Talk:Chiropractic/Draft

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 Definition A complementary, alternative health-care profession that aims to heal using manual therapies on the spine and extremities. [d] [e]
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Approved version 1.1!

I have placed the approval template for version 1.1 of this article. Congratulations for your hard work everyone! Stephen Ewen 13:16, 29 March 2007 (CDT)

Stephen, Thank you! I made two copyedits on dead links. Please verify that these are allowable-we have discussed extensively on the Forums that approving editors may have a brief window of opportunity to "proof". Nancy Sculerati 13:46, 29 March 2007 (CDT)

Yes, thanks Stephen, and I am fine with the two changes so all is good:) Good job on this article and thank you very much for all your patience and hard work, especially Nancy and Gareth. --Matt Innis (Talk) 13:54, 29 March 2007 (CDT)

Omission-Chiropraxy

I'm a little surprised that a common synonym – "chiropraxy" – isn't mentioned in the lead. --Peter J. King  Talk  05:15, 3 April 2007 (CDT)

Hi Peter, thanks. I suppose it would be a good idea to have a whole etymology section. We can work on that. I have never seen chiropraxy used in the USA. I do see it in the medical literature a lot. --Matt Innis (Talk) 07:58, 3 April 2007 (CDT)
I think that it's the more common form here in the U.K. (I don't remember ever seeing "Chiropractic" before this article...). --Peter J. King  Talk  08:56, 3 April 2007 (CDT)

That's one great thing about CZ, we can all fully realize that we're hopelessly provincial! :-) Nancy Sculerati 11:42, 3 April 2007 (CDT) Oh- but make sure it really is the same. I have to look up the actual terms, but I know that in Germany 2 different words are used, one for professional licensed chiropractors, one for massage practitioners who may be unlicensed and are not chiropractors, but use some of the techniques. Nancy Sculerati 11:44, 3 April 2007 (CDT)

Wow, all those certainly are strange thoughts. If we want to make this truly "international" I suppose we should entertain the idea of expounding on all of those. As more authors and editors arrive, we can add to it until we have enough to make a section. --Matt Innis (Talk) 12:10, 4 April 2007 (CDT)
I tried to post this yesterday, but kept hitting error messages, and losing my dat. I googled "chiropraxy", and it is simply a synonym for "chiropractic" (used pretty well exclusively in the U.K., and pretty widely in the U.S.). --Peter J. King  Talk  15:23, 4 April 2007

(CDT)

How 'bout a couple of actual references? I have looked up licensing in several US States and have not seen the term. Nancy Sculerati 20:47, 4 April 2007 (CDT)

I did originally provide four or five references, but the software glitches ate them. For the U.K., the Royal Commission on Chiropraxy and Osteopathy is mentioned in a number of places, and there's this; for the U.S., there's this and this (mention of the Los Angeles School of Chiropraxy). elsewhere there's this. To be honest, googling "chiropraxy" brings up a huge number of hits, including British NHS documents, U.S. documents, French, Japanese, documents, etc. --Peter J. King  Talk  04:27, 5 April 2007 (CDT)
The Los Angeles School of Chiropraxy only gets the one hit. I wonder if it is a typo or mental error on the part of the person that typed that page? Keep lookiing for USA mentions. --Matt Innis (Talk) 10:16, 5 April 2007 (CDT)

Well, to be honest U.S. mentions don't matter; I just threw them in because I came across them. --Peter J. King  Talk  17:19, 5 April 2007 (CDT)

I agree, it would be more just to decide if we should differentiate according to regions, or countries, etc. for accuracy sake. --Matt Innis (Talk) 18:20, 5 April 2007 (CDT)

Good point. I've got a couple of Canadian ones, if that helps: [1], [2]. --Peter J. King  Talk  07:59, 6 April 2007 (CDT)

Peter, with all due respect, although it may be absolutely technically correct that Chirpraxy has been used as a synonym for chiropractic, and is used that way in some places, there are other considerations to including it as a parenthetical equivalent in the introduction. To do that, we must research exactly how that word is used in different countries under the law for practice of health professionals. It would be a mistake - in my opinion - to include this in the article unless the status of that word in the regulation of health professions in every area of the world where Chiropractic is a licensed health profession is verified, except as a foot note. If in fact, there are areas (perhaps the UK?) where it is equivalent,and not only mentioned as such in legal licensing requirements, but stands as the more commonly used word for the profession in that region, then that should absolutely be mentioned in the appropriate section. Chiropractors have struggled for decades to achieve a certain level of education and training recognized for practice. In every health or healing arts profession that has done so, there are always people without these qualifications who advertise their services using words that are legally permissible in the various systems, and imply that they are what they are not. The word doctor is a famous one, and although there are any number of references that will show all sorts of people using doctor and physician as synonyms (including physicians), they are not that under the law. So, in an encyclopedia aimed to educate the global public in health matters, we would therefore never begin an article on "Physician" as Physican (also called doctor) or (synonym doctor) because that might easily mislead the naive reader. Same here, the up side of including a synonym for completeness is not near the magnitude of the downside of muddying the actual limits of professional practice and certification. see for example,[ http://www.chiroweb.com/world/germany.html] Nancy Sculerati 08:17, 6 April 2007 (CDT)

I agree. These links almost make it look like chiropraxy may be used by others to describe the method, while chiropractic is still the profession. They don't quite use the terms interchangeably. In fact the Royal Commission's report is on "Chiropraxy and Chiropractic." I don't see any chiropractor's using the term chiropraxy. I was thinking that this could be a lay term? --Matt Innis (Talk) 08:52, 6 April 2007 (CDT)

Interesting; I'm not sure whether or not the impression is accurate, though it makes a lot of sense. The question now is whether someone looking up "chirpractic" or "chiropraxy" would be expecting to find an article on the profession, but which also deals with the practice, or an article on the practice, but which also deals with the profession. Speaking personally, I'd be expecting the latter. Similarly, in my own field, I'd be surprised to find an article on philosophy that took as its main subject the profession of academic philosophy rather than the subject itself. On the other hand, while Philosophy is about the activity of philosophising (the so-called "academic meaning"), its lead mentions prominently other common usages of the term "philosophy". --Peter J. King  Talk  10:41, 6 April 2007 (CDT)
[after edit conflict]
Well, some of my links were to NHS sites, and I've mentioned the Royal Commission on Chiropraxy. The situation seems to be that both forms are used here; the professional organisations prefer "chiropractic", but "chiropraxy" is used by individual chiropractors, and in respectable, as well as government-related, documents (a few more: [3], [4], [5], [6],[7], [8], [9], [10].
In any case, if "chiropractic" is commonly called "chiropraxy" (and this does seem to be a common synonym, in many countries), we should say so, even if professional chiropractors don't like it. Similarly, I should have thought that we should explain in the lead of Physician that the term "doctor" is commonly used; we surely shouldn't risk misleading or confusing people by sticking to technical or strict legal usages. After all, if the facts of usage muddy limits of professional practice, that's not our responsibility; our responsibility is rather to report the facts, though explaining distinctions and the limits of usages.
(I can't deny that I find the use of "chiropractic" peculiar (I can't think of another noun formed in this way), and I suspect the same response leads to so many people choosing a word that fits better with normal English rules. Still, the fact is that they do.) --Peter J. King  Talk  09:07, 6 April 2007 (CDT)

In terms of reporting facts- absolutely, and, since we are doing so in context we can even have a whole section on "chiropraxy". What we need are the actual facts about how this term is used, not simply that it exists, although that fact is a fascinating point that may deserve careful development. Our interest in no way has to do with what chiropractors do or do not like, it has to do with our primary responsibility of providing an accurate real-world presentation of the subject of the article: which is, after all, the profession of chiropractic. As to the medical profession, in an article such as Physician, you are of course correct, the word doctor would be discussed. My point, just a tiny one and perhaps made badly, is that in no way would this be used as a synonym in parentheses the lead of the article, because it is not accurate. That's all. Nancy Sculerati 09:43, 6 April 2007 (CDT)

I'd be surprised if there were something called "chiropraxy" that was different from what's called "chiropractic", and which would therefore require a separate section — but if there turns out to be, then fine.
With regard to the physician/doctor issue, I suspect that there's a transatlantic problem there too; my impression is that "physican" is used much more commonly in the U.S. than here or in other English-speaking countries. It would be very odd in the U.K. for someone to call herself a physician rather than a doctor, whether she's in general practice or working in a hospital, though again the professional body is the Royal College of Physicians (which nevertheless uses the term "doctor" to refer to medical practitioners). (And it's also odd that the article on Physician, though as yet only a stub, doesn't mention the word "doctor"...) --Peter J. King  Talk  10:41, 6 April 2007 (CDT)

Removed it until the issue is resolved. This is a continuing version of an approved article, which the articles "physician" and "medicine" (and all their ilk) are not- not yet in any approved form. They have not been worked on much here in CZ and so what they do and do not contain is not relevant to what they should contain, and hopefully, someday, will contain. As this article explains, in gruesome detail, this particular profession (Chiropractic) not only began in the USA but at the present time is disproportionately represented by that country, and by North America. That is another reason why, even if the term chiropraxy is synonymous with the profession in the UK- an as yet unproved thesis, but the two terms are not legally synonymous in North America, still the first sentence would not contain it as a universal synonym. As to having another article on the methods employed, if that is in fact what chiropraxy means, that can be done by interested parties.That however, is not this article, whether or not it may prove to be of greater interest to the general audience. Meanwhile, I would love to talk to you about the classics (if you are still talking to me after this dogged rebuttal) -wondering if you can help us on CZ with recruitment (would you e-mail me?). Despite the fact that you have tetanus (from scratch! I understand) I won't needle you anymore, particularly in regards to this subject - in fact- as to your toxic situation, only a shot of the immunoglobulin would have any effect in your present state, and that remedy is such a rare commodity that I do not have any handy. In any event-perhaps you don't need any immediate remedy. Your condition may have locked your jaw, but it has left your fingers quite nimble on the keys, I see. :-) Nancy Sculerati 11:09, 6 April 2007 (CDT)

I must confess that I feel very frustrated; there are more than ample sources showing that the term "chirpraxy" is widely used throughout the world, in popular and official documents, and yet it's been removed from the article, apparently on the basis that U.S. chiropractors don't like it (even if this were a good reason, I've Googled and found no mention of this dislike anywhere), and it's not a "universal synonym" (how many synonyms are?). I'll take the article off my Watchlist and get on with other things, as I don't want my attitude to Citizendium to be soured as happened to me at Wikipedia.
With regard to Classics — it's not really my field, except where it overlaps with ancient philosophy. Neither of the two colleges with which I'm mainly involved – Pembroke & Teddy Hall – offer Classics, so I don't have any close colleagues in the field. I have friends, though, and I'll talk to them about editing here. --Peter J. King  Talk  05:26, 7 April 2007 (CDT)

Peter, I also feel frustrated. I have written as clearly as I know how that it is not enough to simply google a word and come up with a large number of hits- especially when these are heavily weighted in other languages (French) and never actually define the word, and expect on the basis of the magnitude of the response to the search, and personal impressions of how the word has been used in one's own experience, that this proves the point. It doesn't. Not to the point that we will accept the word chiropraxy as a synonym for chirpractic to be placed in parenthesis after the lead word of the article. I don't understand why you state that this is on the basis of dislike? I've explicitly stated that this reason has nothing to do with whether or not chiropractors like the word, and I did so honestly, and I've explained-in detail-why it is important, for the sake of accuracy, that all words used to name licensed health professions have legal implications. I did so because I am trying my best to communicate. Those legal implications exist in health professions because most countries in the world (maybe every country) agree that, for the public safety, regulation of these professions must be carried out by the government and that part of that regulation is to demand licenses that can only be obtained if certain educational and practice standards are met. This is not the case with Philosophy. Nancy Sculerati 07:30, 7 April 2007 (CDT)

Nancy, I too have to confess to puzzlement about the resistance to including the word "chiropraxy" somehow in this article, on the strength of the evidence not to be found on the Google search results page, but to be found on the pages linked from there, which are much more credible than Google. For example, in SNOMED, the Systematized NOmenclature of MEDicine, "Chiropraxy" is listed as the "preferred" name of a regime and "Chiropractic" is listed as "synonym." Here's info about SNOMED. Let me take a shot at replying to your arguments.

  • The hits are heavily weighted in other languages: in the Google search, only one in ten of the first ten hits references a French language document. All others are in English. Non-U.S. documents, however, do seem to predominate.
  • Never actually define the word: effectively, many of the documents do define the word (as in the SNOMED browser, which gave a "synonymous" definition of chiropraxy: it means "chiropractic"), or at least make it perfectly clear that it refers to the practice started by D.D. Palmer. There are no reasonable grounds for doubt about the fact that it at least roughly refers to the same thing that "chiropractic" refers to. Why don't you pull out the OED, Nancy? I know you have a copy.  :-) If we are worried that people will look up "chiropraxy" in a Scottish phone book and end up going to someone who isn't a licensed chiropractor, we can provisionally say, in the article, that the term "chiropraxy" is in currency in Europe, but it isn't perfectly clear to us whether it means exactly the same as "chiropractic." Of course, if it does turn out to mean precisely the same, then we'll be embarrassed for declaring our ignorance of this.  :-) Needs Research.
  • It is important, for the sake of accuracy, that all words used to name licensed health professions have legal implications: all right, even granted that it is very, very important that we call chiropractic "chiropractic," for some legal reasons better known to you than to me, that does not entail that we cannot report the information that chiropractic is also called "chiropraxy," particularly in Europe (if that's the case--I don't know; look at this). This is simply a matter of neutrality, as I see it.

But now let me put a little weight on Nancy's side, against Peter (I don't really want any friends!): bear in mind that, while a Google search is usually only weak evidence of anything, the fact that "chiropractic" gets 15 million hits while "chiropraxy" gets only 3,000 is indeed good evidence that the word "chiropraxy" need not get top billing, i.e., it need not be listed in parentheses after "chiropractic" is defined. That's because Google's implied usage statistics would have to be off by three orders of magnitude for us to consider giving "chiropraxy" top billing. Even if it got 30K hits, or 300K, it would still not deserve top (parenthetical) billing. Perhaps we could bury the reference some paragraphs down; perhaps in a bit about the spread of this largely North American practice around the world?

But I have to agree that because the term is in some currency, and is used by some apparently credible sources, and for no other reason than that, it should be included in the article, with the appropriate qualifications if necessary for legal purposes. --Larry Sanger 08:51, 7 April 2007 (CDT)

With respect to the google search, isn't the internet dominated by US centric sites, so that might explain such as bias. I am also from the UK and I had never heard of the term chiropractic until I came to the US. Chris Day (Talk) 09:21, 7 April 2007 (CDT)

Just as a point of interest; there are 451,000 google hits for accupuncture when the correct spelling is acupuncture. If chiropraxy is a lay term, or misspeak (I also see chiropractary), I don't think Citizendium wants to be in the business of perpetuating a misnomer. It's all about being an accurate resource. If it takes us some time to figure this out, so be it. That's what makes us different than wikipedia, a very important difference. The difference between making a statement like:

  • Chiropractic, also known as chiropraxy,...

versus

  • Chiropractic, sometimes misstated as chiropraxy,...

--Matt Innis (Talk) 09:18, 7 April 2007 (CDT)

Now Matt, the Royal Commission is not misstating anything. Chiropraxy should be mentioned in the article, in a suitable place. And should that be carried out, the addition would be welcomed. If it is another word that is used for chiropractic treatment, we should say so- in context. I still don't understand just what that context is, or where in the world that term is routine, and how exactly it is properly used by the people who do use it, and that's the only reason I myself have not proposed an alternative text to include the term. I removed it from the lead for all the reasons I have hammered to death about why it should not be there. Peter, perhaps you can fix it- if not inclined to do so, perhaps others will. [Also friendless :-( ] Nancy Sculerati 09:22, 7 April 2007 (CDT)
Nancy, of course the Royal Commission would not misstate anything, but so far all we have seen is this commission's name in a footnote. It says nothing about what they are calling chiropraxy. I believe I've also seen cheiropractic [11] but at least it describes what they are talking about, and I have no problem adding that one, too. (Notice the same site calls cheiropraxy/chiropraxy the German equivolent of chiropractic (english). I think we need a whole section for these things, as I said above. We just need to know what they are talking about. --Matt Innis (Talk) 09:59, 7 April 2007 (CDT)

Far be it from me to gainsay an actual chiropractor, but I'm just looking at the evidence gathered not on the Google search page, but on the links provided on that page, and there seems to be reason to think that "chiropraxy" is not merely a mistake. First, SNOMED, the Systematized NOmenclature of MEDicine, actually prefers the term "chiropraxy." Second, as this article and this Google search make amply clear, there is something called a "Royal Commission on Chiropraxy and Osteopathy" in Quebec. Indeed, a whole book or report called Chiropraxy is available. Neutrality demands we acknowledge the other term, not necessarily in the first line, but somewhere, and not by saying that it is a "mistake" but that it is an alternate term, particularly outside of the U.S.

Finally, there is this from D.D. Palmer himself.

--Larry Sanger 10:51, 7 April 2007 (CDT)

Is a raw google search adequate substitute for scholarship? As Chris Day says- it's not neutral. There are a lot of other things it's not. The issue appears to be fixed with a link to the article using the search term chiropraxy. However, it seems to me that if a point cannot be won by actual scholarship and logic, that it's easy - perhaps even easier than doing a google search- to assume that the lack is in others.It is also a traditional approach, but not of the strong or the erudite. Nancy Sculerati 11:22, 7 April 2007 (CDT)

Finding evidence via a Google search is not the same thing as looking at a Google search results page and not going past there. The evidence I've collected is actual scholarship: I found a reference in a book by D.D. Palmer himself, as well as conclusive evidence that a "Royal Commission on Chiropraxy and Osteopathy" exists in Quebec. Does this count for nothing? --Larry Sanger 11:54, 7 April 2007 (CDT)

It counts for nothing in terms of the argument on this page, which you joined belatedly, that argument being about the wisdom of placing Chiopraxy in parenthesis after Chiropractic (hit history tab of article). It doesn't help us understand how the word is currently used in Quebec or England. My concern is about establishing a precedent that a Google search is a primary means to support a position,rather than scholarly pursuasion by constructing a logical argument backed up by individual sources that have been carefully read and analyzed. You merely commented on the search, and in a fashion that taught me (and I'd venture, everyone) something. Against all inclination, I have become a little knowlegable about chiropractic and its history, and the fact that DD Palmer used the term is intruiging. My remarks above are in no way directed at your contributions to this discussion.Nancy Sculerati
Google is fine for finding a legitimate source but one has to be able to see the difference between the wheat and chaff. Larry's sources seem like wheat to me. Google is illegitimate when it is used as an opinion poll, or worse, an appeal to authority based on the number of hits. Clearly the latter is flawed analysis. Chris Day (Talk) 12:28, 7 April 2007 (CDT)
Good work everybody. So this is what we have so far. A book that is written by the same guy that wrote the Quebec report for the Royal Commmission of chiropraxy and osteopathy in 1965, Lacroix. The SNOMED source points to chiropraxy as a regime/therapy that eminates from it's parent "procedures" column. There are no nomenclatures for professions themselves, only procedures. Chris sees chiropractors and no chiropraxy in the yellow pages. The World Health Association does not mention chiropraxy except in a reference to the Royal Commission report stated previously. However, they do describe different educational paths that healthcare professionals may use to be able to be called chiropractors. There is a list given to DD Palmer written by Rev Samual Weed (the guy who gave DD the idea for the name) that includes chirpraxy and defined as the science and art of doing by hand while chiropractic is defined as done by hand or one that advocates or does hand practice. I seem to remember that DD eventually eventually chose chiropractic over chiropraxy in his 1910 book, but I'll see if I can find it. After reading this about LaCroix and his Commission that took ten years to investigate chiropractic was well aware of the definition of chiropraxy as the science and art of doing by hand. It was basically Canada's Wilk suit that resulted in insurance reimbursement and acceptance of chiropractic as a legitimate healthcare field. He chose that word for a reason. It appears that the words are synonymous, though I am not sure that they are equivalent, yet. Is it used commonly, or is it used just by those that don't know what chiropractic is? Once we know that, I think we're done here. --Matt Innis (Talk) 16:51, 7 April 2007 (CDT)

I think we are done here, now. This issue lacks any credibility. I also searched (multiple methods) phone listings in several English communities - such as London and Oxford. Yellow page listings -lots of chiropractor, lots of chiropractic. Zero chiropraxy. Do we have an encyclopedia to write, or what? We are not writing a thesaurus, after all. :-)(B the way Matt, I never checked to see that the Royal reference was just a footnote- I admire your thoroughness) Nancy Sculerati 18:58, 7 April 2007 (CDT) (copied) Yell.com has no matches for "chiropraxy" anywhere in the United Kingdom. To help us find what you're looking for: Try searching for another classification. Try browsing our A to Z of classifications.

Yep, see below. Unless someone has anything that we have not considered, I'm done with this as well. --Matt Innis (Talk) 19:09, 7 April 2007 (CDT)

Just one last nail in the coffin- I searched the online Oxford English Dictionary for "chiropraxy" and got NO RESULTS as response, a unique experience for me. An apology is likely too much to ask for, though it would be a singular mark of high character. Nancy Sculerati

Chiropraxy (Part 2)

The above section was getting long so I've continued it here.

Chris, do you get the feeling that chiropraxy and chiropractic are the same things or is chiropraxy a more evidence based practice based on spinal manipulation. In other words, I am seeing orthopedic web sites claiming to offer chiropraxy to it's patients. I am wondering if in the UK, chiropractic is more aligned with medicine and osteopathy is the profession that holds to the more metaphysical concepts. In effect, perhaps the roles are reversed over there. Are there chiropraxists? (what would you call them then?) There are chiropodists, too, but they only work on feet and are different than chiropractors. --Matt Innis (Talk) 09:46, 7 April 2007 (CDT)

I don't know- but that's why we have to actually research it. Gareth (missing in action) might be able to steer us to the right sources. For example, in the UK- from the best I know second-hand, the education and licensing for the practice of medicine is very different- the MD degree is an advanced research degree and there are less academically rigorous qualifications to practice medicine. In the USA, the MD degree is a graduate degree (although certainly not requiring Ph D level critical thinking and independant research) and is Not enough to actually practice medicine. So, in an article about the practice of medicine, not only is MD not globally recognized as a practicing physician, but there are those-like Chiropractors (I leave out the sappy smile, but I do mean it kindly) and Naturopaths who are casually called physicians (Chiropractic, Naturopathic used as adjective) and do not practice medicine. The wikipedia article medicine so fully includes every possible meaning of the word that it ends up being useless as an reference for Medicine. That's one reason I think healing arts is such a useful term. It can include everything and yet leave each practice and profession its own distinct articles. The reason I happened to come accross the German stuff about chirotherapy is that - I think it was the Lancet, but I don't recall the damn article reference- there was a rebuttal to an article that reported stroke as a complication of Chiropractic, and it was explained there that the case actually occured in Germany and was not a complication of chiropractic. The manipulation was carried out by an unlicensed massage provider, called Chirosomething in German, and that it was both a linguistic and legal mistranslation to call that person a Chiropractor. So, Chris, and Peter-lacking Gareth's input-do you know which body defines health practices in the UK? Do they have a website? Nancy Sculerati 10:03, 7 April 2007 (CDT) PS-what we need is a disambiguation page so that if a person searches for Chirpraxy looking for what we have written about can find it. Can you guys fix it?
Exactly. If the two are equivolent, then we can just make a redirect (which Peter has already done) and keep the etymology section as is. If not, then we need to do whatever is necessary to draw the distinctions between all of them. --Matt Innis (Talk)

Since I'm a botanist I should think I am the last one you want for an opinion but the term I was familiar with was chiropractor, which obviously refers to the individual. To be honest, apart from seeing their clinics here and there I paid little attention to the business. FYI, I just looked at the UK yellow pages and indeed chiropractic is well represented in buisness names too but chiropraxy got no hits. So my input here is clearly one of great ignorance or poor recollections. Basically, even more biased than a google search :) As far as my two peneth is concerned the term is clearly legitimate from what I have seen above. The issue is how common is its usage. Chris Day (Talk) 11:49, 7 April 2007 (CDT)

Thanks, Chris. All good information. I agree on the common part and am lookin ginto that right now. --Matt Innis (Talk) 18:27, 7 April 2007 (CDT)

There is this Britain passes "Chiropractic Act" from 1994. Also note that there are 0 hits on the chiro.web website for chiropraxy while there are 111 hits for United Kingdom. I do realize that editors could have edited the word chiropraxy to chiropractic. --Matt Innis (Talk) 18:27, 7 April 2007 (CDT)

103 hits for Chiropractic on BMJ website 0 hits for Chiropraxy on BMJ website --Matt Innis (Talk) 18:35, 7 April 2007 (CDT)

A very interesting and important chiropractic history in the UK does not mention chiropraxy. [12] --Matt Innis (Talk) 19:03, 7 April 2007 (CDT)

Chiropraxy (part 3)

Sorry I missed the fun. Googling isn't perfect but I get 3,800 hits for chiropraxy vs 13.8 million hits for chiropractic. Most of the academic related references that I've seen converge on a Royal Commission report in Quebec in 1963, which makes me wonder about French Canadian usage as the French term for ciropractic is chiropraxie. Some dictionaries give it as a synonym for chiropractic but some sources use it as a generic tern to include manipulative therapies that were precursors. Obviously in the UK, chiropractic is governed by the General Chiropractic Council; can't find chiropraxy in anything I've read in theirs. It's a synonym, but I don't think it's widely used in the UK in that I hadn't come across it at all.Gareth Leng 05:28, 10 April 2007 (CDT)

Good, I think that was our my general assessment as well, though I hadn't made the French connection. I think we need to make sure we use the English version in this compendium, otherwise we risk creating a whole new sect. --Matt Innis (Talk) 08:43, 10 April 2007 (CDT)


Subluxation

Was surprised to see that the term 'subluxation' is limited to chiropractic (as it is the article on vertebral subluxation). This needs to be discussed because, as it is, the term is not exclusive to chiropractic at all. I have made a pdf file of 5,497 article abstracts from PubMed that make it clear that the term is common in many other disciplines in health care and research. The literature refers to subluxations of extremities (predominantly the shoulder and the hip) the spine, the eye, the ossicles, etc. Of the 5,497 articles, 933 specifically delineate subluxations of the spine, predominately the cervical spine. Subluxations are commonly noted without specific criteria giving me the impression that it is either commonly understood to be a specific or well defined term or, conversely, it is used in an ambiguous manner. In either case, its use is universal given that the journals are from Japan, Italy, Germany, France etc. The definitions, if made in the literature, include, joint dislocation, joint instability, joint micro-instability, excessive intra-joint space, and joint hyperlaxity.

In addition, I can not agree with the perspective given here at all on the way this is viewed in Chiropractic either. Palmer may have been less than qualified to provide an empirically based description of what he advocated, but the work and the common beliefs held by chriopractors are not limited to the view presented here. The article is presenting what could be called 'classic chiropractic' which was prevalent back in the days of their version of leeches--innate intelligence. By the time I had finished my degree at Cleveland Chiropractic twenty years ago (in 1986), it was clear that the view presented here was attributed universally to those who termed themselves "straight chiropractors". They are hardly a majority. The article is simply not accurate in that in it conveys much the same view as would be true of describing medicine in the days of Soranus of Ephesus, true once but out of date today. Thomas Simmons 18:53, 8 April, 2007 (EPT)


This is in the first section. "In the health sciences, subluxation always means that there is a physical dislocation such that the part is completely out of place. In chiropractic subluxations, this is almost never the case. Unless otherwise specified, the word 'subluxation' in this article uses the chiropractic definition.[1])". The meaning of subluxation in the health sciences, and biology, is always the same - a part that is out of place-dislocated completely (in some sense) out of position.That's why you'll find the term being applied to the lens of the eye, various joints etc. Of that I'm sure. In every country, if we are talking health sciences. This phenonomon of displacement out of normal position may occur because of "joint dislocation, joint instability, joint micro-instability, excessive intra-joint space, and joint hyperlaxity" but, I swear, is not defined by any of them. I'm a little testy, (see above) after having spent hours here needlessly, so forgive me my bolds and italics, but I am (as I am sure you are) doing my very best to get the language right. I may be on "the other side" but I have respect for chiropractors as good people who practice a legitimate healing art. No matter- the actual use of the word "subluxation" is not the same in chiropractic and health sciences. It is the same word- same spelling, it can sometimes (rarely) refer to the same finding in the back, but it is not the same. Read it over again, please. Nancy Sculerati 07:53, 8 April 2007 (CDT) PS- if you think, as you apparently do, that there is a better way to present the chiropractic meaning of the word- please do so. Edit the article, or even better, since it may well get controversial, put it here on the talk page and let us all discuss it, and develop it together. Nancy Sculerati 08:03, 8 April 2007 (CDT)
Hi Nancy, and all. [NB: Sticking this in the text here is common on email but might seem rude, here - I intend it to simply form part of the text in a coherent manner.]
The issue for us twenty years ago was, 'when' is it out of place and under what conditions. That it was a minor dislocation was not an issue. We knew that. In other words, at one of the oldest of the chiropractic schools, more than a few clinicians from a number of chiropractic colleges openly stated that a subluxation was, in fact, a dislocation, specifically of a minor but significant degree. A dislocation that would not necessarily be evident on a radiograph. In chiropractic the difference was very evident to us. We knew there were more than a few of the old guys who did not give it any further thought: Palmer dogma was paramount. However, we represented a much broader degree of education and skepticism (the situation was not unlike the young turks fighting the status quo in the days of leeches and dark, closed rooms, bland gruel and quiet rest for any thing that ails you).
This was 20 years ago. Cleveland College was started when Kansas City had twelve 'medical' schools, most of them diploma mills. I knew one old guy that was a 'medical' doctor. He had been grandfathered in when the laws on qualifications were changed. He kept envelopes of strange powders in his desk and dispensed them as he saw fit. This is in my lifetime. My mother's childhood physician, Dr. Bilington, was an osteopath in Basic, Nevada outside Las Vegas. He used to go around to the home of his patients and during flu and pneumonia epidemics he would massage their chests and have the patients breath deeply several times each day. He never lost a patient and there are still folks in that town who will attest to this. I knew him years later when he moved to Prairie Village, Kansas and he confirmed what my mother told me. He never lost patients but the medical doctors did. Anecdotal, yes, but indicative of the possiblities that were present as far back as the 1920s. Right now we are addressing that same sort of change and limiting chiropractic education and perspective to those days of Palmer and Son as is done in the article is simply not constructive.
Case in point: In 1985, I took a patient to Kozakowski and Whitehead, (orthopedic surgeons) in Prairie Village, Kansas. The patient had a severely inflammed costal-vertebral joint, (thoracic region if memory serves). He spent the day lifting things onto a conveyor belt and then turning and bending down to the right to pick-up another object. Everything presented made the specific problem fairly suspect. The health insurance he had would not cover chiropractic so I took him to my orthopedist. Whitehead, was very well known: Treated a lot of guys on the KC Chiefs football squad, had worked for the U.S. military, published etc. He looked at my workup and made the same diagnosis I did, an acutely inflammed, subluxated joint. The key is this, the joint was not statically dislocated, it was dynamically dislocated. In other words, in movent it was not where it should be (biomechanically abnormal) but stationary there was no significant change in facet distance or angle between the vertebral and the costal heads of the joint. Subluxation in this instance was what I thought it was, a minor dislocation that was manifest only in movement. Twenty-two years ago a second-year chiropractic student and a well respected orthopedic surgeon saw eye-to-eye on the definition of 'subluxation. I frequently perused the KU Med School Library (I loved to catch the old timers out so I read a lot) and the definitions I found there, agreed with what clinicians were teaching at Cleveland Chiropractic. This is important though. They did not all teach this definition and the old perspective was constatly being challenged by me and others like Terry M. Elder who later went on to National College of Chiropractic (now National University of Health Sciences) in Lombard, NY where he teaches technique. Like I stated, the dispute was heating up. Anyway, yes, dislocated but under what conditions? My guess is, in fact I infer, that the defintion has reached a much greater degree of agreement in the last 20 years Thomas Simmons 10:49 10 April, 2007 (EPT)
Further-the appearance of the word in a Pub med search, no matter how many times, or the appearance of the word in a google search, again, no matter how many times, are not acceptable methods to make a scholarly point about the CONTENT of the references that are selected by the search. Unless the references are actually read and analyzed, the mere appearance of the word has very limited significance, and impressions, no matter how strong, are no substitute for actual analysis. I say this, because it is the responsibility of the individual raising the point and providing the search results, to make that analysis. We just spent all sorts of time and trouble over an issue that turned out to be false impressions, and circumstantial evidence, that we were placed in the position of sorting out. In other words, if you really believe that what you are saying about the health sciences' use of the terms, depite my rebuttal, is true, ok- we will discuss it, but it's up to YOU (not ME, the tired and cranky) to carefully construct an analysis of your sources. Should you do so, I will respond in turn. Like Bob Dylan (or somebody ) said- my time is all I have. details of such a less than thankless task are in the discussion in the previous section (omission). Nancy Sculerati 09:04, 8 April 2007 (CDT)
Yea, I have to disagree with you Nancy. Eliminating a resource as unscholarly simply by fiat is not going to advance the debate. I need to see a well-stated argument. My points:
1. The term 'subluxation' is in use outside chiropractic and it is quite widespread.
2. The term is occasionally defined in the literature and the definition does cover a range of possible explanations which in turn leads to more questions but of an informed nature.
The level of analysis of PubMed sources supports these two points and nothing more and no further claims are made for this analysis.
The issues I raise here are (a) the article's confinement of the term to chiropractic-falsified and (b) the definition in chiropractic-also falsified. To that second point I have the personal experience of having graduated some time ago from a chiropractic school and do know that the issue was constantly discussed then and state conclusively that the term given in the article is (a) not exclusive to the chiropractic domain and (b) the definition given in the article is not universal in the chiropractic domain. Thomas Simmons 10:49 10 April, 2007 (EPT)


Thomas, you might certainly have a unique perspective as I assume chiropractic is only a recent addition to the far east. Are you saying that in Japan the Vertebral subluxation as we have it presented here is similar to the way all the health sciences professions see it over there? --Matt Innis (Talk) 13:03, 8 April 2007 (CDT)

Can not go that far. The term 'subluxation' is definitely used in Japan as is evident from the literature that originates from clinicians and researchers in Japan. As to what they mean by it, that is uncertain but I surmise that at the very least it is meant to mean 'dislocation'. To what extent this dislocation occurs and its parameters are unknown to me. Thomas Simmons 10:49 10 April, 2007 (EPT)

Subluxation Part two

(Hope you don't mind but I am breaking this up for ease of access.)

Got this from an article in the Canadian Medical Association Journal about a merger/association with Canadian Memorial CC and York University. I put a statement by and attributed to Jean Moss, CMCC President, here to simply build a case for the change in perception about subluxation originally promoted in the Palmer paradigm

"Today, most chiropractors restrict their practices to providing relief from acute lower-back pain, for which spinal manipulation is known to work. Moss says CMCC now teaches classical subluxation theory only for its historical interest. That fact, and a new emphasis on clinical research by institutions like CMCC, has helped edge chiropractors closer to the medical and academic mainstream." Source: Terry Johnson (1999) Angry scientists fight university’s attempt to affiliate with chiropractic college. CMAJ • JAN. 12, 1999; 160 (1) --Thomas Simmons 21:17, 3 May 2007 (CDT) +17 hours

I agree with that statement. I also am aware that LACC has made similar transformations, as well as Palmer itself. National College in Chicago has always concentrated on the science and I understand my alma mater, Logan, has started a Phd program with Washington University in St. Louis, Missouri. It seems that the FCER (Federation for Chiropractic Education and Research) has recently placed Reed Phillips (past president of LACC and quoted researcher in one of our articles) into the top spot. At the same time, I would also suggest that there is still a contingent that holds to the subluxation theory and another much larger contingent that just keeps working on musculoskeletal conditions while speculating that there might be a link that a healthy spine means a healthier body. Does our article say that well? --Matt Innis (Talk) 22:14, 3 May 2007 (CDT)

The article is about the resistance to an affiliation between the two institutions. Have not done a follow up but will do. Am also going into as much detail as I can find on the New Zealand College of Chiropractic. They have a B.Sc Chiropractic but no doctorate. Some years back when I submitted my transcripts to the NZQA (Qualifications Authority) they rated the D.C as a bachelor's. --Thomas Simmons 18:46, 4 May 2007 (CDT) +17 hours

From the National Center for Complementary and Alternative Medicine Chiropractic and Its Use in Treating Low-Back Pain:

  • "He [D. D. Palmer] also believed that subluxations, or misalignments of the spine (a concept that had already existed in the bonesetter and osteopathic traditions), interrupt or interfere with this "nerve flow."
  • "Some chiropractors continue to view subluxation as central to chiropractic health care. However, other chiropractors no longer view the subluxation theory as a unifying theme in health and illness or as a basis for their practice. Other theories as to how chiropractic might work have been developed." --Thomas Simmons 20:37, 4 May 2007 (CDT) +17 hours

Did you see this one from Panjabi [13]

  • "A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit. Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management."

Sounds familiar. I think this is what you were saying earlier. --Matt Innis (Talk) 21:13, 4 May 2007 (CDT)


Too bad it is pay-per-view. Would love to get a copy. Checked the libraries in Wellington - they do not carry it. --Thomas Simmons 20:50, 5 May 2007 (CDT)+17 hours

An article on Chiropractic in 'Skeptical Inquirer'

Larry said to join in the discussion. I know nothing, so I offer what appears a thoughtful and factual article from the Committee for Skeptical Inquiry's magazine, 'Skeptical Inquirer'.

Download PDF attachment located at: http://base.google.com/base/a/1525701/D15230860405512093808

In my opinion, CZ Biology authors/editors should cultivate an attitude of skeptical inquiry. To paraphrase space engineer, James Oberg, keep an open mind — a virtue — but not so open your brains fall out.

--Anthony.Sebastian (Talk) 19:25, 16 April 2007 (CDT)

LOL. OK. I like that. Will be using it from time to time - Thomas Simmons 14:40, 17 April, 2007 (EPT)

Read the article. Can't say I am surprised by what the chiropractic associations are doing. However, S. Homola is a case in point for me. He is a chiropractor and he is very sceptical of the Palmer dogma. My guess is that what a lot of the chiropractors are reporting is purely anecdotal and they simply make their assertions from there. And no surpises there. Developing the ability to set up, run , analyse and report trials that would have met with the approval with the scientific community was never taught at Cleveland or any other school that I knew of by the late 80s. Since then do not know.

Bed-wetting is an interesting example for me. Several of us at the college in 1985-86 had experience with adjusting children, say 6- 12 years of age, who ceased bedwetting after we had adjusted them. There was no way we could tell what had actually taken place. It was merely anecdotal. When we suggested setting up trials to see if there was any where to go with this, some Palmer oriented clinicians said of course that will happen and merely reasserted their belief that chiropractic was the great cure for what ails you. Other clinicians, not the sort who bought into Palmer’s dogma, were interested but had no explanation. We never did get a chance to set up trials. We discussed it and realised that any study that adhered to strict methodological guidelines would be very difficult and probably expensive. We let it go at that.

If guys like Homola are going to rely on the people who run the associations, he will have plenty of material with which to criticise the field. If he looks for those who are practising and are like him, sceptical, he will find there is a very different attitude amongst a lot of practitioners. Change comes slowly for those who are overly concerned with keeping up appearances. - Thomas Simmons 15:01, 17 April, 2007 (EPT)

Thomas, your last point, well put. Perhaps that point, in some NPOV-way, and PC, should go into the article. Perhaps, also, readers should have access to the article by citation, and perhaps an explanatory note, commentary, to make your point. --Anthony.Sebastian (Talk) 14:28, 19 April 2007 (CDT)
By way of following the historical thread from my experience, Steve Smalley (Oncologist, MD, University of Missouri-Kansas City Med School, did his residency at Mayo), wrote a letter of recommendation for me to get into the school. His rationale was, 'you can not argue with results'. He had been very active in sports in high school and a number of his friends had gone to chiropractors for various problems. They had gotten a lot of relief. He based his simple and succinct analysis on that alone. He inferred nothing else from it. To my mind, this is what has driven Chiropractic all this time. Chiropractors get a few obvious changes that can be reasonably correlated to various interventions that qualified minds will also see. Then they make their bloomer: they make the most tenuous of cause-and-effect links, fail to account for other reasonable factors, and then compound this by extrapolating even greater ramifications from there. At the bottom of it all is the predilection for sweeping assumptions to day just as Palmer made in the 19th century. I had a clinician at Cleveland who had an MSc. in microbiology from the university in Grenoble, France. She should have known about the process of scientific enquiry but she continued to make sweeping statements (she was very big on Gonsted) and simply assumed that what chiropractors were saying would be born out by methodologically sound clinical trials and a wholesale review of clinical data. It never happened.
The assertion that chiropractors do not engage in well developed and designed clinical trials is an understatment and the resources and impetus to do so is controlled by the very people Homola is taking to task. They do not know what it would take to even do so (those that I have conversed with, read and listened to at the seminars). Many chiropractors limp along on satisfied customers, build their ethos and rationale around the result-driven justification, go to practice building seminars and look for the day when they can retire in affluent splendor. Not being bitter or cynical, just realistic. What is needed and I think we can do this here, is to call attention to what work may have been done in this area that shows any attempt at sound clinical methodology. I have gone over to the National Guideline Clearing House (similar to the Cochrane Collaboration) and found that there are very few indications in methodology that would indicate that guidelines are being produced from literature that show evidence of controlled clinical trails that would stand up to harsh scrutiny. (See Manual medicine guidelines for musculoskeletal injuries. Academy for Chiropractic Education). Another guideline Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash. (submitted by Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory Boards, Clinical Practice Guidelines Development Initiative, and the Guidelines Development Committee (GDC), and reported in J Can Chiropr Assoc 2005;49(3):158-209. [with 218 references]), stated "The caliber of the studies precluded quantitative syntheses (e.g., statistical pooling)," which indicates to me that even with an extensive search, the literature did not contain any studies that were conducive to an important aspect of critical analysis. (Not much to go on from there but it does fit the pattern, eh?). So the critical aspect of this issue needs to be reported here to present an informative source, IMHO, and what work that is being done to counter this yawning abyss--if any--also needs to be listed here. - Thomas Simmons 15:07, 20 April, 2007 (EPT)

Hello Anthony and Thom, have you looked at the Critical views of chiropractic article, particularly the external links to most all of Homola's works and others. The article is basically an extension of this article. We ran out of room. --Matt Innis (Talk) 22:20, 19 April 2007 (CDT)

This is fun. The article by Kent, Critical thinking (which I thoroughly enjoyed) appears in the Chiropractic Journal whose stated mission is to advocate chiropractic as "a unique paradigm as a subluxation-based health care field focused on the detection and correction of vertebral subluxation (nerve interference) for lifetime family wellness care." - Thomas Simmons 19:38 19 April, 2007 (EPT)

Hi, Matt: Thanks for the link. Checked out "CHIROBASE, Your Skeptical Guide to Chiropractic History, Theories, and Practices, Operated by Stephen Barrett, MD, and Samuel Homola, DC http://www.chirobase.org/ " No mention of the "Skeptical Inquirer" article. Copyrighted probably. --Anthony.Sebastian (Talk) 15:31, 21 April 2007 (CDT)
My pleasure Anthony. I read through the Skeptical Inquirer article again, too. It looks like we could use it as a source for some of the criticisms that we made on the Critical views of chiropractic article, especially the section on primary care or treatment of otitis media, infantile colic, etc. We can also cite it as a chiropractor's opinion about his colleaques and allow for appropriate rebuttal, just to be fair. --Matt Innis (Talk) 22:04, 22 April 2007 (CDT)

Text Clarity Issues

Not at all sure what this could mean:

  • "Chiropractic has won public acceptance and has become the most established of the alternative medical professions in the developed western world."

How would we establish anything as the 'most established' of anything? Number of schools, number of patients, number of patient visits, number of liability suits :-0, number of doctors in practice . . . what is the measure of such a statement? Just asking since it seems to be a throw-away statement you might hear at a tea put on by a DC's spouse in Paola, KS to introduce the benefits of seeing a Chiropractor. It has a --sorry, don't mean to beat up on the writer--Tupperware party flavour to it.

And which countries do we mean by 'developed western world'? Do we include Croatia and Greece? Do we use industrial indicators like how much hydrochloric and sulfuric acid they produce? --Thomas Simmons 19:34, 8 May 2007 (CDT) +17 hours (EPT)

I hear the criticism and I am waiting for the alternative. --Matt Innis (Talk) 19:54, 8 May 2007 (CDT)


For example:

Chiropractic has become well established in LMNOP countries which have allowed/encouraged the establishment of governing bodies to regulate Chiropractic practice and practioners. With some X patients visits a year by Y% of the population of LMNOP countries, Chiropractic has achieved acceptance as an alternative health care approach to ‘A’ type health problems. In addition, D% of health care insurers have provided varying degrees of coverage for policy holders and the QRS agencies/institutions etc have also begun /do employ Chiropractors to treat personnel/employees etc.

--Thomas Simmons 20:29, 8 May 2007 (CDT) +17 hours (EPT)

I'm okay with that (so long as the blanks are filled in of course). Go for it and lets see what you end up with. --Matt Innis (Talk) 20:33, 8 May 2007 (CDT)

Wellllll, it will take some time. Meantime, the rather loose prose could be slightly altered so that it reads a little more like what one might expect in an encyclopedia? --Thomas Simmons 00:06, 9 May 2007 (CDT) +17 hours (EPT)

This was a collaborative effort so I can't speak for everyone. However, I like your first attempt. There is no hurry. We can probably find some sources that back up some of what you say rather quickly. Some might be a little tougher, but I think you are on the right track. When we are finshed it should be quite encyclopedic. --Matt Innis (Talk) 08:27, 9 May 2007 (CDT)

Maybe we can find some good stuff in these:

--Matt Innis (Talk) 08:59, 9 May 2007 (CDT)

I'll just drop these off here while I look for some online versions.

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults Clinical Practice Guideline No. 14.

AHCPR Publication No 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.

Boline PD, Kassak K, Bronfort G, et al. Spinal manipulation vs amitriptyline for the treatment of chronic tension-type headaches: A randomized clinical trial. Journal of Manipulative and Physiological Therapeutics 1995;18(3): 148-54.

Dobson A, Freyer T, Levinson J. Integration of Chiropractic Services with Managed Care. Fairfax, VA : The Lewin Group, 1997.

Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine 1993; 328: 246-52.

Haldeman 5, Chapman-Smith D, Petersen D (eds). Guidelines for Chiropractic Quality Assurance and Practice Parameters: Proceedings of the Mercy Center Consensus Conference. Gaithersburg, MD: Aspen Publishers, 1992.

Hansen JP, Futch DB. Chiropractic services in a staff model HMO: Utilization and satisfaction. HMO Practice 11(1);39-42.

Horwitz AD, Hosek RS, Codario R. Making the case for chiropractic referrals. Managed Care 1995,4(1): 33-34.

Lippman H. Results of the Business & Health 1996 Executive Opinion Poll. Business & Health December 1996;45-57.

Manga P, Angus D, Papadopolous C, Swan W. A Study to Examine the Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. Richmond Hills, Ontario: Kenilworth Publishing, 1993.

Maust, et al. The Chiropractic Patient in Rural, Health Professional Shortage Areas of the United States: An Exploratory Analysis. Richmond, VA Research Dimensions Incorporated, 1994.

Meade T, Dyer S, Browne W, Frank AO. Randomized comparison of chiropractic and hospital outpatient, management for low back pain: results from extended follow-up. British Medical Journal 1995;3(11): 349-51.

Mosley C, Cohen I, Arnold R. Cost-effectiveness of chiropractic care in a managed care setting. American Journal of Managed Care. 1996; 2(3): 280-82.

Chirstensen MG, Morgan DRD. Job analysis of chiropractic: a project report, survey analysis and summary of the practice of chiropractic within the United States. Greeley, CO: National Board of Chiropractic Examiners, 1993.

Palsbo SE. Chiropractic care in health maintenance organizations. Journal of the American Chiropractic Association1995; 32(9): 50-52.

Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low-back pain. Annals of Internal Medicine 1992; 117(7): 590-598

Stano M, Smith M. Chiropractic and Medical Costs of Low Back Care. Medical Care 1996; 34(3) :191-204.

--Matt Innis (Talk) 10:03, 9 May 2007 (CDT)

Research Sources

How about we start listing credible research here.

Note: Decided to leave the degree alphabet with the authors to provide some sense of where this is coming from. - Thomas Simmons 20:59, 19 April, 2007 (EPT)

Clinical Trial

  • Jeffrey Balon, M.D., Peter D. Aker, D.C., Edward R. Crowther, D.C., Clark Danielson, M.P.A., P. Gerard Cox, M.B., Denise O'Shaughnessy, Corinne Walker, Charles H. Goldsmith, Ph.D., Eric Duku, M.Sc., and Malcolm R. Sears, M.B. (1998) A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma. Volume 339:1013-1020, October 8, Number 15 [14]

Study states that "In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit." and that there were no previous clinical trials in the literature that met methodological criteria.

Note on source. If you do not have access to NEJM at a library, the NEJM on-line will allow non-subscribers access to a limited number of articles 6 months after publication. This is one of them. - Thomas Simmons 20:31, 19 April, 2007 (EPT)
  • Peter A. Guiney, DO; Rick Chou, DO; Andrea Vianna, MD; Jay Lovenheim, DO (2006) Effects of Osteopathic Manipulative Treatment on Pediatric Patients With Asthma: A Randomized Controlled Trial. Journal of the American Osteopathic Assoc. JAOA • Vol 105 • No 1 • January 2005 • 7-12. [15]

Study stated that they “conducted a randomized controlled trial attempting to demonstrate the therapeutic relevance of OMT in the pediatric asthma population. With a confidence level of 95%, results for the OMT group showed a statistically significant improvement of 7 L per minute to 9 L per minute for peak expiratory flow rates. These results suggest that OMT has a therapeutic effect among this patient population.” - Thomas Simmons 21:12, 19 April, 2007 (EPT)

  • S E. Bockenhauer, DO; K. N. Julliard, MA, MFA; Kim S. L., DO; E. Huang, BS; A. M. Sheth, BS (2002) Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma JAOA • Vol 102 • No 7 • July 2002 pp 371-75 [16]

Study states that,” subjective evaluation of symptoms improved slightly after OM procedures compared with sham procedures, but the difference was not statistically significant. - Thomas Simmons 21:18, 19 April, 2007 (EPT)

Review of the literature

  • Sunita Vohra, MD, FRCPC, MSc, Bradley C. Johnston, ND, Kristie Cramer, MSc and Kim Humphreys, DC, PhD (2007). Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review. PEDIATRICS Vol. 119 No. 1 January, pp. e275-e283 [17]

OBJECTIVE: Systematically identify and synthesize available data on adverse events associated with pediatric spinal manipulation.

METHODS: Search of 8 major electronic databases (eg, Medline, AMED, MANTIS) from inception to June 2004 irrespective of language. Thirteen studies (2 randomized trials, 11 observational reports) were identified for inclusion. Reports were included if they (1) were a primary investigation of spinal manipulation (eg, observation studies, controlled trials, surveys), (2) included a study population of children who were aged 18 years or younger, and (3) reported data on adverse events. Data were summarized to demonstrate the nature and severity of adverse events that may result rather than their incidence.

RESULTS: Identified 14 cases of direct adverse events involving neurologic or musculoskeletal events. Nine cases involved serious adverse events (eg, subarachnoidal hemorrhage, paraplegia), 2 involved moderately adverse events that required medical attention (eg, severe headache), and 3 involved minor adverse events (eg, midback soreness). Another 20 cases of indirect adverse events involved delayed diagnosis (eg, diabetes, neuroblastoma) and/or inappropriate provision of spinal manipulation for serious medical conditions (ie, meningitis, rhabdomyosarcoma).

CONCLUSIONS: Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients. - Thomas Simmons 20:48, 19 April, 2007 (EPT)


Review of the Discipline

  • William C. Meeker, DC, MPH, and Scott Haldeman, DC, PhD, MD, FRCP(C) Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. Annals of Internal Medicine. 5 February Volume 136 Issue 3. Pages 216-227[18]

This is very interesting and good historical data as well. Scott Haldeman had made quite a name for himself by the time I graduated. He was looked upon as a beacon of reason. My guess is that quite a number of people have read this or at least heard of it. The report notes a number of controlled trials showing positive evidence for intervention in back pain and inconclusive findings for treatment of disorders not directly related to the musculoskeletal system. - Thomas Simmons 22:00, 19 April, 2007 (EPT)

  • Monica Smith, DC, PhD and Lynne Carber, BS (2002) Chiropractic Health Care in Health Professional Shortage Areas in the United States. American Journal of Public Health. December 2002, Vol 92, No. 12 [19]

This study is the flip side of the first CAM review (Astin et al) in that it reports on the extent to which chiropractors refer to medical practioners. - Thomas Simmons 22:24, 19 April, 2007 (EPT)


Review of Complimentary or Alternative Medicine

  • John A. Astin, PhD; Ariane Marie, BA; Kenneth R. Pelletier, PhD; Erik Hansen; William L. Haskell, PhD. (1998) A Review of the Incorporation of Complementary and Alternative Medicine by Mainstream Physicians Arch Intern Med. 1998;158:2303-2310.[20]

CAM (complementary/alternative medicine) study showing rate of acceptance amongst medical practioners. - Thomas Simmons 22:24, 19 April, 2007 (EPT)

Biblio

seemed a shame to lose the above so I dropped it into the Bibliography subpage, where it could be perhaps useful.Gareth Leng 05:12, 31 January 2008 (CST)

Good idea, by the way, Gareth, could you take a look at this and see what you think. It is the latest development in the stroke controversy. Let me know what you think.
  • According to the Bone and Joint Decade 2000-2010 Task Force on Neck Pain, a multidisciplinary research initiative associated with the United Nations and World Health Organization, "There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke."[1]
  1. Spine - Fulltext: Volume 33(4S) February 15, 2008 p S5-S7 The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Executive Summary.. Retrieved on 2008-01-25.

Workgroup

This approved article ought to have at least one workgroup assigned to it. David Finn 21:04, 18 November 2011 (UTC)

The 'Healing Arts' workgroup category should also be removed from the main page, since that workgroup was abolished in December 2010 and we do not place categories on main pages anyway. As the page is locked, only someone with sysop rights can remove it. Also, that EC directive seems to indicate that this article should be assigned to the Health Sciences Workgroup, but the banner at the top of the article says that a constable has to do this (not sure why). John Stephenson 04:33, 3 December 2011 (UTC)

Highly critical article

I am not certain if the source is reliable, but Does Chiropractic Work? is getting Facebook discussion, seemed worth a link here. Sandy Harris 19:48, 30 September 2013 (UTC)