAMA. 296(14):1757-63, 2006 Oct 11. UI: 17032989 Abstract:CONTEXT: School immunization requirements have played a major role in controlling vaccine-preventable diseases in the United States. Most states offer nonmedical exemptions to school requirements (religious or personal belief). Exemptors are at increased risk of acquiring and transmitting disease. The role of exemption policies may be especially important for pertussis, which is endemic in the United States. OBJECTIVE: To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs personal belief exemptions; (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs medium and easy vs difficult processes for obtaining exemptions; and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements. DESIGN, SETTING, AND PARTICIPANTS: We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry and 1986 through 2004 pertussis incidence data for individuals aged 18 years or younger. MAIN OUTCOME MEASURES: State-level exemption rates and pertussis incidence. RESULTS: From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence. CONCLUSIONS: Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

Centers for Disease Control and Prevention (CDC). Pertussis outbreak in an Amish community--Kent County, Delaware, September 2004-February 2005. [Journal Article] MMWR - Morbidity & Mortality Weekly Report. 55(30):817-21, 2006 Aug 4. UI: 16888610 Vaccine-preventable disease outbreaks continue to occur among undervaccinated populations in the United States, including contained religious communities. The Amish practice separation from the world through group solidarity and caring for their own. Amish religious doctrine does not prohibit vaccination; however, coverage levels for routine childhood vaccination remain low in many Amish communities. This report describes an outbreak of pertussis in an Amish community in Kent County, Delaware, during September 2004-February 2005, that resulted in 345 cases and affected primarily preschool-aged children. The outbreak underscores the need to promote vaccination in Amish communities through culturally appropriate strategies, such as education and outreach to community leaders.

No disagreement?

I don't think there is actually any disagreement between us here, and certainly hope there is none. I fully agree with what you have said on the science. A minor point - to oppose a law is a perfectly respectable position; not to comply with a law is not. I don't see the organisations promoting non compliance, so it seems that formally they are opposing a particular law but that does not mean they do not support "the (rule of) law."

We have to consider some things carefully, after all there will one day be articles on Critical views of medicine and Critical views of science, so in part what I have in mind is what would be fair and reasonable to include in those. For example, on medicine would it be fair to include criticism of overprescription? Here GPs have been very sharply criticised (including by the NHS itself) for being too willing to prescribe antibiotics and antidepressants for example. The issue is, when does legitimate criticism of the opinions or behaviour of individual doctors become legitimate criticisms of the profession as a whole or of the whole edifice of the profession? Would it be fair to criticise Science for the high profile cases of fraud? My view would be clearly fair if there was evidence of "institutional" acceptance of fraud (as there is perhaps in the technical issue of "honorary" authorship), much harder to decide otherwise

Obviously, many chiropractors have opinions with which Nancy and I (as probably typical? representatives of academic medicine and science) strongly disagree, opinions that are much more seldom held within our professions. I also suspect that most chiropractors are fat white American protestant conservative males, though perhaps there is a chapter of revolutionary socialist chiropractors out there somewhere. My point is simply that attitudes common amongst chiropractors with which I may disagree are in some part attitudes common in the social group, not intrinsic to chiropractic, and might not be held by a black Jewish female communist chiropractor working in, say, Glasgow.

I think it is fair to criticise Chiropractic for the anti vaccinationist bias of many chiropractors because in part this attitude is related to the philosophy of chiropractic. That said, for me the door is open to criticise on vaccination, and to make that criticism as clear as possible. I'll try to expand it myself, but if my style is not acid enough, feel free to adjust :). Gareth Leng 05:02, 14 March 2007 (CDT)

OK I've expnded the section in some haste, please check and ammend or revise as appropriateGareth Leng 06:24, 14 March 2007 (CDT)

Hey, just because I am a fat white American protestant male doesn't make me conservative! I'm not sure which of those adjectives I'm supposed to feel good about:) hehe! -Matt Innis (Talk) 07:46, 14 March 2007 (CDT)

Hi Chris - your edits removed some text I'd put in, think you hadn't intended this; seems to have been an edit conflict bug; I've tried to incorporate all yours, but if I've missed any it wasn't intendedGareth Leng 08:06, 14 March 2007 (CDT)

OK, I've significantly expanded the vaccination section in I hope a fair way, added to the references generally and linked them, and added a para at the introduction that needs consideration. This article is an article reporting criticisms, it's not an "attack article", but it's not neutral in the sense that there is no offsetting argument. The defense is that this article is not making the arguments or endorsing them (definitely not our job), merely reporting them. Can we move to approve?Gareth Leng 09:38, 14 March 2007 (CDT)

I cannot approve this article. It is not a critique of chiropractic, and even the views on vaccination are not to me fairly presented. The 85% rate of vaccination is a ballpark estimate for human to human transmission, and overlooks such diseases as tetanus. The requirement set to have formal peer reviewed publications to document any critical statement, but on the other hand to be willing to state that no specific injury as a result of non-vaccination has ever been traced to chiropractic simply as an official quote is not reasonable. I am not able to research every legal and scientific and government document rto prove that it not so. I consider both of you-Matt and Gareth, and friends, and I do not want to have to write reams of prose here to defend my position. I also am not interested in devoting all my time to this article. I suggest that additional "eyes" are needed, and that this article is very far from being in an approvable state. I am not sure why terms like "acid" are being used, or assumptions are being made that my objections (I say "my" because I am the only objector on this page) are being made on the basis of either race or sex. I am becoming not only frustrated but offended and ask to be excused from further work here for the time being. Thanks, Nancy Sculerati MD 10:24, 14 March 2007 (CDT)

OK Nancy, you don't need to be excused, nobody has to do anything here. I don't know where you got the idea that I thought your objections reflected either race or sex, I was making the very different point that the biases of chiropractors reflect in part their social affiliations not their professional ones, and that it would not be appropriate to attack them for those. I certainly apologise unreservedly for any unintended offence to you. The word acid was meant straight, I don't object at all to acid prose, I just find it difficult to write it and be neutral. I don't think tetanus is relevant here as I think the chiropractic opposition is to mass compulsory vaccination, which is for infectious diseases where human to human transmission is the relevant parameter. The requirement for verification applies to statements of fact, statements of opinion, as here given in direct quotes, need to be attributed verifiably as this was. The article is not a critique of chiropractic and would not be appropriate for an encyclopedia if it was, but a documentation of critical views, as explained in the Introduction. I earlier reworded this sentence "Despite overwhelming evidence that vaccination is a highly effective method of controlling infectious diseases, some chiropractors maintain a strongly antivaccination bias." This I have changed as it was clearly offensively worded. To be specific about neutrality; we have revised chiropractic in part because the word propaganda applied to the AMA although accurately applied according to the dictionary, has negative connotations. Here the case is even clearer. Clearly the chiropractors who oppose vaccination don't do so while accepting that the evidence is overwhelming, and clearly to describe their opinions as biases is pejorative. I'm sure there are other cases where the wording needs attention. I think we need Larry's views on neutrality generally and phrasing in particular.Gareth Leng 10:45, 14 March 2007 (CDT)

The opposition to vaccination is strictly on the basis of adhering to a Chiropractic notion of dis-ease. There may well be official schools that are officially nuetral, but in the US, any formal school or organization that advocated breaking the law in official publications and documents would be sued and probably disbanded. In fact, it is likely the social and educational characteristics of individual chiropracters that bring them more in line with a medical view, rather than otherwise. Respectfully, I ask that you actually investigate chiropractic in the USA by writing to the various schools, corresponding with the organizations and looking through yellow pages and directories of health servces on the web. I once knew a neurosurgeon who felt that it was better to not write notes-that way nothing was in writing-you couldn't be hung by your own data. In Chiropractic, there is very little formal published research, self-policing of the profession, and a general dearth of self-reported practices on any kind of recognized scientific "polling" basis. It is not reasonable to expect that unless offical groups write statements that would get them sued that these views are not prevalent. Just what do you base your understanding of chiropractic on, Gareth? Matt has his own experiences as a chiropracter, and the history he has studied. I have my review of the literature and my experience with patients who have seen chiropractors, and local attitudes in a rural community where chiropractic is an accepted alternative to seeing a physician. If, in fact, there are practically no chiropractors where you live and you are basing your view strictly on friendship and written interaction with one DC and the public literature that is available on-line in libraries, I respectfully suggest that you may be making some very mistaken assumptions. Imagine a person who had never done laboratory science, never participated in publishing peer-reviewed papers, never was involved in awarding peer reviewed grants, but had some close personal relationships with scientists and read the available literature.No matter how intelligent and well-read, that person could easily make basic mis-assumptions without realizing it, since the ability to "read between the lines" would be lacking, except in a very general sense. Nancy Sculerati MD 11:11, 14 March 2007 (CDT)

Misplaced quotation

Confusion. "no specific injury as a result of non-vaccination has ever been traced to chiropractic"?? Where is this? Gareth Leng 10:54, 14 March 2007 (CDT)

I was referring to this:"We are not aware," they write, "of a single well-controlled study which found that chiropractic care prevented any infectious disease or reduced the severity of such a disease." They declare that it is dishonest of chiropractors to warn their patients about the danger of vaccinations without advising them of their benefits, and endorse the guidance of the College of Chiropractors of Ontario, which states, in its "Standard of Practice", that "Chiropractors may not, in their professional capacity express views about immunization/vaccination as it is outside their scope of practice."[7] [edit] and I admit I mis-read it. I feel like I'm in court, here. I am taking some time off.Nancy Sculerati MD 11:15, 14 March 2007 (CDT)

My outsider's take

I'm not sure what precisely the neutrality question here is, but a few observations which might or might not help...

First, I think a list of annotated links is not an encyclopedia article but a Web bibliography. That strikes me as being of limited value. From an outsider's perspective, I have to wonder whether the leading internal criticisms of Chiropractic can all be found online. Moreover, I find it unlikely that an authoritative account of the history of criticism of chiro best takes the form of an annotated bibliography. Perhaps I am misunderstanding what's going on, though.

Next, 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.

Even an article titled "critical views of chiropractic" must be neutral. Its primary focus is defined by the title: it is concerned with summing up in a readable, authoritative fashion what the critical views of chiro are. In stating these views, it must not state, imply, or hint that these critical views are correct; that's for the reader to decide. Furthermore, by stating these critical views without a reply (i.e., a published reply, or what would plainly be a standard reply from chiropractors) is very easy to endorse.

I like the fact that the article sets out the game plan vis-a-vis bias in the beginning, by the way.

Anyway, that's all I have time for now. I absolutely must focus my attention on high-priority launch-related tasks.

--Larry Sanger 11:12, 14 March 2007 (CDT)

OK. This is tough because so many issues are covered here. the vaccination section then needs a chiropractic response. I think the issues in the bibliography are explained neutrally (Matt?) and can be dropped to the end of the article rather than being the central core.Gareth Leng 11:28, 14 March 2007 (CDT)

One other thing. I am not going to wade into the dispute above, because I trust everyone involved to resolve it (eventually) brilliantly. If you want me to comment on or decide anything, which I hope will not be necessary, I hope you will be able to agree to some relatively clear question that I can think about. Probably, in thinking about what the question should be, you'll figure out a way to come to an agreement yourselves.

Also, there is some suggestion, from someone, that matters of tone are important to neutrality. This is absolutely true. Neutrality requires that one describe positions with a sympathetic tone, within the bare constraint that other positions must also be described with a sympathetic tone as well. It often comes down to the selection of just a few different words. --Larry Sanger 11:34, 14 March 2007 (CDT)

OK, Take a pause

Matt, I don't think you've written anything on this, and maybe you shouldn't as you'll be needed to comment on whether there is anything in this version that chiropractors could reasonably be expected to take offence at; you're therefore in the pole position for approval. This is important given the subject. As Nancy has correctly said, I have no first hand knowledge of chiropractic whatsoever. The only thing I can do is to try to represent the literature accurately, and contribute to the interpretation of the science on my own authority as a physiologist and neuroscientist. I don't think I've tried to do more, and actually I don't know what else there is to do. Researching the topic independently would certainly be original research, and if anything is not in the record then I don't see any route to verifying any statement that could be contentious. If I'm misreading the literature or omitting anything significant, then I'm happy to be told or for others to add. I am absolutely opposed to representing opinions that, for whatever reason, are not verifiably reported in significant publications. So I'm going to have to write a chiropractors rebuttal to the criticisms about vaccination. I agree with Larry that that's the right thing to do, Matt can say if I get it right.Gareth Leng 12:22, 14 March 2007 (CDT)

I'll do my best. You guys are doing fine without my input. I haven't seen anything I disagree with yet. --Matt Innis (Talk) 12:35, 14 March 2007 (CDT)

Peered reviewed articles

I believe that the Critical View of Chiropractic should be sympathetic to the critical view- not more than sympathetic and should of course strive for neutrality. Here are some references. I will place some quotes, but assume that Gareth has access to full text. If text wanted and not available, e-mail me privately . These are mostly taken from chiropractic and alternative medicine journals, rather than Medical journals.Nancy Sculerati MD 13:03, 14 March 2007 (CDT)

1)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)

Quote from end of article "If you peel away all the arguments about the safety and effectiveness of immunizations, you will find at the core of this debate, chiropractic philosophy." It is therefore informative to briefly review aspects of historical chiropractic philosophy as may relate to current views on vaccination. Chiropractic Philosophy: Chiropractic was founded by David D. Palmer and developed by his son Bartlett Joshua (BJ).The Palmers held that infectious disease was the result of spinal subluxations, and BJ in particular wrote extensively about how infectious diseases and other ailments (including cancers) can readily be cured by removal of the subluxation. For example, BJ wrote in 1909': Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox, I can prove to you where, in one, you will fmd a subluxation and you will fmd the same condition in the other ninety-nine. I adjust one and retum his functions to normal and you could do the same with the other ninety-nine. Although sometimes referred to as "chiropractic phil- osophy," the doctrines originally espoused by the Palmers and maintained by modem fundamentalist chiropractors cannot be considered to constitute a true philosophy in that they are not subject to change. It is more correct to categorize historical chiropractic philosophy as a belief system, in that any true philosophy should be dynamic and is accountable to a methodological pursuit of knowledge. The historical belief system of chiropractic, as advocated by the Palmers, does not allow for the acceptance of vaccination. According to DD Palmer: It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison.. .No one wilj ever pollute the blood of any member of my family unless he cares to walk over my dead body to perform such an operation. Historical chiropractic belief systems provide a number of benefits, however, including simplistic answers to complex problems and provision of a "unique" service among health care providers resulting in decreased com- petition. Because flindamentalist practitioners do not "cure" or "treat conditions aside from subluxations, which may or may not be symptomatic, treatment frequency and duration are entirely determined by the practitioner. Consequently, the result of adhering to a belief system of practice that can be applied rapidly, and administered to each and every presenting patient on an ongoing, and often frequent, basis, has obvious financial implications. This scenario may offer some insight as to why some chiropractors adopt historical belief systems that entail negative views toward vaccina- tion. As written by a third-year chiropractic student at CMCC," "I feel that chiropractic in Canada needs to go more towards a philosophical subluxation approach or we may no longer exist as a separate health profession. There is too much competition for patients at the evidence-based end of things." CONCLUSION The chiropractic antivaccination position was estab- lished by DD Palmer by likening vaccines to "filthy animal poisons."* Palmer's views resulted not from any objective analysis of scientific data, but from a rejection of anything he perceived to be associated with the medical profession of the day." His anti-immunization position was a narrowly dogmatic one that did not allow for scientific advancements or the introduction of new data. In the face of now overwhelming evidence to show that vaccination is an effective public health procedure. Palmer's modem followers have turned to whatever sources they can to support chiropractic's archaic anti- immunization position. However, our preliminary discus- sion suggests that current chiropractic anti-immunization arguments rely heavily on biased and selective misrepre- sentations, or omissions, of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely "philosophical," not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths, and false information to support this position."

2)Is Autism a Brain Disorder or a Gut Disorder? By: Fallon, Joan. Today's Chiropractic, May/Jun2005, Vol. 34 Issue 3, p50-54, 3p; (AN 17081408)(my critque-one of many examples of the poor level of scientific understanding and alarmist advice the chiropractic literature is permeated with)

Focuses on the concept that autism is caused by the mercury-based preservative in vaccines, which is causing brain damage in children. Conflicting findings that have prevailed in the literature with respect to the potential of vaccines as a causative factor in autism. Certain findings, that have pointed to a live measles virus in the gastrointestinal tracts of children with autism. Anecdotal reports of regressive autism following administration of one or more vaccinations. Parents' report of developmental problems from birth pointing to autism.

3)Managing Chronic Migraines, Daily Headaches, and Fibromyalgia. By: Murphy, Dan. American Chiropractor, Apr2005, Vol. 27 Issue 4, p19-19, 2/3p; (AN 17003908)

My summary- suggests that glutamate kills brain cells and that vaccines contain glutamate (MSG), vaccines are not major point, I submit this as evidence-again-of the level of the discussion and scholarship in the literature.

4)Your Child's Best Shot: A Parent's Guide to Vaccination, Second Edition (Book). By: Ferrance, Randy J.. Journal of the Canadian Chiropractic Association, Sep2004, Vol. 48 Issue 3, p241-241, 3/4p; (AN 14693967) Book review of a Pediatrician's Guide to Vaccine in a Chiropractic Journal. The review is favorable, but points out that chiropracters are likely to take offense that it is not anti-vaccine. (I include this as more evidence that the anti-vaccination bias is an integral part of Chiropractic)

5) Vaccinations: how about some facts for a change? By: Ferrance, Randy J.. Journal of the Canadian Chiropractic Association, Sep2002, Vol. 46 Issue 3, p167, 6p, 1bw; (AN 7683511)

Scholarly essay, written by Canadian Chiropractor. Rational view that is not reflective of the "pseudoscience" and "conspiracy theories" rampant in many of the US publications cited.

Published notices of meetings of Chiropracters that mention Vaccines or advocate General Health Care

I show this notice of evidence of the Profession's support for public education that vaccines are dangerous for children.Nancy Sculerati MD 17:08, 14 March 2007 (CDT)

1) From Alternative Health Watch: The World Chiropractic Alliance will hold its annual International Summit, Friday, April 15 to Saturday, April 16, 2005, in Washington, DC. "The event will offer a variety of presentations by many top chiropractic speakers, including Dr. Ben Lerner, author of the best-selling "Body by God;" Dr. Christopher Kent, renowned chiropractic researcher and president of the Council on Chiropractic Practice; Dr. Jay Holder, developer of the Torque Release Technique (TRT) and president/co-founder of the American College of Addictionology and Compulsive Disorders; Dr. Madeline Behrendt, whose groundbreaking research on chiropractic and infertility made national headlines; Matthew McCoy, editor of the Journal of Vertebral Subluxation Research; Barbara Loe Fisher, founder and president of the National Vaccine Information Center; Leona Fischer, one of only two members of the Veterans Affairs Chiropractic Advisory Committee to vote in favor of direct access for chiropractors; and Terry A. Rondberg, president of the World Chiropractic Alliance and Chiropractors for Wellness."

National Vaccine Information Center [http://www.909shot.com/] OUR MISSION: The National Vaccine Information Center (NVIC) is a national, non-profit organization dedicated to preventing vaccine injuries and deaths through public education and defending the right to informed consent to vaccination.

WCA to sponsor 'Children's Health Day International'. Health Watch, 7/7/2004, Vol. 9 Issue 25, p1-3, 3p; (AN 13729413)

The event will be preceded by an aggressive public relations and publicity campaign to generate awareness of the program so that participating doctors will benefit from increased exposure in their communities. It will position chiropractors as the only major health care providers offering drug-free children's health care.

The drug-free aspect of chiropractic is particularly important today, since parents are increasingly alarmed by news of the dangers of many drugs and vaccines, the overuse and abuse of antibiotics for otitis media and other common children's ailments, the misuse of Ritalin and growth hormones, and the lack of proper testing of drugs given to children.

The World Chiropractic Alliance (WCA) strongly supports the right of parents to seek and obtain chiropractic care for all their children, regardless of age or presence or absence of symptoms. It has been in the forefront of the campaign to provide the full data needed for parents to make an informed decision about vital health care issues involving their children.

The care of children is consistent with recommended chiropractic guidelines, as set forth in the Council on Chiropractic Practice "Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice," included in the National Guideline Clearinghouse.

This document, which has been widely embraced by the chiropractic profession, states: "Since Vertebral Subluxation may affect individuals at any age, Chiropractic care may be indicated at any time after birth. As with any age group, however, care must be taken to select adjustment methods most appropriate to the patient's stage of development and overall spinal integrity. Parental education by the Subluxation-centered Chiropractor concerning the importance of evaluating children for the presence of vertebral Subluxation is encouraged."

Ample documented evidence is available that chiropractic care is safe for children and can have beneficial effects on health and fitness from newborn to adult stages. However, many people still don't realize that chiropractic can benefit children. An over emphasis on chiropractic for back pain in adults has given the public a limited view of chiropractic, once that the WCA tries to expand by its public education program.

Published essays(in Journals) by Chiropractors that reveal general philosophy to avoid standard medical care

1)Parenting in the Chiropractic Philosphy. By: Bell, Katie K.. Today's Chiropractic, Apr/May2006, Vol. 35 Issue 2, p42-46, 4p; (AN 21370296) informal discussion of home births, lack of rotine medical care, choice in which vaccines (despite law)

Published articles by Chiropractors in which unfounded treatments are advocated

Doctors Finding New Ways to Help autistic children. By: Stechschulte, Pattie. Today's Chiropractic, Sep/Oct2003, Vol. 32 Issue 5, p42, 5p; (AN 11051135)

Multiple statements that are given as facts-about food allergies, about treating otitis media with tympanograms. Nancy

Found the link for that one. [http://www.todayschiropractic.com/issues/archives/sep_oct_03/so2003_feature_autism.html] -Matt Innis (Talk) 14:40, 14 March 2007 (CDT)

Anyone see this ref?

i found this when checking for PMID numbers for the otitis media links. It seems to be a thorough and recent overview of all the data. Chris Day (Talk) 14:32, 14 March 2007 (CDT)

Ernst E., (2003) Chiropractic manipulation for non-spinal pain--a systematic review. N Z Med J. 116(1179):U539. PMID 14513080

AIMS: Chiropractic manipulation is mostly used for spinal problems but, in an increasing number of cases, also for non-spinal conditions. This systematic review is aimed at critically evaluating the evidence for or against the effectiveness of this approach. METHODS: Five electronic databases were searched for all randomised clinical trials of chiropractic manipulation as a treatment of non-spinal pain. They were evaluated according to standardised criteria. RESULTS: Eight such studies were identified. They related to the following conditions: fibromyalgia, carpal tunnel syndrome, infantile colic, otitis media, dysmenorrhoea and chronic pelvic pain. Their methodological quality ranged from mostly poor to excellent. Their findings do not demonstrate that chiropractic manipulation is an effective therapy for any of these conditions. CONCLUSIONS: Only very few randomised clinical trials of chiropractic manipulation as a treatment of non-spinal conditions exist. The claim that this approach is effective for such conditions is not based on data from rigorous clinical trials.

Evidence that Chiroprctors promote themselves as physicians in all but name

My critical view of Chiropractic- Although in the US the term physician (at least in most states) is restricted to individual licensed to practice medicine, many chiropractors see themselves as able to treat all health disorders. Although they (generally) do not call themselves physicians, the term "doctor", which is a near synonym in healthcare that is not legally restricted is often used-including in published official journals. Although these doctors do not claim to give drugs or practice surgery, they argue that these are not required for good health care and advocate advoidance of medical care. Physician, Nurses, and other health science professionals are alarmed at what they see as a fraudulent assertion that Chiropractic is an efficacious method of comprehensive primary health care, particularly since of segment of the Chiropractic profession appears to be involved in an aggressive campaign to promote themselves as primary care doctors for general health.

references to support the above:

Cambron, Jerrilyn A. DC, PhD a; Cramer, Gregory D. DC, PhD b; Winterstein, James DC c PATIENT PERCEPTIONS OF CHIROPRACTIC TREATMENT FOR PRIMARY CARE DISORDERS. Journal of Manipulative & Physiological Therapeutics. 30(1):11-16, January 2007.

Objective: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat.

Methods: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients. Results: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions. Conclusions: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.

Gaumer, Gary PhD a; Gemmen, Eric b CHIROPRACTIC USERS AND NONUSERS: DIFFERENCES IN USE, ATTITUDES, AND WILLINGNESS TO USE NONMEDICAL DOCTORS FOR PRIMARY CARE. Journal of Manipulative & Physiological Therapeutics. 29(7):529-539, September 2006. Objective: To determine the differences in attitudes and other determinants of care-seeking behavior between persons who have used chiropractic services and persons who have not. A second objective is to determine the interest in members of these 2 groups in choosing nonmedical doctors for providing routine services. Methods: In 1998, a nationwide telephone survey of randomly selected households in the United States was done, including 400 adults who have used chiropractic services and 400 adults who have not. Survey participants were asked about their use, knowledge, and attitudes about chiropractic care, attitudes about personal role in health care, current source of obtaining usual and routine care, and willingness to consider use of nonmedical doctors as the usual source of such care. The analysis compares persons who have used with those who have not used chiropractic services by using a [chi]2 test to determine significance of differences between the responses of the 2 groups. A multivariate analysis is done of willingness to use alternative providers for routine care. Results: Persons who have seen a doctor of chiropractic before have different attitudes and preferences about health and health care than others who have never seen a doctor of chiropractic. Almost all of persons in both groups have medical doctors that they use for routine care, and a sizeable portion of both groups would be willing to consider using a nonmedical doctor for this role. Although willingness to use a chiropractor in this role is much higher among persons who have used a chiropractor before, both groups would prefer physician assistants and nurse practitioners to chiropractors in this role. Conclusion: For persons participating in this survey, unwillingness to accept the idea of a chiropractor in a primary care role may be largely due to poor knowledge about chiropractic care.

The California Chiropractic association [http://www.calchiro.org/about.html] explains (as a leading statement) that "The purpose of chiropractic is to provide a first health care contact for wellness and the optimization of health.", and goes on to claim that "Educational requirements for medical doctors and chiropractors in basic and clinical sciences are very similar."

The Council on Chiropractic Pediatrics is one of the specialty departments of the International Chiropractors Association located at 1110 N. Glebe Road, Arlington, Virginia. Established in 1993, the Council is a membership organization designed to bring together doctors of chiropractic with a special interest in caring for children and pregnant women and providing them with opportunities, resources, and support to enhance their professional development and expand their clinical skills. [http://www.icapediatrics.com/education-faq.php]

(There is public advication-directly to parents and patients-of unproven statements that contain no clauses that might indicate to a naive person that none of this is recognized as health science. see below:Nancy Sculerati MD 16:06, 14 March 2007 (CDT))

When should I take my child to a chiropractor?

When you want to give your child a head start in good health and all the benefits of a conservative, drugless approach to health care, you should take your child to a chiropractor. It is important to have a chiropractic exam during the first year of a child’s life as spinal trauma can occur during birth, as well as from tumbles while learning to sit up or walk. Improper lifting and carrying can also contribute to spinal stress.

Your child’s spine grows almost 50% in length during the first year. This is equivalent to a six-footer growing to nine feet in just 12 months! It’s this kind of tremendous growth and developmental changes which make a complete chiropractic examination so important in the early stages of a child’s life. If there is a problem, the earlier it is corrected the less likelihood there is of it becoming a chronic or more serious problem later in life.

Doctors of chiropractic believe it’s much more important to prevent diseases than wait till some disease occurs.

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How effective is chiropractic care for children?

Chiropractors have been providing safe and effective care for children for more than 103 years. Without efficacy, parents would have long ceased to seek out a doctor of chiropractic for their children. A 1992 survey showed that the most common conditions for which children visit a chiropractor are: earaches, neck pain, check-up, headache, upper respiratory, low back pain, allergies, asthma, enuresis, and thoracic pain. Other reasons are ADD and ADHD, colic, torticollis, insomnia, growing pains, and persistent crying in infants.

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How can chiropractic care help an older child who is not ‘sick’?

Chiropractors do not treat diseases, they help to correct spinal misalignments that can cause health problems. Through regular adjustments, counseling on proper nutrition, exercise, and posture, the chiropractor can help you raise a child who is structurally and functionally sound.

The number one “illness” in children is accidents. You may not realize it, but youngsters take numerous tumbles -- learning to ride a bike, or even just jumping and running around. If your child takes part in athletic activities, the “sack” of a quarterback could twist a young spine, pitching a ball can throw a vertebra out of alignment. These underlying injuries, if left uncorrected, can cause serious problems as the child grows into adulthood.

Doctors of chiropractic can do more than correct these problems. They can also help improve performance on and off the field by helping the body to function at its optimum level, naturally, and without drugs.

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What if my child has a health problem that does not respond to chiropractic care?

Doctors of chiropractic are trained to recognize complex health problems. Their primary obligation is the welfare of the child. It is the position of the ICA Council of Pediatrics and its parent organization, the International Chiropractors Association, that when the doctor of chiropractic or any doctor reaches the limits of their skill and authority that they are “ethically and morally bound to make patient referrals to practitioners in other fields of healing when such referrals are necessary to provide the highest quality of patient care.”

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There are so many different health specialists today, who is responsible for the health of my child?

You are. As a parent or guardian you must take responsibility for your child’s health and use your best judgment as to what is most appropriate for your child. Fortunately, there are some outstanding primary health care providers to help you make your decision, including your doctor of chiropractic, pediatrician, and dentist. These professionals should make up your child’s personal health care team.

Do all Doctors of Chiropractic care for children? How do I choose?

All chiropractic schools have required courses in pediatrics. Doctors of Chiropractic are also licensed in all 50 states of the US to provide chiropractic care to children and adults. However, there are chiropractors who take postgraduate courses in pediatrics after graduation because they want to specialize in this field. The ICA Council of Chiropractic Pediatrics offers a 3-year postgraduate program (320+ hours) that leads to Board Certification in Chiropractic Pediatrics. Graduate doctors are recognized by the letters DICCP (Diplomate of the ICA Council on Chiropractic Pediatrics) after their name. Since all chiropractors are licensed to care for children, there are many doctors of chiropractic who also see children in their practice on a regular basis.

When you choose a DC who is a member of the ICA Pediatrics Council, you will get a chiropractor who is either Board Certified in Chiropractic Pediatrics (with the DICCP credential) or is in family practice and has experience in caring for children.

The ICA Pediatrics Council regularly updates its members with the latest in chiropractic pediatric care and provides them with opportunities to continually refine and/or expand their diagnostic and clinical skills with continuing education classes or other resources.

To find a chiropractor in your area who cares for children, click on Membership Referral Directory.

An example of "patient education" by the ICA Pediatric Council

[http://www.icapediatrics.com/reference-articles.php#Vaccination] 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)

herd immunity

While it is an important phenomenon ...it's very thin ice -- it will stop working if more people stopped getting vaccinated. -Tom Kelly (Talk) 15:51, 14 March 2007 (CDT)

This doesn't really fit here but it seems like vaccines are a hot topic on this talk page.

I agree with the outline Gareth has proposed. That is why every reference that I have included is from organizations of chiropractors, regional meetings, published journals-usually of chiropractic, and not one single instance of individual advertisement. Nancy Sculerati MD 09:20, 15 March 2007 (CDT)

I think you have done a very good job of reporting. I will now go through and see what I notice. --Matt Innis (Talk) 09:27, 15 March 2007 (CDT)

Matt, do you get any of the Chiropractic Journals? Can you tell me which ones I should search for? Are there titles of Chiropractic texts from Schools of Chiropractic that you can list? Perhaps textbooks that teach the history and summarize practice to students? I think that any profession is partly defined as being somewhat autonomous, meaning no one is more expert on the profession than the authorities in the profession- and using these references- books actually used by experts in the field of Chiropractic in professional schools, would go a long way towards elucidating the field. Nancy Sculerati MD 09:36, 15 March 2007 (CDT)

Hey Nancy. As far as journals, each association puts out their own. We get several free magazines and then we have those that we can subscribe to. I get Dynamic Chiropractic and receive the weekly updates from the [[http://www.fcer.org/ Federation of Chiropractic Education and Research]. I also subscribe to the JACA ,though I am not a member of the association, but like to keep up with them. I don't know if this has anything you wanted, but while I was looking I found [http://www.chiroweb.com/about/mediakit/publish.html this] on the Dynamic Chiropractic site that shows the different magazines that are available. You can access Dynamic chiropractic right there on the website and do searches. I'll see what I can find from the schools, but this can get you started. By the way, very little chiropractic history is taught at Logan, other than DD discovered it when he adjusted a janitor and his hearing returned and BJ developed it. I assume the straight schools were taught more about the history, but there isn't that much time spent on it. Too busy trying to learn the Carboxylic acid cycle. We learned more about Semmelweis, Lister, and Koch. I do remember hearing Hahnemann, too. Anyway, also check [http://www.chiro.org/Plus/History/navigate.html the chiro history archives] for primary and secondary sources of chiropractic history. Do you know if medicine has a history archive? It would be great to get these two together to see how thigs match up. --Matt Innis (Talk) 11:12, 15 March 2007 (CDT)

Perhaps the Keating section and the Kent section should be together merged into a major new section on "Critical thinking in chiropractic" and perhaps expanded to bring in ome of the issues that Nancy has alluded to?Gareth Leng 13:07, 15 March 2007 (CDT)

[http://www.mic.ki.se/History.html] The Karolinska Institute of Sweden provides this rich resource covering the history of the healing arts. That has some of both. I'd like to do some thinking here, and hope to come up with what I think tis article-and Chiropractic-are lacking.That's an integrated view. It's not that we have any right to offer people advice, but we have an obligation to present things not only neutrally but in a real-world user friendly way. So, for example, in Chiropractic, if we give each school or philosophy of chiropractic equal weight in the text without carefully specifying which (if any) are fringe groups that have a only a small number of users, which are likely to be found in what settings (geographic, HMO etc), how Canadian Chiropractic and UK hiropractic have certain laws and regulations that are not true in the USA, then our effort at neutrality becomes perpetration of bias. On the face of it, it reduces the more influential and numerous groups to a false equality with the lesser, and distorts the picture. I myself don't have the knowledge to weigh, for example, the importance of one group's official websites and publications as compared to others. To try to put it more clearly, if I was summing up Dermatology as a clinical specialty in medicine, and writing a section on the United States, I would be able to convey the idea that there is an ideal in academic medicine of teaching research and service, and explain that there are academic medical centers where a certain type of practice can be expected, and then there are a larger number of community practitioners who offer a certain level of patient care, I could give general statistics in what percentage of the specialty has a tertiary care practice, is involved in reasearch. It's so hard to be accurate and it's so much work to find the data, but it gives an important sense about things. Am I making sense to you? I would like to convey, as best as we can, what the demographics and influence of te different subgroups in chiropractic are within the profession and the country and the world. I would like to do that- and I intend shortly to write up something on healing arts and health sciences- because I believe that Citizendium has a duty to provide the kind of information that allows lay people (which is really all of us) to have a reliable source of neutral information that can help them in a practical sense. That does not mean we give advice, that means we outline these topics such that a person, in the case of Chiropractic, for example, has a much clearer idea of what to expect from a Chiropractor, where in the world the are located, what they do, what sorts of questions might be reasonable to ask of them what sorts of credentials they should have, and also-to know enough that the web in general and Citizendium in particular can be used to provide more detailed information. To be able to sift through all that information, there must be framework that allows an intelligent and thoughtful person to be able to evaluate sources and put things in perspective. That's why, here in Critical Views, I think we have to convey that Chiropractic, as a profession, has been accepting of ancedotal evidence like a correlation in timing (such as vaccines and autism) being presumptive proof of causality, but when it comes to criticism of the profession, having a different standard- a stroke suffered after spinal adjustment is only due to the adjustement if proven beyond a reasonable doubt with direct evidence, otherwise, it's a coincidence.I think that chiropracic manipulations are quite safe, it's the lack of critical thinking that must be discussed, among other things. Nancy Sculerati MD 15:40, 15 March 2007 (CDT)

I think that has exciting implications. That has always been out probelm; we can't say one thing that covers every subgroup. If we are able to go into much more detail about each group, perhaps we can help readers understand the vast differences in chiropractors and why it is difficult to make blanket statements about any of them. There is no way we are going to be able to put all the information into one article, though. Would you consider just cleaning this one up some and then using the "approaches" section to link to new articles on straight chiropractic (where we can differentiate into objective straights), and one on mixer chiropractic (where we can illustrate the incorporation of CAMs) , etc from there? It will definitely be more research (that I too have been trying to avoid), but maybe then we will be able to explain things better. It would be nice if chiropractic were structured like medicine, that would make things so much easier. --Matt Innis (Talk) 16:18, 15 March 2007 (CDT)

Yeah, I'd be willing to approve, and keep working. Nancy Sculerati MD 16:22, 15 March 2007 (CDT)

Okay, Now I will make one more go through, add some heading links for straights and mixers and we can finish this article up before we go "Live". I don't intend to change anything substantial ( if I see anything I will bring it here). If there is anything that you want to change, go ahead and do it now, too. --Matt Innis (Talk) 19:53, 15 March 2007 (CDT)

please look at

The word dubious in the lead. It seems to suggest that there are some dubious chiropractors. This may be true, but shouldn't we say "alleged" or maybe just drop it out.

In the AMA section there is a sentence that states - "However, the AMA Report also stated that most chiropractors continue to claim that chiropractic manipulation cures disease rather than simply relieving symptoms. " I really don't know of any type of chirpractor that would claim to cure disease or relieve symptoms. They correct subluxations (straights) or improve body function (mixers). If that results in a "cure", that is the body's doing. I'll see if I can reword it some, you can change it if it doesnt' work for you. --Matt Innis (Talk) 20:40, 15 March 2007 (CDT)

I looked at the actual AMA statement and see that this is an actual quote per a telephone conversation with the NACM (National Association of Chiropractic Medicine) and illustrates an example of why other chiropractic groups have renounced the NACM as spreading misinformation about chiropractic. That is a whole other story that starts in the 70's. There is a rebuttal here, but it will be out of context. I'll think about it. --Matt Innis (Talk) 20:55, 15 March 2007 (CDT)

Everything else looked pretty good. I did add some stuff that could use some verifying, clarifying, adding to and clean-up. Nancy, maybe we can fit a lot more on this page. So far the things I have added can be differentiated here rather than seperate articles. --Matt Innis (Talk) 21:59, 15 March 2007 (CDT)

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)

↑ Campbell JB et al (2000) Chiropractors and Vaccination: A Historical Perspective Pediatrics 105: e43 [http://pediatrics.aappublications.org/cgi/content/abstract/105/4/e43]

[1] Campbell JB et al (2000) Chiropractors and Vaccination: A Historical Perspective Pediatrics 105: e43 [http://pediatrics.aappublications.org/cgi/content/abstract/105/4/e43]

[1]

@@ Line 516: / Line 516: @@
 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. [[User:Nancy Sculerati MD|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.
+[[User:Gareth Leng|Gareth Leng]] 10:29, 21 March 2007 (CDT)

Talk:Critical views of chiropractic: Difference between revisions

Revision as of 09:29, 21 March 2007

Contents

criticism of tone

references for vaccination/personal preference

No disagreement?

Misplaced quotation

My outsider's take

OK, Take a pause

Peered reviewed articles

Published notices of meetings of Chiropracters that mention Vaccines or advocate General Health Care

Published essays(in Journals) by Chiropractors that reveal general philosophy to avoid standard medical care

Published articles by Chiropractors in which unfounded treatments are advocated

Anyone see this ref?

Evidence that Chiroprctors promote themselves as physicians in all but name

An example of "patient education" by the ICA Pediatric Council

herd immunity

please look at

Snowed in

Membership stats

went through Gareth's rewrite

For Approval

Meaning of neutrality

Act of congress? Misleading advertising

rewrote start of article

Full circle again

Gareth's revision of intro

Navigation menu

Talk:Critical views of chiropractic: Difference between revisions

Revision as of 09:29, 21 March 2007

criticism of tone

references for vaccination/personal preference

No disagreement?

Misplaced quotation

My outsider's take

OK, Take a pause

Peered reviewed articles

Published notices of meetings of Chiropracters that mention Vaccines or advocate General Health Care

Published essays(in Journals) by Chiropractors that reveal general philosophy to avoid standard medical care

Published articles by Chiropractors in which unfounded treatments are advocated

Anyone see this ref?

Evidence that Chiroprctors promote themselves as physicians in all but name

An example of "patient education" by the ICA Pediatric Council

herd immunity

please look at

Snowed in

Membership stats

went through Gareth's rewrite

For Approval

Meaning of neutrality

Act of congress? Misleading advertising

rewrote start of article

Full circle again

Gareth's revision of intro

Navigation menu

Search