Talk:Critical views of chiropractic

Critical views of chiropractic

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Article Checklist for "Critical views of chiropractic"

Workgroup category or categories	Healing Arts Workgroup, Health Sciences Workgroup [Categories OK]
Article status	Developed article: complete or nearly so
Underlinked article?	Yes
Basic cleanup done?	Yes
Checklist last edited by	Matt Innis (Talk) 10:47, 11 April 2007 (CDT)

To learn how to fill out this checklist, please see CZ:The Article Checklist.

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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)

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)