Talk:Critical views of chiropractic: Difference between revisions

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This should be titled [[critical views of chiropractic]] unless "chiropractic" is usually capitalized.  Titles are lower-case. --[[User:Larry Sanger|Larry Sanger]] 17:29, 16 December 2006 (CST)
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Please see quote from artocle below:
= Editor Instructions, do not archive =
"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.<ref>Campbell JB ''et al'' (2000) Chiropractors and Vaccination: A Historical Perspective ''Pediatrics'' 105: e43
[http://pediatrics.aappublications.org/cgi/content/abstract/105/4/e43] </ref>


"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 o 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.
''Editors should articulate their common sense of how this article should be approached here.''


The objectives here are


a) to detail the common criticisms of chiropractic, in a way that explains them neutrally without appearing to endorse them and


== criticism of tone ==
b) explain the common response of Chiropractic to those criticisms, again making it clear that we are reporting the views of chiropractors, not endorsing them.  
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. [[User:Nancy Sculerati MD|Nancy Sculerati MD]] 17:57, 13 March 2007 (CDT)


So, the key questions (for me) are


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.
1) Is it clear what the common criticisms (from Health Sciences) of chiropractic are? Are they expressed coolly and clearly?


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.
2) Is it clear how chiropractors seek to answer those criticisms?
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?
3) Is it clear that the opinions, for and against, are in neither case associated with Citizendium or its editors but attributed appropriately?  


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.
4) Could either the criticisms, or the responses, be expressed more cogently then they are?


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.
5) Are the criticisms and the responses expressed neutrally, - respectful of the different points of view, i.e. without editorial disparagement?


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?
6) Has any significant criticism of chiropractic been omitted, and has any significant response to the criticisms been neglected?


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.
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.  


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.
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.


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''. [[User:Nancy Sculerati MD|Nancy Sculerati MD]] 17:57, 13 March 2007 (CDT)
= Comments =


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:
==Call for help here, more eyes==
*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).
--[[User:D. Matt Innis|Matt Innis]] [[User talk:D. 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. [[User:Nancy Sculerati MD|Nancy Sculerati MD]] 17:57, 13 March 2007 (CDT)
This has been a tough article to write, one that is a test in a way of Citizendium's capacity to report on controversies while keeping a neutral distance from them. This article began as a simple detailing of the common criticisms, in a way that tried to report that these criticisms were commonly made but without appearing to endorse them. Larry rightly commented that the response of chiropractors ''must'' also be given. So, the objectives here were and are


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):
a) to detail the common criticisms of chiropractic, in a way that explains them neutrally without appearing to endorse them
and


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. -[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 21:35, 13 March 2007 (CDT)
b) explain the common response of Chiropractic to those criticisms, again making it clear that we are reporting the views of chiropractors, not endorsing them.


== references for vaccination/personal preference ==
So, the key questions (for me) are
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.
1) Is it clear what the common criticisms (from Health Sciences) of chiropractic are? Are they expressed coolly and clearly?
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'''
2) Is it clear how chiropractors seek to answer those criticisms?
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?==
3) Is it clear that the opinions, for and against, are in neither case associated with Citizendium or its editors but attributed appropriately?
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
4) Could either the criticisms, or the responses, be expressed more cogently then they are?


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.  
5) Are the criticisms and the responses expressed neutrally, - respectful of the different points of view, i.e. without editorial disparagement?


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 :).
6) Has any significant criticism of chiropractic been omitted, and has any significant response to the criticisms been neglected?[[User:Gareth Leng|Gareth Leng]] 10:58, 12 April 2007 (CDT)
[[User:Gareth Leng|Gareth Leng]] 05:02, 14 March 2007 (CDT)


OK I've expnded the section in some haste, please check and ammend or revise as appropriate[[User:Gareth Leng|Gareth Leng]] 06:24, 14 March 2007 (CDT)
(from the Archive, copied here, Larry's guidance:


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! -[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 07:46, 14 March 2007 (CDT)
"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.")[[User:Gareth Leng|Gareth Leng]] 11:22, 12 April 2007 (CDT)


===Response by Stephen Ewen===
Please take all this in the spirit of respect in which I intend it:


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 intended[[User:Gareth Leng|Gareth Leng]] 08:06, 14 March 2007 (CDT)
#'''The Intro section'''. The first harbinger of things to come that makes this article ring a very loud bias tone begins with the first sentence in the introduction: "Chiropractic has not only survived a century of controversy, but has thrived, becoming the most popular alternative medical profession in the West."  The Into section then goes on to cite not the AMA's critical views of Chiro, their position ''against'' Chiro indicative of its philosophical contentions with it during the period (and still much to this day), but the judge's defensive decision. It overall rings a tone of saying "Chiros have been blameless yet persecuted victims of the allopaths, so you should accept us and visit us." And then the supposed "balancing" part to this supposed to be criticism section is "responded to" with the views of Chiropractic from the Health Sciences, showing how the field has advanced and improved and so forth.
#'''The "many styles of practice" section'''. I frankly have no idea why this even belongs here, except as a sort of apologia for the profession.
#'''The Evidence standards in chiropractic section'''. All cited to Chiropractic sources. President of the Council on Chiropractic Practice, and Keating. Using Chiros to depict the criticisms of their profession is, to understate it, not the best way to summarize the criticisms of the same.
#'''The Scientific foundations of chiropractic section'''. The entire section reads like a bald apologia for the profession, again sourcing only Chiros.
#'''And so forth''' in the same basic vein....


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?[[User:Gareth Leng|Gareth Leng]] 09:38, 14 March 2007 (CDT)
This article reads not like a neutral article but like an apologia for Chiro written atop an article on Critical views. Any criticism here appears neutered, denatured, and filtered for what ''seems'' reasons of interest. For an analogy, imagine a court case with two sides, the prosecuting side and the defense side. This article reads like the prosecuting side did not get its say, but was somehow forced to sit down while the defense side presented the prosecution's side instead.


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, [[User:Nancy Sculerati MD|Nancy Sculerati MD]] 10:24, 14 March 2007 (CDT)
Frankly, I think this article needs to be blanked, given a six month to a year-long hiatus, and started again from scratch with additional participants thereafter. When that is done, the whole pattern of organization needs to be different. It would be far superior to let this article be a summary of ''major non-Chiropractic authors'' who have criticized Chiropractic ("the prosecution") who get to make their strongest case possible. And then, let ''major Chiropractic authors'' ("the defense") get up and make their defense, their strongest case possible. Then the reader really can decide.


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.
[[User:Stephen Ewen|Stephen Ewen]] 03:53, 13 April 2007 (CDT)
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.[[User:Gareth Leng|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. [[User:Nancy Sculerati MD|Nancy Sculerati MD]] 11:11, 14 March 2007 (CDT)
: While, if what Steve says about the apparent slant of the article is correct, that is a serious problem. Presumably, the purpose of the article is to introduce the criticisms of chiropractic, first and foremost, and also to put those criticisms into context primarily by allowing chiropractors to respond.


: But I can't support Steve's suggestion that it be blanked and given a months-long hiatus.  I am opposed to giving articles hiatuses, generally.  People can be encouraged to take breaks of a day or two, but if the problems remain after one or two days, they will remain after six to twelve months.  Besides, we're supposed to have (or have within our means) the ability to resolve content disputes authoritatively.  It might take hard work to do so.  Let's not put off the work. --[[User:Larry Sanger|Larry Sanger]] 12:19, 13 April 2007 (CDT)


Thanks Stephen. The first difficulty is that the criticisms of chiropractic in the published literature virtually all come from within chiropractic. Keating and Homola are the major critics, and they are the ones extensively cited in all critical sites. It's difficult to find anything critical of chiropractic from any authoritative medical source - if you take the statements of the NHS, NIH, AMA etc they are all bland, neutral, supportive in some circumstances. The hostility has been expressed informally, on websites and in the media occasionally. I agree on the strongest case possible and strongest response. The problem is the strongest case is one that must be based on evidence. Notably, the judge in the Wilk case expressed confusion on this point, in saying that the witnesses called by the AMA at its case in fact provided evidence that was supportive of chiropractic. 


==!!??!!==
So here is the problem, for me. ''major non-Chiropractic authors'' who have criticized Chiropractic? There aren't any. ''major Chiropractic authors'' ("the defense") No, again there aren't any. But there are a few extremely lucid, cogent and highly critical authors within chiropractic who have done the job of expressing the criticisms. The defense is less lucidly and coherently presented than it is here. There isn't much criticism in the UK, virtually none in fact, it's small and well regulated. The hostility is mainly US, but where are the reputable sources of criticism?  
Confusion.
"no specific injury as a result of non-vaccination has ever been traced to chiropractic"??
Where is this?? Are we reading the same article here??
[[User:Gareth Leng|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]
However, I'm more than happy to blank. The prelude I agree doesn't help. It was meant to explain why the criticism comes from within chiropractic - in that the extent ranges from some who align themselves fully with Medicine to others who totally reject it. Hence, why the criticism comes from within. In this case, another reason for choosing chiropractors to express the criticisms is that it is an implicit acceptance that the criticisms are reasonable.
[edit]
and I admit I mis-read it. I feel like I'm in court, here. I am taking some time off.[[User:Nancy Sculerati MD|Nancy Sculerati MD]] 11:15, 14 March 2007 (CDT)


== My outsider's take ==
On the current flow, the Intro follows straight on from the list of criticisms, and that list is given without responses; if the list was simply moved to head the Intro the balance would read differently I think.
[[User:Gareth Leng|Gareth Leng]] 04:42, 13 April 2007 (CDT)


I'm not sure what precisely the neutrality question here is, but a few observations which might or might not help...
:No major non-Chiro authors who have been critical of Chiro?  C'mon, they are utterly replete going back to Chiro's founding: books, journals, statements by professional organizations, newspaper and magazine articles, speeches, every possible venue imaginable. I have two older books I can dig out from my garage, one scientific from the 1950s, and a popular one from the 1980s, both which I read 17 years ago. For a few recent additions, you might start [http://www.amazon.com/Chiropractic-Greatest-Hoax-Century/dp/0965785521/ref=pd_bbs_1/002-0550295-5778457?ie=UTF8&s=books&qid=1176458596&sr=8-1 here], [http://www.amazon.com/Chiropractic-Victims-Perspective-Consumer-Library/dp/157392041X/ref=pd_sim_b_2/002-0550295-5778457?ie=UTF8&qid=1176458596&sr=8-1 here], [http://www.amazon.com/Spin-Doctors-Chiropractic-Industry-Examination/dp/155002406X/ref=pd_sim_b_2/002-0550295-5778457?ie=UTF8&qid=1176458596&sr=8-1 here] and [http://www.amazon.com/Health-Robbers-Quackery-America-Consumer/dp/0879758554/ref=pd_sim_b_3/002-0550295-5778457?ie=UTF8&qid=1176458596&sr=8-1 here] and follow the sources in the bibliographies.  Why would one favor Chiropractic sources on critical views of Chiro over non-Chiros who have indeed published on the topic? How can anything unbiased even begin to come from that? These authors I am giving you need to be read and their arguments summarized in the article in the strongest possible light, and then the inverse. You might argue that those books are not "strictly scientific", but that fails to fully appreciate the nature of this topic from the get-go. Most publications have been popular publication, and not necessarily for the scientific community, because the authorial goal has mostly been to reach popular people, potential patients - the same goal as in this article as it now stands, I suspect, but in a terribly biased way. [[User:Stephen Ewen|Stephen Ewen]] 05:15, 13 April 2007 (CDT)


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.
Yes, I should have made it clear that I was talking about the academic literature. It is a core problem; if we use such sources should we also use books and websites that promote chiropractic? I don't think so.[[User:Gareth Leng|Gareth Leng]] 07:00, 13 April 2007 (CDT)


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.
:I'd say that we should use such sources and label them appropriately.  CZ introduces expert views first and foremost, but it serves our readership poorly if we do not present other views as well--properly contextualized. --[[User:Larry Sanger|Larry Sanger]] 12:27, 13 April 2007 (CDT)


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.
Larry and Gareth...Right now the article relies on many sources that are largely ''promotional materials'' for Chiro.  Like I said, if we fail to recognize that the domain of critical views of Chiro is among the popular press, we simply fail to appreciate the very nature of this topic, including its historical and current contentious nature in the U.S., and we will wind up creating an artificial article.  We cannot dilute the actual criticisms  of Chiro, lest this article be simply misleading.  The books I posted above -- one is by Ludmil A. Chotkowski MD FACP, one is  by Stephen Barrett MD, another by Stephen Barrett MD and William T. Jarvis PhD, and another by an award-winning Canadian journalist.  We should NOT reject these as bunk or "non-expert" and place them on par with run-o-the-mill websites. Most authors critical of Chiro do not care one wit to publish such criticisms in journals, where ''potential patients'' rarely read.  [[User:Stephen Ewen|Stephen Ewen]] 13:07, 13 April 2007 (CDT)


I like the fact that the article sets out the game plan vis-a-vis bias in the beginning, by the way.
:I just scanned the archives for the first time. There is clearly some very important sources in Archive 1. [[User:Stephen Ewen|Stephen Ewen]] 15:17, 13 April 2007 (CDT)


Anyway, that's all I have time for now.  I absolutely must focus my attention on high-priority launch-related tasks.
== We need a fair article of this title-cannot be blanked==


--[[User:Larry Sanger|Larry Sanger]] 11:12, 14 March 2007 (CDT)
I see that again the article has been edited to remove views I had placed-this time explaining about the so-called "musculoskeletal arena" not including diseases like multiple sclerosis. This is an important explanation from the perspective of readers who are not scientists. I would appreciate that explanation being re-inserted. After having myself been culpable in getting articles on Chiropractic approved such that Citizendium in now weighted towards that subject in its approved articles, I do not think that "blanking" this article is viable. Citizendium needs to have a fair and neutral article with this title - not a white wash (I agree with the above analysis by Stephen), and not a rout ("bullying"), Instead a presentation of the actual criticisms -which again are both regional and, in intensity, vary according to subgroups within chiropractic. Those subgroups are not labelled in the real world , however, in a way that potential patients can easily recognize, and so in fairness, this article cannot be restricted to only discuss the criticisms that proponents of chiropractic feel are fairly made of the median of the profession. Of course the article must be neutral and of course rebuttal must be offered. Perhaps the editor in chief or Gareth, or Matt, can approach, directly,  other health science editors, besides myself, and ask them to try to provide that - at least the start of that. To edit this and to collaborate. Unless one of them steps up. [[User:Nancy Sculerati|Nancy Sculerati]] 05:47, 13 April 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.[[User:Gareth Leng|Gareth Leng]] 11:28, 14 March 2007 (CDT)
No, that comment is wholly retained, it's just moved down to the section on extent of practice. The lead duplicated criticisms of extent of practice, so to keep the lead clean and concise I left that short but put your addition in the section. Sorry if it wasn't clear what I'd done there.[[User:Gareth Leng|Gareth Leng]] 06:20, 13 April 2007 (CDT)
 
Please replace it so that it is in the lead list. Let additional health science editors sort it out. [[User:Nancy Sculerati|Nancy Sculerati]] 06:24, 13 April 2007 (CDT)
 
Done. This article is still in Healing Arts workgroup incidentally.[[User:Gareth Leng|Gareth Leng]] 06:39, 13 April 2007 (CDT)
 
:This article should be in both the health science workgroup and the healing arts workgroup. It is'' Chiropractic'' that is not health science, I assure you, the'' major critical views of chiropractic'' are health science. (except of course-in ''this'' article, as it now stands, which is Stephen's point-I think) (not smiling and awaiting something that begins with the letter a) [[User:Nancy Sculerati|Nancy Sculerati]] 07:02, 13 April 2007 (CDT)
 
{{nocomplaints}}
 
Good morning everyone, and Stephen, welcome.  Good to have some new input as well.  I am open to your suggestions as well as Gareth's and Nancy's.  I don't see much problem either way, they are all just different directions for the same article and I think an editorial decision.  The question is whether it is a Healing Arts decision or a Health Sciences decision.  I suppose we should make that distinction now, because the acupuncturists, homeopaths and faith healers are coming, too.  I can go either way, but keep in mind that neutrality is paramount.  Yes, there are all sorts of criticism about chiropractic that swell out there.  We should even throw in the pseudoscience accusation, but there is also the other side of the story that needs to be told as well.  As long as we keep it neutral, it should not be a problem.  But don't shoot the messenger from either side of the fence.  We all appreciate each other personally, and I know I respect everyone's intellect and willingness to share.  This is a controversial subject that is bound to get intense, and we would are all human, regardless of our training.  The challenge is to separate ourselves from our beliefs and evaluate each of these criticisms to see if they are based in knowledge, based in fallacy, based in mallace, or based in competition.  Only then will we have anything worth printing.  Let's keep building, nobody says we have to Approve anything until we are all satisfied.  If it takes us 6 months or a year, then so be it.  If more editors pop in, okay.  If it gets to the point that it is not Maintainable, the healing arts workgroup can delete it.  It's the push to Approve that gives the sense of anxiety that causes us to lose our wits. --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 08:06, 13 April 2007 (CDT)
 
{{nocomplaints}}
 
I am too late to the current iteration of the controversy.  I'm sorry about that; my help could have been used a few days ago.  Anyway, I would like to suggest that everyone take a break for a day--that's all.  (Not for six months. :-) )  I am going to lay down a few ground rules--which themselves are subject to debate/clarification.
# Unapproved articles are unapproved articles.  Unless there is ''gross'' abuse, which there is not, the suggestion that they be blanked or deleted is not appropriate.
# The article and the discussion about it will, I think, be most positively effected if we do the following.  I suggest that in the interests of both clarity and [[CZ:Neutrality Policy|neutrality]] that this article be cast in a point-counterpoint fashion.  I don't mean actually to ''use the words'' "point" and "counterpoint," but that the criticism be made, and then a reply made that uses approximately the same space (it needn't be exact).
# As we all can remember from college bull sessions, arguing about generalities is rarely productive.  The way forward is to identify a set of ''very specific'' issues, and seek resolution about each of them.  I'd like to suggest that everyone at work on this article (well, Nancy, Matt, and Gareth) list (and edit as necessary) the most important specific texts that they regard as problematic, and state ''concisely'' (not at great length) what is problematic about them.  This will help both me and others we might invite to look at this page to understand where, operationally, the problems are.
# Not only should we remember the dictates of [[CZ:Professionalism]], we should recall that making ''any'' sort of ''general'' characterizations of others' work are ''usually'' not helpful.  Please refrain.
# I think it is very unreasonable to ask any person to come to a fast and furious debate, if he/she must ''first'' review reams of discussion.  Hence, I don't want specifically to invite others to the debate (which they may join at any time if they wish--it's a wiki) until the specific points of contention have been laid out as just suggested.
# The article needs to be copyedited.
 
--[[User:Larry Sanger|Larry Sanger]] 12:39, 13 April 2007 (CDT)
 
===The spirit behind my blanking and hiatus suggestion...===
...was because it ''very much'' seems the principle authors could very much be benefited by a break; was to give CZ more time to get more eyes and additional authors for this topic; was as a way to approach the topic ''fresh'' afterward; was in recognition that we just do not need <nowiki>{{no complaints}}</nowiki> templates right now when there is so many other things to do.  Myself, I would be happy to dust off some old books, and buy and read three or four others, and role up my author sleeves; but right now I have things that are simply ''much'' higher priority for CZ...namely, helping to figure out media policy!  [[User:Stephen Ewen|Stephen Ewen]] 13:27, 13 April 2007 (CDT)
 
: I am fully in agreement with Larry's suggestion, and am also fully happy to leave the presentation of criticism to others and confine myself to helping Matt with the counterpoint. Stephen Barrett and William Jarvis are clear and good writers who have worked closely with Samual Homola and some of the present content certainly reflects my reading of these. The present cited references however have avoided any promotional sites for chiropractic, and indeed the chiropractic literature sources have been selected as expressing criticism, generally very outspoken criticism, of chiropractic; they were also chosen becuse they are electronically available. The highly critical book of Homola's is cited, as it is wholly available online. In fact, the present rebuttal also avoids using promotional sources, and I would prefer to continue to avoid these.
We have avoided citing directly from websites like chirobase, and this probably needs some policy direction. Personally I dislike citing from any websites except stable academic institutional sites; again it's hard to see how a consistent policy might permit citing from critical opinion sites but not from  promotional sites.
Any perception that this is promotional of chiropractic is unintended, just as there was no intention that this article should be seen as derogatory, but it is an important criticism, and I fully agree that any such perception must be eliminated. I was certainly very conscious of avoiding the impression that the criticisms were endorsed by Citizendium's editors.
 
The technical problem of point-counterpoint is how do we avoid recursion? - i.e., how do we avoid the problem that the counterpoint argument is made irrelevant by a change in the point that is made to avoid the particular counterpoint? This will lead to endless iteration unless the form of the points are stabilised before the counterpoints are written. Accordingly I'd suggest that the points be written first and stabilised, then the counterpoints are introduced. [[User:Gareth Leng|Gareth Leng]] 06:46, 14 April 2007 (CDT)
 
Well, you can't avoid recursion entirely, but you can set limits, as we have with [[CZ:Summaries of policy arguments]].  The big advantage of point-counterpoint is that it is very clear who is "speaking."  The trouble with mixing up different views within the same paragraph, or sentence, is that there is then the perception of a third speaker--the narrator--whose implied views are supposed to be authoritative.  And then there is a struggle about which view this authoritative narrator is made, very subtly, to endorse.  Letting the different sides "speak for themselves" eliminates the authoritative narrator. --[[User:Larry Sanger|Larry Sanger]] 11:31, 16 April 2007 (CDT)
 
:Just thinking aloud here... Is it a possibility to simply string together quotes from various authors? Say, critic A says X and respondent B says Y. While they may not in their original context have been addressing one another, it ''might'' work well. And it would be fair use of longer quotes, in this context, I think. [[User:Stephen Ewen|Stephen Ewen]] 23:43, 18 April 2007 (CDT)
 
== List (and edit as necessary) the most important specific texts that they regard as problematic ==
 
===The list===
One of my problems is with the list of criticisms.  They need to be parsed into individual complaints as the format now buries arguments and makes rebuttal impossible.  This is the current list:
 
*That an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model, and advocate expansion of market base into the care of the well child.
*that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
*that Chiropractic argues that such coursework in "medical diagnosis" qualifies its practitioners to be fully qualified to make medical evaluations, and to rule out signs of serious disease.
*that the theoretical basis of the key chiropractic concept of [[vertebral subluxation]] is not scientifically sound.
*that some chiropractors advise parents that ''all'' vaccinations have higher risks and less benefit than any organized health science or biological science group accepts, thus exposing children to the risk of preventable illnesses and putting the general population at risk of epidemics.
*that, in the USA, chiropractors are not trained in medicine, nursing, or health science, and so are not competent to act as comprehensive primary health care providers, yet some chiropractors make that claim, without protest by the larger organized groups in the profession.
*that Chiropractic accepts a level of self-promotion in advertising that is unprofessional and misleading.
*that while chiropractic has been shown to be effective for backpain, headache and certain musculoskeletal conditions, chiropractors treat patients for a much wider range of conditions where there is no strong objective evidence that their interventions are effective.
*that although chiropractic has been shown to be effective for a limited set of conditions that are associated with backpain, claimed efficacy is generalized to "muscloskeletal conditions", a phrase without specific meaning that does not include the conditions, such as myasthenia gravis, multiple sclerosis, or rheumatoid arthritis, that any reasonably knowlegable layman might assume to be such a condition.
 
 
 
This is the list we had last week:
*that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
*that the theoretical basis of the key chiropractic concept of [[vertebral subluxation]] is not scientifically sound.
*that rejecting universal vaccination in favor of personal choice puts the general population at risk of epidemics, and might expose pediatric patients to the risk of preventable illnesses.
*that chiropractors are not adequately trained in the diagnosis of medical diseases, and so are not competent to act as comprehensive primary health care providers.
*that the care of patients with conditions that have never been shown to be efficaciously treated by chiropractors is not warranted if patients forego medically recommended treatments.
*that Chiropractic accepts a level of self-promotion in advertising that is unprofessional and misleading.
 
We can add more things, but I would like to see arguments stated more concisely and less repeatedly.  --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 08:14, 14 April 2007 (CDT)
 
==Edit wars==
It's possible to spend a lot more time editing a page's discussion than constructively improving the page itself...I have found that contentious discussions tend to improve the quality of a page, as people are forced to substantiate their opinions, their knowledge deepens.  OTOH, it can also be counterproductive.  Criticism of chiropractic is controversial by definition...is it worthy of an encyclopedic entry?  Maybe the whole page could be replaced with the sentence "Chiropractic is a popular mode of health care that has remained outside the medical mainstream for over 50 years."--[[User:Michael Benjamin|Michael Benjamin]] 15:15, 18 April 2007 (CDT)
 
Ahh, a man of few words, but deep thoughts.  I wonder if we would argue over the 50 years? :-) --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 19:48, 18 April 2007 (CDT)
 
Probably, but the edits would be a lot shorter.  Think of the forest, not the trees...--[[User:Michael Benjamin|Michael Benjamin]] 02:14, 19 April 2007 (CDT)
:May be we should thinking 'copse' due to the small size of your proposed article :) [[User:Chris Day|Chris Day]] [[User talk:Chris Day|(talk)]] 11:21, 20 April 2007 (CDT)
 
I do not wish to have an edit war, particularly with a friend. Please do not change the lead here until the part of the article that was never written is written. Please see above where Gareth made proposals for doing that. [[User:Nancy Sculerati|Nancy Sculerati]] 08:43, 30 May 2007 (CDT) What happened to the bullet list? Why does it no longer appear?
 
Critics from [[Medicine]], especially in the USA, have claimed:
*that an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model of total health care, and even advocate expansion of market base into the care of the well child.
*that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
*that Chiropractic argues that such coursework in "medical diagnosis" qualifies its practitioners to be fully qualified to make medical evaluations, and to rule out signs of serious disease.
*that the entire basis ([[vertebral subluxation]]) of chiropractic theory is not scientifically sound.
*that some chiropractors advise parents that ''all'' vaccinations have higher risks and less benefit than any organized health science or biological science group accepts, thus exposing children to the risk of preventable illnesses and putting the general population at risk of epidemics. Worrisomely, this subgroup is the ''same'' group that advocates chiropractic as comprehensive primary health care for children.
*that, in the USA, chiropractors are not trained in medicine, nursing, or health science, and so are not competent to act as comprehensive primary health care providers, yet some subgroups of chiropractors make that claim, without protest by the larger profession.
*that Chiropractic accepts a general level of self-promotion in advertising that is unprofessional and misleading.
*that while chiropractic has ''only'' been shown to be effective for backpain, and some types of headache, chiropractors advertise for and treat patients for non-musculoskeletal conditions like [[infant colic]], none the less.
*that the chiropractic profession promotes the notion that chiropractic is effective in "muscloskeletal conditions", when the evidence for relief of backpain does ''not'' in any way show that chiropractic care helps conditions such as myasthenia gravis, multiple sclerosis, or rheumatoid arthritis, or other serious and common conditions that a reasonably knowlegable layman would assume to fall into the category of "musculoskeletal conditions".
 
[[User:Nancy Sculerati|Nancy Sculerati]] 08:48, 30 May 2007 (CDT)
 
Hi Nancy, yes, I just marked out the list (it is still there) because we left it in a non-neutral manner.  The article has not changed otherwise, it still has each argument at the top of each section and the greater argument below it with an appropriate rebuttal after that. 
 
The problem having a list at the beginning without any chance for immediate rebuttal is that some will not read through the article to view the opposing points.  Consider, for instance and article on "Great views of chiropractic" presented with a list of 'wonderful things they cure' with the rebuttals far down in the text.  Surely you don't feel that is a neutral way to present that subject and neither do I, so why would we present this one that way? --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 13:40, 30 May 2007 (CDT)
 
::Having a summary list of the critical views in the article ''entitled'' the critical views is not "non-neutral". Matt, I think that you better ask for some kind of dispute resolution. I absolutely refuse to remove that list. I have spent hundreds of hours writing this article and all that happens is what I write is removed or so watered down that it is unrecognizeable. Write all you want- Rebut all you want, but do so in your own section as Gareth suggested- that list is not a slanted outrageous attack on chiropractic, it is a ''very'' moderate summary of the actual critical views of physicians and health science.I do feel that having that list to be followed by explanations is absolutely neutral. This is not an arm wrestling match between MD and DC- where "neutral" means "even" this is an encyclopedic article on the critical views of Chiropractic. That list could be a slanted biased nasty list- it is instead nothing more than the minimum realistic actual criticisms of US physicians and health science professionals- as is made clear, again and again.
[[User:Nancy Sculerati|Nancy Sculerati]] 14:42, 30 May 2007 (CDT)
 
My problems with the list have not changed.  The list that we had before this one was fine and agreed upon, but it was changed.  If you must have a list, then please review my concerns [http://en.citizendium.org/wiki/Talk:Critical_views_of_chiropractic#List_.28and_edit_as_necessary.29_the_most_important_specific_texts_that_they_regard_as_problematic above).  --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 15:06, 30 May 2007 (CDT)
 
::I've answered that criticism and I am not interested in answering it again. [[User:Nancy Sculerati|Nancy Sculerati]] 16:11, 30 May 2007 (CDT)
 
== Historical perspective ==
 
This article appears to lack historical perspective, which would explain many of the objections that medical practitioners have to chiropractic. My impressionistic reading of this is that the more expansive claims of chiropractic were much more common in the first half of the 20th century, and much more aggresively promulgated by chiropractors, with less scientific basis than exists now. There does seem to be some of this currently around in chiropractic circles, but most chiropractors today stress overall holistic health care much more than was common previously, and more than is common with most physicians today. I'd suggest that people familiar with the history of the conflict between chiropractic and the medical profession give this article a thorough going-over. [[User:Anthony Argyriou|Anthony Argyriou]] 16:53, 30 May 2007 (CDT)
 
::You might have something there Anthony.  It worked well on the [[Chiropractic]] page, maybe something like that will also work here.  I think we would all agree that the criticism has helped constructively shape the profession especially in the late 20th century, while at the same time showing that chiropractic has helped mainstream healthcare address its weaknesses as well. --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 20:52, 31 May 2007 (CDT)
 
:::Anthony, I wrote a good deal of that article. There are now 2 approved articles on Chiropractic subjects on the Citizendium. Matt has remarked to me several times that he trusted me and that I had taught him worthwhile things in my research into those articles ''while we wrote them together''. It is difficult perhaps to face criticism in your field, Matt, but nothing about those bullet points is unfair. If you would like to write a "Critical views of Medicine" as a healing arts article- be my guest. This article Critical views of Chiropractic was requested, as I recall, by you Matt, and Gareth, and it must actually contain -rather than supress- the critical views- and especially the critical views of American physicians for all the reasons of history and the geographic variations in Chiropractic practice. These must be presented clearly and of course must have room for rebuttal, but they will ''not'' be hidden or neutralized by being buried. I could easily add to the present list, but I would rather not. Every one of the bullet points can be discussed by you Matt. Why don't you work on that? I will be as fair as I can be, but I will not lie or supress what the critical views of chiropractic are by the most reasonable physicians. [[User:Nancy Sculerati|Nancy Sculerati]] 21:20, 31 May 2007 (CDT)
 
Nancy, you did make it quite clear above that you did not want to discuss the list anymore and I have respected that.  I am satisfied with the rebuttal sections as they were presented because your new list did not bring anything new to the table for me to discuss.  My point remains that it only garbled it with more language that I feel only confuses the reader and makes it difficult to parse.  You don't seem to agree and I can respect that, so I stopped arguing with you.  Anthony gave us some constructive criticism and I was responding to it, that is my perogative. If he thinks that we could use some historical perspective, I appreciate his input as an outsider looking in.  Also, thank you for helping with the Chiropractic article, but please check the [http://en.citizendium.org/wiki?title=Chiropractic&action=history history].  --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 22:11, 31 May 2007 (CDT)
 
==Neutrality==
 
My response to the title of this article is the same as my response to its content, which is to quote the following from the Citizendium Neutrality Policy:  ''"One can think of unbiased writing as the cold, fair, analytical description of debates."'' and ''"If we're going to characterize disputes fairly, fairness demands we present competing views with a consistently positive, sympathetic tone. "''  and ''"But experienced academics, polemical writers, and rhetoricians are well-attuned to bias, so that they can usually spot a description of a debate that tends to favor one side."''  --[[User:Catherine Woodgold|Catherine Woodgold]] 09:12, 10 June 2007 (CDT)
 
==The list==
If we accept Nancy's list as correctly characterising the criticisms of chiropractic then we have to move to characterising the responses to these. As Matt has indicated this leads to problems. Let's just look at the first on the list
"that an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model of total health care, and even advocate expansion of market base into the care of the well child."
 
What is the response from chiropractors? The problem is that I think that an intelligent chiropractor would say that this, as phrased, contains a series of insinuations all of which need rebuttal. However, being polite, perhaps they would simply say
"Chiropractors indeed believe that it is important to minimise the use of drugs, and see their role in particular as being to pursue alternatives to drugs. They believe that preventative care is also an important part of health care, one that is particularly important for children."
 
If they were just a little less polite they might add.
"The insinuation that chiropractors are motivated by profit rather than concern for their patients is one that they vigorously refute. Certainly chiropractors have to earn a living, but they generally do not earn the large incomes typical of conventional physicians in private practice; accordingly they consider the insinuation that they are primarily motivated by personal profit to be unfair and indeed hypocritical."
 
If we stick with Nancy's list perhaps we should confine the style of rebuttals to the former? Matt, will restraint and polite understatement do well here? Or do you think the rebuttals should be payment in kind?[[User:Gareth Leng|Gareth Leng]] 10:08, 28 June 2007 (CDT)
 
:I do not think that 'payment in kind' is necessary at this point, though you state it quite well. --[[User:D. Matt Innis|Matt Innis]] [[User talk:D. Matt Innis|(Talk)]] 10:57, 28 June 2007 (CDT)
 
::Matt, you happen to have hit one of my grammar hot buttons. "The insinuation that ... is one that they vigorously refute." Not "refute" but "deny"! [[User:Sandy Harris|Sandy Harris]] 00:02, 5 September 2010 (UTC)
 
:::Some responses are in the main article. I really question if this should be separate from it. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 17:47, 27 January 2011 (UTC)
 
== Singh lawsuit ==
 
An article by Simon Singh brought a libel suit from the British Chiropractic association, which they eventually dropped.
* [http://en.wikipedia.org/wiki/Simon_Singh#Chiropractic_lawsuit_and_backlash WP coverage] with extensive references
* [http://www.wired.com/magazine/2010/08/mf_qa_singh/ Wired interview] with Singh
* [http://www.simonsingh.net/ Singh's own site]
I'd say this should be discussed here. [[User:Sandy Harris|Sandy Harris]] 00:18, 5 September 2010 (UTC)
 
== Allied health sciences term ==
 
I reverted what should be [[allied health professions]], which has a specific meaning different from physicians. In general medical usage, allied health includes a wide range of nonphysician midlevel and basic level fields that support medicine.  Nursing is sometimes included, or put in its own category. In general, however, things that fall into allied health include physical therapy, social work and counseling, imaging and laboratory technologists, respiratory therapy, dietetics, orthopedic and surgical technicians, etc. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 07:12, 23 December 2010 (UTC)

Latest revision as of 11:47, 27 January 2011

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 Definition:  An indepth discussion of the aspects of chiropractic that define its position in the modern healthcare arena with special emphasis on those related to its role in alternative medicine. [d] [e]
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Editor Instructions, do not archive

Editors should articulate their common sense of how this article should be approached here.

The objectives here are

a) to detail the common criticisms of chiropractic, in a way that explains them neutrally without appearing to endorse them and

b) explain the common response of Chiropractic to those criticisms, again making it clear that we are reporting the views of chiropractors, not endorsing them.

So, the key questions (for me) are

1) Is it clear what the common criticisms (from Health Sciences) of chiropractic are? Are they expressed coolly and clearly?

2) Is it clear how chiropractors seek to answer those criticisms?

3) Is it clear that the opinions, for and against, are in neither case associated with Citizendium or its editors but attributed appropriately?

4) Could either the criticisms, or the responses, be expressed more cogently then they are?

5) Are the criticisms and the responses expressed neutrally, - respectful of the different points of view, i.e. without editorial disparagement?

6) Has any significant criticism of chiropractic been omitted, and has any significant response to the criticisms been neglected?

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.

Comments

Call for help here, more eyes

This has been a tough article to write, one that is a test in a way of Citizendium's capacity to report on controversies while keeping a neutral distance from them. This article began as a simple detailing of the common criticisms, in a way that tried to report that these criticisms were commonly made but without appearing to endorse them. Larry rightly commented that the response of chiropractors must also be given. So, the objectives here were and are

a) to detail the common criticisms of chiropractic, in a way that explains them neutrally without appearing to endorse them and

b) explain the common response of Chiropractic to those criticisms, again making it clear that we are reporting the views of chiropractors, not endorsing them.

So, the key questions (for me) are

1) Is it clear what the common criticisms (from Health Sciences) of chiropractic are? Are they expressed coolly and clearly?

2) Is it clear how chiropractors seek to answer those criticisms?

3) Is it clear that the opinions, for and against, are in neither case associated with Citizendium or its editors but attributed appropriately?

4) Could either the criticisms, or the responses, be expressed more cogently then they are?

5) Are the criticisms and the responses expressed neutrally, - respectful of the different points of view, i.e. without editorial disparagement?

6) Has any significant criticism of chiropractic been omitted, and has any significant response to the criticisms been neglected?Gareth Leng 10:58, 12 April 2007 (CDT)

(from the Archive, copied here, Larry's guidance:

"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.")Gareth Leng 11:22, 12 April 2007 (CDT)

Response by Stephen Ewen

Please take all this in the spirit of respect in which I intend it:

  1. The Intro section. The first harbinger of things to come that makes this article ring a very loud bias tone begins with the first sentence in the introduction: "Chiropractic has not only survived a century of controversy, but has thrived, becoming the most popular alternative medical profession in the West." The Into section then goes on to cite not the AMA's critical views of Chiro, their position against Chiro indicative of its philosophical contentions with it during the period (and still much to this day), but the judge's defensive decision. It overall rings a tone of saying "Chiros have been blameless yet persecuted victims of the allopaths, so you should accept us and visit us." And then the supposed "balancing" part to this supposed to be criticism section is "responded to" with the views of Chiropractic from the Health Sciences, showing how the field has advanced and improved and so forth.
  2. The "many styles of practice" section. I frankly have no idea why this even belongs here, except as a sort of apologia for the profession.
  3. The Evidence standards in chiropractic section. All cited to Chiropractic sources. President of the Council on Chiropractic Practice, and Keating. Using Chiros to depict the criticisms of their profession is, to understate it, not the best way to summarize the criticisms of the same.
  4. The Scientific foundations of chiropractic section. The entire section reads like a bald apologia for the profession, again sourcing only Chiros.
  5. And so forth in the same basic vein....

This article reads not like a neutral article but like an apologia for Chiro written atop an article on Critical views. Any criticism here appears neutered, denatured, and filtered for what seems reasons of interest. For an analogy, imagine a court case with two sides, the prosecuting side and the defense side. This article reads like the prosecuting side did not get its say, but was somehow forced to sit down while the defense side presented the prosecution's side instead.

Frankly, I think this article needs to be blanked, given a six month to a year-long hiatus, and started again from scratch with additional participants thereafter. When that is done, the whole pattern of organization needs to be different. It would be far superior to let this article be a summary of major non-Chiropractic authors who have criticized Chiropractic ("the prosecution") who get to make their strongest case possible. And then, let major Chiropractic authors ("the defense") get up and make their defense, their strongest case possible. Then the reader really can decide.

Stephen Ewen 03:53, 13 April 2007 (CDT)

While, if what Steve says about the apparent slant of the article is correct, that is a serious problem. Presumably, the purpose of the article is to introduce the criticisms of chiropractic, first and foremost, and also to put those criticisms into context primarily by allowing chiropractors to respond.
But I can't support Steve's suggestion that it be blanked and given a months-long hiatus. I am opposed to giving articles hiatuses, generally. People can be encouraged to take breaks of a day or two, but if the problems remain after one or two days, they will remain after six to twelve months. Besides, we're supposed to have (or have within our means) the ability to resolve content disputes authoritatively. It might take hard work to do so. Let's not put off the work. --Larry Sanger 12:19, 13 April 2007 (CDT)

Thanks Stephen. The first difficulty is that the criticisms of chiropractic in the published literature virtually all come from within chiropractic. Keating and Homola are the major critics, and they are the ones extensively cited in all critical sites. It's difficult to find anything critical of chiropractic from any authoritative medical source - if you take the statements of the NHS, NIH, AMA etc they are all bland, neutral, supportive in some circumstances. The hostility has been expressed informally, on websites and in the media occasionally. I agree on the strongest case possible and strongest response. The problem is the strongest case is one that must be based on evidence. Notably, the judge in the Wilk case expressed confusion on this point, in saying that the witnesses called by the AMA at its case in fact provided evidence that was supportive of chiropractic.

So here is the problem, for me. major non-Chiropractic authors who have criticized Chiropractic? There aren't any. major Chiropractic authors ("the defense") No, again there aren't any. But there are a few extremely lucid, cogent and highly critical authors within chiropractic who have done the job of expressing the criticisms. The defense is less lucidly and coherently presented than it is here. There isn't much criticism in the UK, virtually none in fact, it's small and well regulated. The hostility is mainly US, but where are the reputable sources of criticism?

However, I'm more than happy to blank. The prelude I agree doesn't help. It was meant to explain why the criticism comes from within chiropractic - in that the extent ranges from some who align themselves fully with Medicine to others who totally reject it. Hence, why the criticism comes from within. In this case, another reason for choosing chiropractors to express the criticisms is that it is an implicit acceptance that the criticisms are reasonable.

On the current flow, the Intro follows straight on from the list of criticisms, and that list is given without responses; if the list was simply moved to head the Intro the balance would read differently I think. Gareth Leng 04:42, 13 April 2007 (CDT)

No major non-Chiro authors who have been critical of Chiro? C'mon, they are utterly replete going back to Chiro's founding: books, journals, statements by professional organizations, newspaper and magazine articles, speeches, every possible venue imaginable. I have two older books I can dig out from my garage, one scientific from the 1950s, and a popular one from the 1980s, both which I read 17 years ago. For a few recent additions, you might start here, here, here and here and follow the sources in the bibliographies. Why would one favor Chiropractic sources on critical views of Chiro over non-Chiros who have indeed published on the topic? How can anything unbiased even begin to come from that? These authors I am giving you need to be read and their arguments summarized in the article in the strongest possible light, and then the inverse. You might argue that those books are not "strictly scientific", but that fails to fully appreciate the nature of this topic from the get-go. Most publications have been popular publication, and not necessarily for the scientific community, because the authorial goal has mostly been to reach popular people, potential patients - the same goal as in this article as it now stands, I suspect, but in a terribly biased way. Stephen Ewen 05:15, 13 April 2007 (CDT)

Yes, I should have made it clear that I was talking about the academic literature. It is a core problem; if we use such sources should we also use books and websites that promote chiropractic? I don't think so.Gareth Leng 07:00, 13 April 2007 (CDT)

I'd say that we should use such sources and label them appropriately. CZ introduces expert views first and foremost, but it serves our readership poorly if we do not present other views as well--properly contextualized. --Larry Sanger 12:27, 13 April 2007 (CDT)

Larry and Gareth...Right now the article relies on many sources that are largely promotional materials for Chiro. Like I said, if we fail to recognize that the domain of critical views of Chiro is among the popular press, we simply fail to appreciate the very nature of this topic, including its historical and current contentious nature in the U.S., and we will wind up creating an artificial article. We cannot dilute the actual criticisms of Chiro, lest this article be simply misleading. The books I posted above -- one is by Ludmil A. Chotkowski MD FACP, one is by Stephen Barrett MD, another by Stephen Barrett MD and William T. Jarvis PhD, and another by an award-winning Canadian journalist. We should NOT reject these as bunk or "non-expert" and place them on par with run-o-the-mill websites. Most authors critical of Chiro do not care one wit to publish such criticisms in journals, where potential patients rarely read. Stephen Ewen 13:07, 13 April 2007 (CDT)

I just scanned the archives for the first time. There is clearly some very important sources in Archive 1. Stephen Ewen 15:17, 13 April 2007 (CDT)

We need a fair article of this title-cannot be blanked

I see that again the article has been edited to remove views I had placed-this time explaining about the so-called "musculoskeletal arena" not including diseases like multiple sclerosis. This is an important explanation from the perspective of readers who are not scientists. I would appreciate that explanation being re-inserted. After having myself been culpable in getting articles on Chiropractic approved such that Citizendium in now weighted towards that subject in its approved articles, I do not think that "blanking" this article is viable. Citizendium needs to have a fair and neutral article with this title - not a white wash (I agree with the above analysis by Stephen), and not a rout ("bullying"), Instead a presentation of the actual criticisms -which again are both regional and, in intensity, vary according to subgroups within chiropractic. Those subgroups are not labelled in the real world , however, in a way that potential patients can easily recognize, and so in fairness, this article cannot be restricted to only discuss the criticisms that proponents of chiropractic feel are fairly made of the median of the profession. Of course the article must be neutral and of course rebuttal must be offered. Perhaps the editor in chief or Gareth, or Matt, can approach, directly, other health science editors, besides myself, and ask them to try to provide that - at least the start of that. To edit this and to collaborate. Unless one of them steps up. Nancy Sculerati 05:47, 13 April 2007 (CDT)

No, that comment is wholly retained, it's just moved down to the section on extent of practice. The lead duplicated criticisms of extent of practice, so to keep the lead clean and concise I left that short but put your addition in the section. Sorry if it wasn't clear what I'd done there.Gareth Leng 06:20, 13 April 2007 (CDT)

Please replace it so that it is in the lead list. Let additional health science editors sort it out. Nancy Sculerati 06:24, 13 April 2007 (CDT)

Done. This article is still in Healing Arts workgroup incidentally.Gareth Leng 06:39, 13 April 2007 (CDT)

This article should be in both the health science workgroup and the healing arts workgroup. It is Chiropractic that is not health science, I assure you, the major critical views of chiropractic are health science. (except of course-in this article, as it now stands, which is Stephen's point-I think) (not smiling and awaiting something that begins with the letter a) Nancy Sculerati 07:02, 13 April 2007 (CDT)


A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism.

Good morning everyone, and Stephen, welcome. Good to have some new input as well. I am open to your suggestions as well as Gareth's and Nancy's. I don't see much problem either way, they are all just different directions for the same article and I think an editorial decision. The question is whether it is a Healing Arts decision or a Health Sciences decision. I suppose we should make that distinction now, because the acupuncturists, homeopaths and faith healers are coming, too. I can go either way, but keep in mind that neutrality is paramount. Yes, there are all sorts of criticism about chiropractic that swell out there. We should even throw in the pseudoscience accusation, but there is also the other side of the story that needs to be told as well. As long as we keep it neutral, it should not be a problem. But don't shoot the messenger from either side of the fence. We all appreciate each other personally, and I know I respect everyone's intellect and willingness to share. This is a controversial subject that is bound to get intense, and we would are all human, regardless of our training. The challenge is to separate ourselves from our beliefs and evaluate each of these criticisms to see if they are based in knowledge, based in fallacy, based in mallace, or based in competition. Only then will we have anything worth printing. Let's keep building, nobody says we have to Approve anything until we are all satisfied. If it takes us 6 months or a year, then so be it. If more editors pop in, okay. If it gets to the point that it is not Maintainable, the healing arts workgroup can delete it. It's the push to Approve that gives the sense of anxiety that causes us to lose our wits. --Matt Innis (Talk) 08:06, 13 April 2007 (CDT)


A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism.

I am too late to the current iteration of the controversy. I'm sorry about that; my help could have been used a few days ago. Anyway, I would like to suggest that everyone take a break for a day--that's all. (Not for six months. :-) ) I am going to lay down a few ground rules--which themselves are subject to debate/clarification.

  1. Unapproved articles are unapproved articles. Unless there is gross abuse, which there is not, the suggestion that they be blanked or deleted is not appropriate.
  2. The article and the discussion about it will, I think, be most positively effected if we do the following. I suggest that in the interests of both clarity and neutrality that this article be cast in a point-counterpoint fashion. I don't mean actually to use the words "point" and "counterpoint," but that the criticism be made, and then a reply made that uses approximately the same space (it needn't be exact).
  3. As we all can remember from college bull sessions, arguing about generalities is rarely productive. The way forward is to identify a set of very specific issues, and seek resolution about each of them. I'd like to suggest that everyone at work on this article (well, Nancy, Matt, and Gareth) list (and edit as necessary) the most important specific texts that they regard as problematic, and state concisely (not at great length) what is problematic about them. This will help both me and others we might invite to look at this page to understand where, operationally, the problems are.
  4. Not only should we remember the dictates of CZ:Professionalism, we should recall that making any sort of general characterizations of others' work are usually not helpful. Please refrain.
  5. I think it is very unreasonable to ask any person to come to a fast and furious debate, if he/she must first review reams of discussion. Hence, I don't want specifically to invite others to the debate (which they may join at any time if they wish--it's a wiki) until the specific points of contention have been laid out as just suggested.
  6. The article needs to be copyedited.

--Larry Sanger 12:39, 13 April 2007 (CDT)

The spirit behind my blanking and hiatus suggestion...

...was because it very much seems the principle authors could very much be benefited by a break; was to give CZ more time to get more eyes and additional authors for this topic; was as a way to approach the topic fresh afterward; was in recognition that we just do not need {{no complaints}} templates right now when there is so many other things to do. Myself, I would be happy to dust off some old books, and buy and read three or four others, and role up my author sleeves; but right now I have things that are simply much higher priority for CZ...namely, helping to figure out media policy! Stephen Ewen 13:27, 13 April 2007 (CDT)

I am fully in agreement with Larry's suggestion, and am also fully happy to leave the presentation of criticism to others and confine myself to helping Matt with the counterpoint. Stephen Barrett and William Jarvis are clear and good writers who have worked closely with Samual Homola and some of the present content certainly reflects my reading of these. The present cited references however have avoided any promotional sites for chiropractic, and indeed the chiropractic literature sources have been selected as expressing criticism, generally very outspoken criticism, of chiropractic; they were also chosen becuse they are electronically available. The highly critical book of Homola's is cited, as it is wholly available online. In fact, the present rebuttal also avoids using promotional sources, and I would prefer to continue to avoid these.

We have avoided citing directly from websites like chirobase, and this probably needs some policy direction. Personally I dislike citing from any websites except stable academic institutional sites; again it's hard to see how a consistent policy might permit citing from critical opinion sites but not from promotional sites. Any perception that this is promotional of chiropractic is unintended, just as there was no intention that this article should be seen as derogatory, but it is an important criticism, and I fully agree that any such perception must be eliminated. I was certainly very conscious of avoiding the impression that the criticisms were endorsed by Citizendium's editors.

The technical problem of point-counterpoint is how do we avoid recursion? - i.e., how do we avoid the problem that the counterpoint argument is made irrelevant by a change in the point that is made to avoid the particular counterpoint? This will lead to endless iteration unless the form of the points are stabilised before the counterpoints are written. Accordingly I'd suggest that the points be written first and stabilised, then the counterpoints are introduced. Gareth Leng 06:46, 14 April 2007 (CDT)

Well, you can't avoid recursion entirely, but you can set limits, as we have with CZ:Summaries of policy arguments. The big advantage of point-counterpoint is that it is very clear who is "speaking." The trouble with mixing up different views within the same paragraph, or sentence, is that there is then the perception of a third speaker--the narrator--whose implied views are supposed to be authoritative. And then there is a struggle about which view this authoritative narrator is made, very subtly, to endorse. Letting the different sides "speak for themselves" eliminates the authoritative narrator. --Larry Sanger 11:31, 16 April 2007 (CDT)

Just thinking aloud here... Is it a possibility to simply string together quotes from various authors? Say, critic A says X and respondent B says Y. While they may not in their original context have been addressing one another, it might work well. And it would be fair use of longer quotes, in this context, I think. Stephen Ewen 23:43, 18 April 2007 (CDT)

List (and edit as necessary) the most important specific texts that they regard as problematic

The list

One of my problems is with the list of criticisms. They need to be parsed into individual complaints as the format now buries arguments and makes rebuttal impossible. This is the current list:

  • That an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model, and advocate expansion of market base into the care of the well child.
  • that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
  • that Chiropractic argues that such coursework in "medical diagnosis" qualifies its practitioners to be fully qualified to make medical evaluations, and to rule out signs of serious disease.
  • that the theoretical basis of the key chiropractic concept of vertebral subluxation is not scientifically sound.
  • that some chiropractors advise parents that all vaccinations have higher risks and less benefit than any organized health science or biological science group accepts, thus exposing children to the risk of preventable illnesses and putting the general population at risk of epidemics.
  • that, in the USA, chiropractors are not trained in medicine, nursing, or health science, and so are not competent to act as comprehensive primary health care providers, yet some chiropractors make that claim, without protest by the larger organized groups in the profession.
  • that Chiropractic accepts a level of self-promotion in advertising that is unprofessional and misleading.
  • that while chiropractic has been shown to be effective for backpain, headache and certain musculoskeletal conditions, chiropractors treat patients for a much wider range of conditions where there is no strong objective evidence that their interventions are effective.
  • that although chiropractic has been shown to be effective for a limited set of conditions that are associated with backpain, claimed efficacy is generalized to "muscloskeletal conditions", a phrase without specific meaning that does not include the conditions, such as myasthenia gravis, multiple sclerosis, or rheumatoid arthritis, that any reasonably knowlegable layman might assume to be such a condition.


This is the list we had last week:

  • that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
  • that the theoretical basis of the key chiropractic concept of vertebral subluxation is not scientifically sound.
  • that rejecting universal vaccination in favor of personal choice puts the general population at risk of epidemics, and might expose pediatric patients to the risk of preventable illnesses.
  • that chiropractors are not adequately trained in the diagnosis of medical diseases, and so are not competent to act as comprehensive primary health care providers.
  • that the care of patients with conditions that have never been shown to be efficaciously treated by chiropractors is not warranted if patients forego medically recommended treatments.
  • that Chiropractic accepts a level of self-promotion in advertising that is unprofessional and misleading.

We can add more things, but I would like to see arguments stated more concisely and less repeatedly. --Matt Innis (Talk) 08:14, 14 April 2007 (CDT)

Edit wars

It's possible to spend a lot more time editing a page's discussion than constructively improving the page itself...I have found that contentious discussions tend to improve the quality of a page, as people are forced to substantiate their opinions, their knowledge deepens. OTOH, it can also be counterproductive. Criticism of chiropractic is controversial by definition...is it worthy of an encyclopedic entry? Maybe the whole page could be replaced with the sentence "Chiropractic is a popular mode of health care that has remained outside the medical mainstream for over 50 years."--Michael Benjamin 15:15, 18 April 2007 (CDT)

Ahh, a man of few words, but deep thoughts. I wonder if we would argue over the 50 years? :-) --Matt Innis (Talk) 19:48, 18 April 2007 (CDT)

Probably, but the edits would be a lot shorter. Think of the forest, not the trees...--Michael Benjamin 02:14, 19 April 2007 (CDT)

May be we should thinking 'copse' due to the small size of your proposed article :) Chris Day (talk) 11:21, 20 April 2007 (CDT)

I do not wish to have an edit war, particularly with a friend. Please do not change the lead here until the part of the article that was never written is written. Please see above where Gareth made proposals for doing that. Nancy Sculerati 08:43, 30 May 2007 (CDT) What happened to the bullet list? Why does it no longer appear?

Critics from Medicine, especially in the USA, have claimed:

  • that an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model of total health care, and even advocate expansion of market base into the care of the well child.
  • that Chiropractic accepts too low a standard of academic and scientific scholarship in its professional journals and schools.
  • that Chiropractic argues that such coursework in "medical diagnosis" qualifies its practitioners to be fully qualified to make medical evaluations, and to rule out signs of serious disease.
  • that the entire basis (vertebral subluxation) of chiropractic theory is not scientifically sound.
  • that some chiropractors advise parents that all vaccinations have higher risks and less benefit than any organized health science or biological science group accepts, thus exposing children to the risk of preventable illnesses and putting the general population at risk of epidemics. Worrisomely, this subgroup is the same group that advocates chiropractic as comprehensive primary health care for children.
  • that, in the USA, chiropractors are not trained in medicine, nursing, or health science, and so are not competent to act as comprehensive primary health care providers, yet some subgroups of chiropractors make that claim, without protest by the larger profession.
  • that Chiropractic accepts a general level of self-promotion in advertising that is unprofessional and misleading.
  • that while chiropractic has only been shown to be effective for backpain, and some types of headache, chiropractors advertise for and treat patients for non-musculoskeletal conditions like infant colic, none the less.
  • that the chiropractic profession promotes the notion that chiropractic is effective in "muscloskeletal conditions", when the evidence for relief of backpain does not in any way show that chiropractic care helps conditions such as myasthenia gravis, multiple sclerosis, or rheumatoid arthritis, or other serious and common conditions that a reasonably knowlegable layman would assume to fall into the category of "musculoskeletal conditions".

Nancy Sculerati 08:48, 30 May 2007 (CDT)

Hi Nancy, yes, I just marked out the list (it is still there) because we left it in a non-neutral manner. The article has not changed otherwise, it still has each argument at the top of each section and the greater argument below it with an appropriate rebuttal after that.

The problem having a list at the beginning without any chance for immediate rebuttal is that some will not read through the article to view the opposing points. Consider, for instance and article on "Great views of chiropractic" presented with a list of 'wonderful things they cure' with the rebuttals far down in the text. Surely you don't feel that is a neutral way to present that subject and neither do I, so why would we present this one that way? --Matt Innis (Talk) 13:40, 30 May 2007 (CDT)

Having a summary list of the critical views in the article entitled the critical views is not "non-neutral". Matt, I think that you better ask for some kind of dispute resolution. I absolutely refuse to remove that list. I have spent hundreds of hours writing this article and all that happens is what I write is removed or so watered down that it is unrecognizeable. Write all you want- Rebut all you want, but do so in your own section as Gareth suggested- that list is not a slanted outrageous attack on chiropractic, it is a very moderate summary of the actual critical views of physicians and health science.I do feel that having that list to be followed by explanations is absolutely neutral. This is not an arm wrestling match between MD and DC- where "neutral" means "even" this is an encyclopedic article on the critical views of Chiropractic. That list could be a slanted biased nasty list- it is instead nothing more than the minimum realistic actual criticisms of US physicians and health science professionals- as is made clear, again and again.

Nancy Sculerati 14:42, 30 May 2007 (CDT)

My problems with the list have not changed. The list that we had before this one was fine and agreed upon, but it was changed. If you must have a list, then please review my concerns [http://en.citizendium.org/wiki/Talk:Critical_views_of_chiropractic#List_.28and_edit_as_necessary.29_the_most_important_specific_texts_that_they_regard_as_problematic above). --Matt Innis (Talk) 15:06, 30 May 2007 (CDT)

I've answered that criticism and I am not interested in answering it again. Nancy Sculerati 16:11, 30 May 2007 (CDT)

Historical perspective

This article appears to lack historical perspective, which would explain many of the objections that medical practitioners have to chiropractic. My impressionistic reading of this is that the more expansive claims of chiropractic were much more common in the first half of the 20th century, and much more aggresively promulgated by chiropractors, with less scientific basis than exists now. There does seem to be some of this currently around in chiropractic circles, but most chiropractors today stress overall holistic health care much more than was common previously, and more than is common with most physicians today. I'd suggest that people familiar with the history of the conflict between chiropractic and the medical profession give this article a thorough going-over. Anthony Argyriou 16:53, 30 May 2007 (CDT)

You might have something there Anthony. It worked well on the Chiropractic page, maybe something like that will also work here. I think we would all agree that the criticism has helped constructively shape the profession especially in the late 20th century, while at the same time showing that chiropractic has helped mainstream healthcare address its weaknesses as well. --Matt Innis (Talk) 20:52, 31 May 2007 (CDT)
Anthony, I wrote a good deal of that article. There are now 2 approved articles on Chiropractic subjects on the Citizendium. Matt has remarked to me several times that he trusted me and that I had taught him worthwhile things in my research into those articles while we wrote them together. It is difficult perhaps to face criticism in your field, Matt, but nothing about those bullet points is unfair. If you would like to write a "Critical views of Medicine" as a healing arts article- be my guest. This article Critical views of Chiropractic was requested, as I recall, by you Matt, and Gareth, and it must actually contain -rather than supress- the critical views- and especially the critical views of American physicians for all the reasons of history and the geographic variations in Chiropractic practice. These must be presented clearly and of course must have room for rebuttal, but they will not be hidden or neutralized by being buried. I could easily add to the present list, but I would rather not. Every one of the bullet points can be discussed by you Matt. Why don't you work on that? I will be as fair as I can be, but I will not lie or supress what the critical views of chiropractic are by the most reasonable physicians. Nancy Sculerati 21:20, 31 May 2007 (CDT)

Nancy, you did make it quite clear above that you did not want to discuss the list anymore and I have respected that. I am satisfied with the rebuttal sections as they were presented because your new list did not bring anything new to the table for me to discuss. My point remains that it only garbled it with more language that I feel only confuses the reader and makes it difficult to parse. You don't seem to agree and I can respect that, so I stopped arguing with you. Anthony gave us some constructive criticism and I was responding to it, that is my perogative. If he thinks that we could use some historical perspective, I appreciate his input as an outsider looking in. Also, thank you for helping with the Chiropractic article, but please check the history. --Matt Innis (Talk) 22:11, 31 May 2007 (CDT)

Neutrality

My response to the title of this article is the same as my response to its content, which is to quote the following from the Citizendium Neutrality Policy: "One can think of unbiased writing as the cold, fair, analytical description of debates." and "If we're going to characterize disputes fairly, fairness demands we present competing views with a consistently positive, sympathetic tone. " and "But experienced academics, polemical writers, and rhetoricians are well-attuned to bias, so that they can usually spot a description of a debate that tends to favor one side." --Catherine Woodgold 09:12, 10 June 2007 (CDT)

The list

If we accept Nancy's list as correctly characterising the criticisms of chiropractic then we have to move to characterising the responses to these. As Matt has indicated this leads to problems. Let's just look at the first on the list "that an organized subgoup of chiropractors in the USA openly promote "drugless healing" as a business model of total health care, and even advocate expansion of market base into the care of the well child."

What is the response from chiropractors? The problem is that I think that an intelligent chiropractor would say that this, as phrased, contains a series of insinuations all of which need rebuttal. However, being polite, perhaps they would simply say "Chiropractors indeed believe that it is important to minimise the use of drugs, and see their role in particular as being to pursue alternatives to drugs. They believe that preventative care is also an important part of health care, one that is particularly important for children."

If they were just a little less polite they might add. "The insinuation that chiropractors are motivated by profit rather than concern for their patients is one that they vigorously refute. Certainly chiropractors have to earn a living, but they generally do not earn the large incomes typical of conventional physicians in private practice; accordingly they consider the insinuation that they are primarily motivated by personal profit to be unfair and indeed hypocritical."

If we stick with Nancy's list perhaps we should confine the style of rebuttals to the former? Matt, will restraint and polite understatement do well here? Or do you think the rebuttals should be payment in kind?Gareth Leng 10:08, 28 June 2007 (CDT)

I do not think that 'payment in kind' is necessary at this point, though you state it quite well. --Matt Innis (Talk) 10:57, 28 June 2007 (CDT)
Matt, you happen to have hit one of my grammar hot buttons. "The insinuation that ... is one that they vigorously refute." Not "refute" but "deny"! Sandy Harris 00:02, 5 September 2010 (UTC)
Some responses are in the main article. I really question if this should be separate from it. Howard C. Berkowitz 17:47, 27 January 2011 (UTC)

Singh lawsuit

An article by Simon Singh brought a libel suit from the British Chiropractic association, which they eventually dropped.

I'd say this should be discussed here. Sandy Harris 00:18, 5 September 2010 (UTC)

Allied health sciences term

I reverted what should be allied health professions, which has a specific meaning different from physicians. In general medical usage, allied health includes a wide range of nonphysician midlevel and basic level fields that support medicine. Nursing is sometimes included, or put in its own category. In general, however, things that fall into allied health include physical therapy, social work and counseling, imaging and laboratory technologists, respiratory therapy, dietetics, orthopedic and surgical technicians, etc. Howard C. Berkowitz 07:12, 23 December 2010 (UTC)

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