Talk:Chiropractic/Draft

The history seems mixed in with the presentation of the theory, which to some extent is unavoidable, but it seems odd to discuss the concept of subluxation _after_ the legal fight with the AMA. DavidGoodman 21:52, 2 November 2006 (CST)

I've re-ordered. I think this is basically a good aricle, and that the historical approach is a good way to explain the subject, I've trimmed it down from the WP original, and thrown some detail into the references. I'm now done with thisGareth Leng 11:06, 7 November 2006 (CST)

lead

I re-wrote some of the lead to bring it into the 21st century. Chiropractic is much bigger and more complicated than just the looking for and treating the mythical subluxation;) We really treat a lot of pain and work with a lot of musculoskeletal problems while asserting that taking care of your spine is a good idea. That is not to say that there weren't all kinds of methods that have been tried and developed over the years, but they can pretty much be boiled down to working toward this end. --D. Matt Innis 20:56, 3 December 2006 (CST)

Thanks Matt. ..."potential nervous system interference"... think we need in the lead to explain things simply, can you have a think about a rewording that might work for say a 14 year old? Gareth Leng 09:07, 4 December 2006 (CST)

I spent all that money to learn how to think like a 14 year old:) There's a joke in there somewhere. You said it best, I just replaced it! --D. Matt Innis 10:33, 4 December 2006 (CST)

Chiropractic vertebral subluxation

I think you're right that the VS should be closer to the top. I also think that we can do a better job explaining it. Lets go for it. I'll try and get it all down and if you would go behind me and clean up that would be fine. --D. Matt Innis 15:15, 5 December 2006 (CST)

Hi Matt. There's one thing I'm very unclear about. DD Palmer clearly saw that promoting chiropractic as a religion might protect it from being taken over by the medical establishment. How much of this was sincere and how much was it just a stategem? In other words, did he deliberately stress the mystical associations of some concepts, in almost a cynical way? Or did he indeed become self deluded and see himself as a prophet?Gareth Leng 05:32, 6 December 2006 (CST)

Gareth, as you know, I have been reading everything I can find to determine this very question for the last 6 months. There are sources that state it both ways. The problem is that there were battles going back and forth from BJ's group vs DD's group and the mixers (John Howard, et al at National, etc.) on the side shaking their heads. Because BJ had taken over the "fountainhead" role, DD was dying to get it back. He tried to open several new schools, even calling one "Fountainhead", but he couldn't pry it loose. Meanwhile, BJ and his group were building a philosophy based profession and finding a way to get the practice of chiropractic legally seperable from medicine. When DD made the "religious" statement, California (the state has was wanting to move to from Oregon) was fighting a fierce battle with medicine to create a law that would protect chiropractors. BJ's straights kept interfering and because chiropractors could not reach a consensus, they were not able to do so. Meanwhile chiropractors were going to jail by the boatloads. Seeing that BJ was becoming the "philosopher" of chiropractic, and seeing how christian scientists had just won the right to practice citing freedom of religion, it does not seem far fetched to see that DD could kill two birds with one stone; become the "leader" of chiropractic again, and free the profession to practice without the threat of jail. From what I can tell, he was rejected, though that could be because he died months later. BJ then covered up his fathers writing until his death in 1963 in the Palmer archives.

So, I think a case can be built either way using resources, but if we put them all together, it looks to me that DD was intially making sound and bold scientific statements about his idea. He was reducing them as he found out new information, even from nerve pinch to no nerve pinch in the intervertebral foramen, etc. But, after going to jail, his attitude changed drastically and the "vital" elements from his past began to show back up. He was really wanting to be a scientist, but because of the political environment, it wasn't going to happen. I really think that the next several generations held these concepts in order to keep medicine from dictating how they could practice until science could catch up, similar to John Howards statement about "DD palcing a veil around chiropractic to protect it until it grew up." --D. Matt Innis 07:07, 6 December 2006 (CST)

On Approval - I think we need to set in place a process for approving this article, and I'd propose that we ask Nancy if she'd take on the role of "objective editorial oversight" to guide and be the ultimate arbitor.Gareth Leng 05:32, 6 December 2006 (CST)

Comments and suggested changes by Nancy

Chiropractic approach to healthcare

current article text : The traditional, 'medical' or 'allopathic' approach to health care regards disease as usually the result of some external influence, such as a toxin, parasite, allergen, or infectious agent: the solution is to counter that influence (e.g. using an antibiotic for a bacterial infection). By contrast, chiropractic involves a naturopathic approach, believing that lowered 'host resistance' is necessary for disease to occur, so the answer is to strengthen the host.[7]

My comment: Allopathy is a historical practice, and does not connotate current medicine. Medicine is simply medicine, the professional current practice of medicine, and not 'medicine ', If you hyperlink medicine to the current CZ article, that might help. I think a line like: "Although host responses and resistance are considered important in medicine, few treatments in mainstream medical practice are actually aimed at fighting disease through augmenting host response alone." In medicine and nursing, host resistance is more often generally approached through nutrition, exercise and physical therapy.

If I wait too long on an editing page, I'll have a problem posting and so my comments are going to be parcelled. more to come. (by the way, I think the writing is very good) Nancy Sculerati MD 07:09, 6 December 2006 (CST)

Allopathy is a historical practice, and does not connotate current medicine.

I am so glad to see you say that. I agree. I have that same problem with chiropractic. The current practice of chiropractic is the whole of what chiropractors do, not just the DD Palmer definition. But when we begin to write that, we realize that when we say chiropractors use physical therapy, we are stepping on the toes of physical therapists who claim it as theirs and nutritionists, etc. But pigeonholing both medicine to "drugs to fight disease" and chiropractic to "free the 'vital spark'" is really innaccurate. We have to differentiate chiropractic from what chiropractors do and medicine from what medical doctors really do. Perhaps we should say 'the allpathic model" or "the historical allopathic model". Or we can return to using this as the quote from Rbert Mootz,D.C as his opinion. What do you think? --D. Matt Innis 08:47, 6 December 2006 (CST)

What about treatment of systemic disease and local infections?

Personally, I would go to a good chiropracter in a minute for a musculo-skeletal problem, and have, in my practice, referred to selected chiropracter's for treatment of back pain. So, I want you to know that I am not an 'enemy physician'. But there is a big issue here that is unsaid. There are many chripracters (at least in NYC) who treat cancer, AIDS, allergy, ear infections in children and basically any illness through adjustments. Some of them tell their patients that antibiotics and other generally accepted medical treatments can interfere with the success of chiropracic therapy. There is nothing at all mentioned in this article about the treatment of specific illnesses, such as breast cancer or gallstones or otitis media in Chiropractic. That is too important to leave unsaid. Matt, could you address it? Do all chiropracters' treat all illnesses? What's the code of ethics for referral? Are there specific schools of chiropractic that have differing outlooks in this regard. I will re-read article, but I don't think this is discussed. Nancy Sculerati MD 07:24, 6 December 2006 (CST)

more specific comments

Here are more comments. I won't make any changes in your article unless explicitly invited for each change I suggest. I view my discussion of your paper as a CZ experiment in alternative editing. Maybe we can develop friendly professional protocols that change the culture without losing the great benefits of open interaction!

You have made a very nice article, that – as far as it goes, is both readable and generally accurate. It’s the best single article I have ever read on the subject. I do think it needs improvement – primarily because it must address the treatment of illnesses other than musculoskeletal pain and conditions by chiropractic to avoid being a misleading introduction of its subject. I cannot begin to address that issue myself. I don’t know the field and I don’t know where to learn about it. I think you (Gareth and Matt) are great resources and I am tremendously interested in reading what you come up with. Except for that, I think this article is ready for approval and should be temporarily frozen in anticipation of the launch. I do think there are minor improvements you might consider, but these, in my mind, (unlike the systemic disease issue) in no way preclude approval.

Since every good article has a voice, and having many writers writing the same piece without orchestration tends to muffle it, instead of accentuating it, I am limiting myself to the discussion page. If there is anything I write here that you’d like to use, take it and cut and paste as you wish. If not, that’s fine too.

1.(present version of article) “In conventional medicine, the term subluxation is usually associated with conditions which are a direct consequence of injury to joints or associated nerves. [1]”

I think that this is much too subtle to be informative. If the reader does not already know both the medical and chiropractic definition of “subluxation” (and few will, I didn’t) they won’t get it. Even if they read the hyperlink, they might not understand. That hyperlink text for subluxation is neither clear nor strictly accurate.

1. (suggested change) The same word, subluxation is routinely used by both physicians and chiropractors, but each of these professions means something entirely different by the term.

The chiropractor uses this term to refer to an invisible phenomenon that involves forces of mental energy that are not described in current biology and not recognized as real by the physician. (full description of just exactly what a chiropracter means by the term in plain language).

A physician, on the other hand, only refers to a body part as” having a subluxation” if it is indisputably out of its functional position. So, when a radiologist reads a spinal x-ray as “showing subluxation of a vertebra”, he or she always means a bone in the spinal column is visibly displaced on the image. A pediatrician calls the elbow joint of a child as subluxed in the condition “nursemaid’s elbow” only if the lower arm bones are pulled out of the joint capsule and the child cannot move the forearm.

The differing use of this term by physicians and chiropractors is one factor that has contributed to the hostility of much of organized medicine against the profession of chiropracter. A patient may feel benefit from a chiropracter's treatment of his back pain, but when he next sees his physician, and announces that the chiropracter "fixed my subluxation", that physician is prone to view the chiropracter as a fraud, rather than a healing arts practitioner who may be on to something useful. After all, she'd reviewed the cat scan of the patients back and knows for a fact that there was no subluxation!

Perhaps the lack of scientific recognition of the chiropracter’s meaning of subluxation is due to lack of a focused study by biologists. Arguments have been made that the theoretical basis of the maneuvers in chiropractic do deserve scientific investigation. However, with few exceptions, chiropractors themselves are not trained in science or in the use of formal research methods. (might fit some of that into the research stuff you already have) Also, I argue that the medical definition is actually a biological definition. It is not just true in medicine, but also would be used by a vetinarian, and by an animal physiologist – by anyone who uses the language of biology.

Anyway, regards to all and I'll stop back again soon. Matt, just write how it really is - but you have to reference it to the national or world state of the profession. It seems that the problem may be that most of the global literature was produced decades ago. Still, the article -though of course should go through the history, best serves the reader by describing the current profession. Best you can, honest and plain language (though also diplomatic, accurate and respectful- of course!!) :) Nancy Sculerati MD 09:24, 6 December 2006 (CST)

Thanks, Nancy, for your very insightful input. I think you have addressed the things that I needed to hear. Sometimes you can't tell if anyone else thinks they are important. I will also have to address them in pieces between other activites. Let me start with giving some input to your conversation to let you know where I'll be trying to go.

Consider for the moment that vertebral subluxation does not involve a "spiritual" component. Consider that there is a functional possibility that a vertebra can be in perfect alignment, but due to adhesions from an old injury, it does not move in the kinetic chain properly, it would not show up on an xray, or for that matter, may not show up if you moved the patient through gross ranges of motion. But if you were able to isolate that one joint and put specific pressures on it and it didn't move or have that "elastic feel" like those above and below it, you would certainly note that it was dysfunctional. We call it subluxated for lack of a better word (from way before our time). We certainly don't expect just anybody to find this, anymore than we expect just anyone to be able to palpate a tumor on the kidney; its a feel that you develop with practice, practice, practice. How many people can palpate an ovarian cyst?

Now, whether there are consequences of this "lack of motion" is also debatable. There is research that shows that if we pin two vertebrae together on a rat, signs of degenerative disc and joint disease begin within months. Is this important? Certainly from an arthritic and pain POV this is reasonably important. Some chiropractors assert that this is important for overall health as well. Certainly from the patient's POV it feels better not to have either of these conditions. There is also some research that may provide a link to th line of thinking about health in general; mostly along the lines of innervation by the recurrent nerve of the spine which exits the intervertebral foreman, innervating the facet and posterior disc before returning to synapse in the lamina levels of spine that coorespond with the gray matter for the autonomic ns. Whether this can explain effects that chiropractors claim by affecting perhaps the vasomotor tone of the blood supply to an organ system or whether the nerve carries some other mechanism of information (neurotransmitters or other end products) that determines the health of the organ is still up for grabs, but I think neuroscientists are getting close to finding that out. OR, are somatic referral systems from "subluxated" facets the explanation for a percentage of right shoulder blade and abdominal pain that is often misdiagnosed as gall bladder pain, accounting for the claims? Again, I think we are close to finding that out. --D. Matt Innis 12:29, 6 December 2006 (CST)

Many efficacious practices in medicine came about before the physiology was understood, often there was a rationale offered that was later changed. But you see Matt, a person such as myself, and practically anybody who is not a chiropracter only knows what's in the books, and that's the hundred plus year old theories. It would be like reading a medical textbook from the civil war and relating it to what goes on today in a hospital. So what I want to know from you is what a chiropracter actually does. I can tell you that all doctors, generally speaking, who see patients go through a ritualistic history, physical exam, review of labs and past history, and depending on specialty might offer treatments. Is there a protocol accepted as proper practice for chiropracters? Do you keep records? What do they look like? Do you take x-rays or perform tests? How is a chiropracter licensed? Certified? Could you write about that here in the discussion? Then, if you like, we could put it together in the article.Nancy Sculerati MD 15:09, 6 December 2006 (CST)

Nancy, I changed the conventional medicine subluxation line to this:

• In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment.

Not sure I've captured the essence, what do you think.

As an extra note, I think most chiropractors see this "imaginary force" as a mental process that has its foundations in an the physical/chemical world, but no-one has been able to reduce it to that yet. Certainly, an emergent process that is explained in concepts that get too complex for the average clinician to relay to his patient is a possibility. So basically, I think it boils down to the subluxation being a milder level of what medicine considers a subluxation with a couple added twists concerning the nervous system's role. Am I making sense? --D. Matt Innis 15:17, 6 December 2006 (CST)

I see you've written more, let me see some patients and I'll get back to you. The answer to all of it is; yes. --D. Matt Innis 15:17, 6 December 2006 (CST)

Chiropractic education etc.

Nancy, this is information that was in the WP chiropractic article at one time but has been split into other articles because the original got much too long. We have apparently imported them into CZ so it may be just a matter of adding the wikilinks, though we might want to paraphrase some in this article to give a short synopsis of each. Just give them a quick look and let me know what you think is the most important.

• Chiropractic education
• Chiropractic school
• Council on Chiropractic Education
• Foundation for chiropractic education and research hmm, this one is missing
• Federation of Chiropractic Licensing Boards
• National Board of Chiropractic Examiners

I think this is all related enough that we can probably write a short section and link all these from there. --D. Matt Innis 22:35, 6 December 2006 (CST)

I've had a go at starting to incorporate Nancy's suggestions, amplified in the light of your comments Matt - see if I've got it about right?Gareth Leng 04:58, 7 December 2006 (CST)

Matt, there is almost nothing in WP that is clearly written and plainly explains. So look through and rewrite or just write it yourself. I'd say. The goal (to me) is not to make a lot of high sounding rhetoric but to actually explain, like you would to a friend who is intelligent but knows nothing about what it takes to be a chiropracter, just how you get to be one, how people generally do, and what the professional and legal regulations are like. Explain it to me, I'd like to know and I am a friend, or at least a penpal. I'm asking you. Don't ask me to read WP for your answer. I don't want to. Nancy Sculerati MD 06:02, 7 December 2006 (CST)

Okay, have done some in VS and Education (tough to make education interesting). Feel free to comment and adjust (pun intended:) --D. Matt Innis 11:11, 7 December 2006 (CST)

Going through again and making comments-Nancy

1 current Chiropractors emphasize their belief that a patient's health is compromised when spinal injuries, which some call vertebral subluxations, interfere with the body's ability to maintain adequate posture and joint function. They assert that, when neglected, these conditions can lead to accelerated degenerative changes such as arthritis and, by interfering with the nervous system, result in many different conditions of poor health. In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment. [1]

Why not say- “Chiropractors believe that…” instead of “Chiropractors emphasize their belief that…” 2. Do you really believe that the problem is spinal injuries? From what I understand from what you have written, chiropractors do a maneuver to ‘crack’ or ‘pop’ the inter-vertebral joints. Even if this has benefits, it does not follow that the joints or spines were originally injured or in any way displaced. When you say “In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment.” It implies that there is a continuum between normal joints and subluxed joints, but that is not really true. It is not a continuous change, in medicine a joint is either dislocated or it’s not, it’s a quantum change. Subluxation specifically means that the joint is dislocated out of the normal position such that it is visible on x-ray and would be visible to the naked eye if you removed the soft tissues covering the joint. Are you arguing that everybody who comes to you has minor subluxations in that sense? If they are so subtle that they cannot be either seen by surgeons or radiologists than they don’t exist. Scientists reject the idea that something exists that cannot be measured. For example, you previously – in the talk section, not in the article, pointed out that many doctors cannot palpate an ovarian cyst that perhaps some doctors do feel. So yes, an ovarian cyst may be there and yet a doctor cannot detect it on physical examination. But even if an ovarian cyst cannot be palpated, if it is there it will show up on ultrasound, or CT scan, or certainly if the ovary was surgically removed and examined by a pathologist. If the ovarian cyst that is said to be there by a doctor cannot be seen on ultrasound, cannot be seen by the surgeon removing the ovary, and cannot by the pathologist sectioning the organ and examining it through a microscope, then it is not there. Nancy Sculerati MD 13:26, 7 December 2006 (CST)