Talk:Critical views of chiropractic
This should be titled critical views of chiropractic unless "chiropractic" is usually capitalized. Titles are lower-case. --Larry Sanger 17:29, 16 December 2006 (CST)
Please see quote from artocle below: "In line with a general philosophy of chiropractic to minimise use of medicines and drugs, 'traditional straight' chiropractors are opposed to childhood vaccination. Their main association, the International Chiropractors Association, is "supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health." This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy.[1]
"This is just the kind of thing that is couched so politely that it obscures it meaning. Whatever context it was in in tha journal article, it is inappropriate as the message o be given in the section on vaccination here. Nobody in the medical profession believes that the use of drugs should be maximized, every reasonable physician believes that medications and drugs should be minimised in children, and what traditional straight chiropracters actually advertise and write is that "vaccines weaken the immune systm' and "are dangerous". So this, especially in an article entitled "Critical views of Chiropractic" is completely misleading. It is an apology and a defense that couches the fact that a health care professional preaches against childhood vaccinations to mothers and fathers that consult him or her, with their child, which puts everyone at risk for epidemics of infectious diseases such as measles, is somehow just a reasonable part of a philosophy of minimizing medication.
criticism of tone
This is just the kind of thing that is couched so politely that it obscures it meaning. Whatever context it was in in tha journal article, it is inappropriate as the message to be given in the section on vaccination here. Nobody in the medical profession believes that the use of drugs should be maximized, every reasonable physician believes that medications and drugs should be minimised in children, and so using the description of straight chiropracters as simply trying to minimise medications as the sole "criticism" of a view that unofficially warns against complying with mandatory vaccinations, and officially suggests that there be an amendment to the law to allow "conscientious objectors" is just not enough to actual present a mainstream view that vaccinations are important to public health, that many traditional straight chiropracters go so far as to actually advertise warnings against vaccinations and write that "vaccines weaken the immune systm' and "are dangerous". Particularly in an article entitled "Critical views of Chiropractic" a critical view that explains why vaccinations must not be optional is important. Just as I would not hesitate to write critical views of how patients are treated in suboptimal ways by American physicians as a result of a training system that can lead to depersonalization of patients, I certainly think that a discussion of foilbles within chiropractic that stem from traditional beliefs are warrented. It must not be presented that if a health care professional preaches against childhood vaccinations to mothers and fathers that consult him or her, with their child, that advocating a policy which is against the law and puts everyone at risk for epidemics of infectious diseases such as measles, is somehow just a reasonable part of a philosophy of minimizing medication. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)
There are several issues here, first this article is in development so feel free to expand, obviously this section was a stub and needs adding to.
There are problems here in that the official statements of the traditional straight organisation express support for individual waivers rather than oppose vaccination, so I haven't yet found evidence that opposition is a formal position of any chiropractic body. Obviously at least some and possibly many chiropractors do oppose vaccination, and the explanation of why they do is needed to understand why it is expected that many do in the absence of any clear evidence that I have seen that in fact they do. (I'm not doubting it, just haven't seen any survey data).
To see the wording as an apology or a defense, is something I can't see in the words. It's an explanation, and it seems that to neglect any explanation of something that raises an obvious question (why would chiropractors oppose vaccination?) would be an omission. I really see no reservation or hesitation at all in the words "This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy." This seems to me about as clear a statement as can be made?
It seems to me that any further statements about this must be made in the form of quotations from notable authorities, and I'm sure we should be able to find those.
As far as tone is concerned, I think our tone must always be polite. We can quote others who are not, but although this is a criticisms article, we are still reporting criticisms, not making them ourselves.
My personal view is that compulsory mass vaccination is an essential part of public health policy, so I am not a supporter of allowing exceptions. That's my view, and it is a conventional scientific view that for vaccination to be effective as a way of controlling disease, there must be at least an 85% vaccination rate in the population, at which point for an individual, the risks become greater for vaccination than for avoiding vaccination. Because of this, the policy has to be compulsory to be fair, otherwise a few who avoid vaccination gain benefits at the expense of the majority, and if too many avoid vaccination this puts all at risk. That's the argument, and it's a complex one to follow, and really belongs in a vaccination article not here. So what else can or should be said here except adding quotes?
I don't think an argument is strengthened by expressing it more forcefully, and think on the contrary that rhetoric merely diminishes the case. That's not merely my style preference, it's also my belief that simple, direct statements that obviously avoid anything that can be read as hyperbole or rhetorical flourish, but which are based on a conservative reading of the evidence and are expressed politely, carry more weight. "This advice is contrary to the general belief of the medical profession that mass vaccination has enormous health benefits and is an essential part of a responsible public health policy" might seem like an understatement. But I think it's hard to read it and either misunderstand it, or doubt it, and hard actually for me to see what stronger statement can possibly be made that remains true. And if it's read and understood and believed - what else is there to say? We can be as rude as we like, it's not about chiropractors being upset but about whether a reader will simply be put off by what may seem like an opinionated rant. We have to trust the reader, let him see the criticisms, understand them, and draw his own conclusions; lead, not force.Gareth Leng 12:05, 14 March 2007 (CDT)
I'm not suggesting we be either impolite or rant. But the official statement of the formal organization of chiropractors cannot be the only acceptable source here for evidence of what chiropractors do. No surveys are routinely taken of health care providers by the US government or any other agency, and the data you ask for is just not available. There are many ads from chiropractors that plainly warn against medicines and vaccinations. The whole reason vaccines work in populations is because a critical proportion of "the herd" is immune and that point must be nmade in order to criticze the idea that vaccination can be a personal preference and still safegaurd the public. To simply couch that "the medical profession" feels mass vaccinations are essential and leave it at that is not helpful when there is already a general acceptance that the "medical profession" is against chiropractors. The real point is that official organizations of chiropractors not only do not condemn the statements of members that warn that vaccines weaken the immune system, but instead argue that it's simply a matter of personal preference whether on not to vaccinate your children- or should be a matter of personal preference- flies against the advancements made in public health over the last century. Look at that statement made by the organization- in the US it is against the law not to vaccinate your children, so do they support the law - No- even the official group suggests that the law should be changed to allow personal preference. That statement cannot be criticized without imparting the knowledge that personal preference removes the public benefits of vaccination for everyone and does not simply affect the person choosing not to be vaccinated - let alone the fact that it is the child who foregoes the protection but the parent who makes the "personal preference".. I just read your (Gareth's ?-the edits are not showing up except in history) and here's a point to consider- it is misleading not to explain that vaccination only works with near uniform compliance (since not every vaccinated person will actually achieve immunity) and just assume that the reader will either already know that or will carefully study another article. A couple of lines must be placed here so that the statements that are here can be understood. When I have time, I will write just that-in polite terms that can be plainly understood. This is, after all-the critical view. I am not happy that my time has to be taken up so much over alternative medicine, I would rather write about other things, but this cannot be so misleading. The tone is so formal and indirect that it cannot be plainly understood by people who are not themselves experts- that's the problem, it's not that I'm advocating rudeness-I am advocating direct statements plainly understandable to laymen, that present the critical view of chiropractic.
You know, Gareth, in the United States there is no central government health service, it's not like Sweden where records are kept on each child and a public nurse shows up and vaccinates your kid if you, as a parent, do not seek vaccination. I don't know how it is in the UK, but I suspect it's more like Sweden than like it is here, it would be a mistake to assume that the USA operates in a similar way that you are used to. In most districts (States), children cannot attend public school unless there are records of vaccination -but there are private schools where this is not true and some people homeschool, and so there are populations of unvaccinated children here. Further, some public schools are not so carefully run that kids are fully checked out, especially if misrepresentations are made by parents. This is not just a philosophical matter of the "conventional scientific" view, this is a matter of public health and safety. That's why I feel so strongly that - anywhere on Citizendium that childhood vaccination is discussed, it has to be plainly understandable to a layman. There are popular beliefs that vaccinations cause autism, destroy immunity and this all feeds in to popular conspiracy theories of government control and financial gain by doctors that is capitalized on, not just by the extreme group of chiropractors, but by Christian Scientists, other religious and political groups. Isn't Citizendium supposed to be an expert and reliable source of information? The scientific view of vaccination is not just another opinion. And it is not uniformly known that vaccination of the population is required to effect protection, it is more often assumed that it is an issue that only effects the individual being vaccinated. Furthermore-it's the law. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)
Here is the ACA's position statement of vaccination. It looks just like the ICA statement. The Assoc of Chiro Colleges didn't mention vaccination:
- VACCINATION
Resolved, that the American Chiropractic Association (ACA) recognize and advise the public that: Since the scientific community acknowledges that the use of vaccines is not without risk, the American Chiropractic Association supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination. The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual's right to freedom of choice in health care matters and providing an alternative elective course of action regarding vaccination. (Ratified by the House of Delegates, July 1993, Revised and Ratified June 1998). --Matt Innis (Talk) 21:35, 13 March 2007 (CDT)
Exactly. But the reason there are laws for mandatory vaccination is that personal choice renders vaccination ineffective - if enough people choose not to immunize. That's not to say that there are not particular vaccines where the risk/benefit ratio is such that it is reasonable to make such a choice. That's not to say that immunosuppressed people or critically ill people are not exempt. But there have been cases of polio in the USA again=in the 70's, because of that kind of thinking, and more recent epidemics of whooping cough. Since not every vaccinated person developes immunity as the result of a series of immunizations, it is not only the unvaccinated child who risks polio because of "personal preference". The vaccines mandated by law are not in the category of personal preference, and although that statement sounds so benign, it's not. Who could be against personal preference? Anybody who understands the biology of vaccinations- that's who. Even the official groups of chiropractors will not endorse following the law. Nancy Sculerati MD 17:57, 13 March 2007 (CDT)
I think you have a very good point and it needs to be made. This is the place to do it. In context of Gareths "why" question that everyone would be asking, here would be the logic (which I think our current version eludes to without saying it):
While there are chiropractors that oppose all things medical, the vast majority don't. There are a lot of fence sitters, including myself, that aren't concerned about the polio, small pox, and measles vaccines. Obviously we have some concern for diptheria, but have never personally seen anyone have a problem with it. It's the flu vaccines every year. It's the chicken pox vaccine. Hepatitis vaccines in infants. Are they really safe, do the risks outweigh the benefits? Those are the ones that keep chiropractors from jumping on the vaccine bandwagon. I think this issue will be there for awhile, because it is still out in the public. I see Texas is planning to pass a law to force vaccinate all young girls for the virus that causes cervical cancer. Do we know anything about this? Do we just trust Merck (the makers of Vioxx?). So these are the issues that chiropractors are facing. Do we say sure to vaccines just to be part of mainstream, do we make a stand against them because we don't believe in drugs at all (maybe 30 years ago, but not any more), or do we go somewhere in the middle. I think the stance that you are seeing is in the middle. Let each one decide based on the merits. Nancy makes a good point about these things being part of the process of getting children into pediatricians so that early detection is possible for other childhood things, but I would wager that those who choose not to immunize their children would go to their pediatrician if they weren't badgered to give them their shots. It is a viable critique of chiropractic's values for what they are worth. -Matt Innis (Talk) 21:35, 13 March 2007 (CDT)
references for vaccination/personal preference
Whooping cough and other infectious diseases are not just a theoretical concern. There is real evidence that "personal preference" leads to preventable illness, and when communities of people elect that preference (by law or otherwise) epidemics have been reported.
Omer SB. Pan WK. Halsey NA. Stokley S. Moulton LH. Navar AM. Pierce M. Salmon DA. Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. [Journal Article. Research Support, U.S. Gov't, P.H.S.] JAMA. 296(14):1757-63, 2006 Oct 11. UI: 17032989 Abstract:CONTEXT: School immunization requirements have played a major role in controlling vaccine-preventable diseases in the United States. Most states offer nonmedical exemptions to school requirements (religious or personal belief). Exemptors are at increased risk of acquiring and transmitting disease. The role of exemption policies may be especially important for pertussis, which is endemic in the United States. OBJECTIVE: To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs personal belief exemptions; (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs medium and easy vs difficult processes for obtaining exemptions; and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements. DESIGN, SETTING, AND PARTICIPANTS: We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry and 1986 through 2004 pertussis incidence data for individuals aged 18 years or younger. MAIN OUTCOME MEASURES: State-level exemption rates and pertussis incidence. RESULTS: From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14) and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence. CONCLUSIONS: Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.
Centers for Disease Control and Prevention (CDC). Pertussis outbreak in an Amish community--Kent County, Delaware, September 2004-February 2005. [Journal Article] MMWR - Morbidity & Mortality Weekly Report. 55(30):817-21, 2006 Aug 4. UI: 16888610 Vaccine-preventable disease outbreaks continue to occur among undervaccinated populations in the United States, including contained religious communities. The Amish practice separation from the world through group solidarity and caring for their own. Amish religious doctrine does not prohibit vaccination; however, coverage levels for routine childhood vaccination remain low in many Amish communities. This report describes an outbreak of pertussis in an Amish community in Kent County, Delaware, during September 2004-February 2005, that resulted in 345 cases and affected primarily preschool-aged children. The outbreak underscores the need to promote vaccination in Amish communities through culturally appropriate strategies, such as education and outreach to community leaders.
No disagreement?
I don't think there is actually any disagreement between us here, and certainly hope there is none. I fully agree with what you have said on the science. A minor point - to oppose a law is a perfectly respectable position; not to comply with a law is not. I don't see the organisations promoting non compliance, so it seems that formally they are opposing a particular law but that does not mean they do not support "the (rule of) law."
We have to consider some things carefully, after all there will one day be articles on Critical views of medicine and Critical views of science, so in part what I have in mind is what would be fair and reasonable to include in those. For example, on medicine would it be fair to include criticism of overprescription? Here GPs have been very sharply criticised (including by the NHS itself) for being too willing to prescribe antibiotics and antidepressants for example. The issue is, when does legitimate criticism of the opinions or behaviour of individual doctors become legitimate criticisms of the profession as a whole or of the whole edifice of the profession? Would it be fair to criticise Science for the high profile cases of fraud? My view would be clearly fair if there was evidence of "institutional" acceptance of fraud (as there is perhaps in the technical issue of "honorary" authorship), much harder to decide otherwise
Obviously, many chiropractors have opinions with which Nancy and I (as probably typical? representatives of academic medicine and science) strongly disagree, opinions that are much more seldom held within our professions. I also suspect that most chiropractors are fat white American protestant conservative males, though perhaps there is a chapter of revolutionary socialist chiropractors out there somewhere. My point is simply that attitudes common amongst chiropractors with which I may disagree are in some part attitudes common in the social group, not intrinsic to chiropractic, and might not be held by a black Jewish female communist chiropractor working in, say, Glasgow.
I think it is fair to criticise Chiropractic for the anti vaccinationist bias of many chiropractors because in part this attitude is related to the philosophy of chiropractic. That said, for me the door is open to criticise on vaccination, and to make that criticism as clear as possible. I'll try to expand it myself, but if my style is not acid enough, feel free to adjust :). Gareth Leng 05:02, 14 March 2007 (CDT)
OK I've expnded the section in some haste, please check and ammend or revise as appropriateGareth Leng 06:24, 14 March 2007 (CDT)
Hey, just because I am a fat white American protestant male doesn't make me conservative! I'm not sure which of those adjectives I'm supposed to feel good about:) hehe! -Matt Innis (Talk) 07:46, 14 March 2007 (CDT)
Hi Chris - your edits removed some text I'd put in, think you hadn't intended this; seems to have been an edit conflict bug; I've tried to incorporate all yours, but if I've missed any it wasn't intendedGareth Leng 08:06, 14 March 2007 (CDT)
OK, I've significantly expanded the vaccination section in I hope a fair way, added to the references generally and linked them, and added a para at the introduction that needs consideration. This article is an article reporting criticisms, it's not an "attack article", but it's not neutral in the sense that there is no offsetting argument. The defense is that this article is not making the arguments or endorsing them (definitely not our job), merely reporting them. Can we move to approve?Gareth Leng 09:38, 14 March 2007 (CDT)
I cannot approve this article. It is not a critique of chiropractic, and even the views on vaccination are not to me fairly presented. The 85% rate of vaccination is a ballpark estimate for human to human transmission, and overlooks such diseases as tetanus. The requirement set to have formal peer reviewed publications to document any critical statement, but on the other hand to be willing to state that no specific injury as a result of non-vaccination has ever been traced to chiropractic simply as an official quote is not reasonable. I am not able to research every legal and scientific and government document rto prove that it not so. I consider both of you-Matt and Gareth, and friends, and I do not want to have to write reams of prose here to defend my position. I also am not interested in devoting all my time to this article. I suggest that additional "eyes" are needed, and that this article is very far from being in an approvable state. I am not sure why terms like "acid" are being used, or assumptions are being made that my objections (I say "my" because I am the only objector on this page) are being made on the basis of either race or sex. I am becoming not only frustrated but offended and ask to be excused from further work here for the time being. Thanks, Nancy Sculerati MD 10:24, 14 March 2007 (CDT)
OK Nancy, you don't need to be excused, nobody has to do anything here. I don't know where you got the idea that I thought your objections reflected either race or sex, I was making the very different point that the biases of chiropractors reflect in part their social affiliations not their professional ones, and that it would not be appropriate to attack them for those. I certainly apologise unreservedly for any unintended offence to you. The word acid was meant straight, I don't object at all to acid prose, I just find it difficult to write it and be neutral. I don't think tetanus is relevant here as I think the chiropractic opposition is to mass compulsory vaccination, which is for infectious diseases where human to human transmission is the relevant parameter. The requirement for verification applies to statements of fact, statements of opinion, as here given in direct quotes, need to be attributed verifiably as this was. The article is not a critique of chiropractic and would not be appropriate for an encyclopedia if it was, but a documentation of critical views, as explained in the Introduction. I earlier reworded this sentence "Despite overwhelming evidence that vaccination is a highly effective method of controlling infectious diseases, some chiropractors maintain a strongly antivaccination bias." This I have changed as it was clearly offensively worded. To be specific about neutrality; we have revised chiropractic in part because the word propaganda applied to the AMA although accurately applied according to the dictionary, has negative connotations. Here the case is even clearer. Clearly the chiropractors who oppose vaccination don't do so while accepting that the evidence is overwhelming, and clearly to describe their opinions as biases is pejorative. I'm sure there are other cases where the wording needs attention. I think we need Larry's views on neutrality generally and phrasing in particular.Gareth Leng 10:45, 14 March 2007 (CDT)
The opposition to vaccination is strictly on the basis of adhering to a Chiropractic notion of dis-ease. There may well be official schools that are officially nuetral, but in the US, any formal school or organization that advocated breaking the law in official publications and documents would be sued and probably disbanded. In fact, it is likely the social and educational characteristics of individual chiropracters that bring them more in line with a medical view, rather than otherwise. Respectfully, I ask that you actually investigate chiropractic in the USA by writing to the various schools, corresponding with the organizations and looking through yellow pages and directories of health servces on the web. I once knew a neurosurgeon who felt that it was better to not write notes-that way nothing was in writing-you couldn't be hung by your own data. In Chiropractic, there is very little formal published research, self-policing of the profession, and a general dearth of self-reported practices on any kind of recognized scientific "polling" basis. It is not reasonable to expect that unless offical groups write statements that would get them sued that these views are not prevalent. Just what do you base your understanding of chiropractic on, Gareth? Matt has his own experiences as a chiropracter, and the history he has studied. I have my review of the literature and my experience with patients who have seen chiropractors, and local attitudes in a rural community where chiropractic is an accepted alternative to seeing a physician. If, in fact, there are practically no chiropractors where you live and you are basing your view strictly on friendship and written interaction with one DC and the public literature that is available on-line in libraries, I respectfully suggest that you may be making some very mistaken assumptions. Imagine a person who had never done laboratory science, never participated in publishing peer-reviewed papers, never was involved in awarding peer reviewed grants, but had some close personal relationships with scientists and read the available literature.No matter how intelligent and well-read, that person could easily make basic mis-assumptions without realizing it, since the ability to "read between the lines" would be lacking, except in a very general sense. Nancy Sculerati MD 11:11, 14 March 2007 (CDT)
Misplaced quotation
Confusion. "no specific injury as a result of non-vaccination has ever been traced to chiropractic"?? Where is this? Gareth Leng 10:54, 14 March 2007 (CDT)
I was referring to this:"We are not aware," they write, "of a single well-controlled study which found that chiropractic care prevented any infectious disease or reduced the severity of such a disease." They declare that it is dishonest of chiropractors to warn their patients about the danger of vaccinations without advising them of their benefits, and endorse the guidance of the College of Chiropractors of Ontario, which states, in its "Standard of Practice", that "Chiropractors may not, in their professional capacity express views about immunization/vaccination as it is outside their scope of practice."[7] [edit] and I admit I mis-read it. I feel like I'm in court, here. I am taking some time off.Nancy Sculerati MD 11:15, 14 March 2007 (CDT)
My outsider's take
I'm not sure what precisely the neutrality question here is, but a few observations which might or might not help...
First, I think a list of annotated links is not an encyclopedia article but a Web bibliography. That strikes me as being of limited value. From an outsider's perspective, I have to wonder whether the leading internal criticisms of Chiropractic can all be found online. Moreover, I find it unlikely that an authoritative account of the history of criticism of chiro best takes the form of an annotated bibliography. Perhaps I am misunderstanding what's going on, though.
Next, in any article that details criticisms of something, it is essential that published or common replies be detailed as well. That is a very straightforward and obvious application of the neutrality policy.
Even an article titled "critical views of chiropractic" must be neutral. Its primary focus is defined by the title: it is concerned with summing up in a readable, authoritative fashion what the critical views of chiro are. In stating these views, it must not state, imply, or hint that these critical views are correct; that's for the reader to decide. Furthermore, by stating these critical views without a reply (i.e., a published reply, or what would plainly be a standard reply from chiropractors) is very easy to endorse.
I like the fact that the article sets out the game plan vis-a-vis bias in the beginning, by the way.
Anyway, that's all I have time for now. I absolutely must focus my attention on high-priority launch-related tasks.
--Larry Sanger 11:12, 14 March 2007 (CDT)
OK. This is tough because so many issues are covered here. the vaccination section then needs a chiropractic response. I think the issues in the bibliography are explained neutrally (Matt?) and can be dropped to the end of the article rather than being the central core.Gareth Leng 11:28, 14 March 2007 (CDT)
One other thing. I am not going to wade into the dispute above, because I trust everyone involved to resolve it (eventually) brilliantly. If you want me to comment on or decide anything, which I hope will not be necessary, I hope you will be able to agree to some relatively clear question that I can think about. Probably, in thinking about what the question should be, you'll figure out a way to come to an agreement yourselves.
Also, there is some suggestion, from someone, that matters of tone are important to neutrality. This is absolutely true. Neutrality requires that one describe positions with a sympathetic tone, within the bare constraint that other positions must also be described with a sympathetic tone as well. It often comes down to the selection of just a few different words. --Larry Sanger 11:34, 14 March 2007 (CDT)
OK, Take a pause
Matt, I don't think you've written anything on this, and maybe you shouldn't as you'll be needed to comment on whether there is anything in this version that chiropractors could reasonably be expected to take offence at; you're therefore in the pole position for approval. This is important given the subject. As Nancy has correctly said, I have no first hand knowledge of chiropractic whatsoever. The only thing I can do is to try to represent the literature accurately, and contribute to the interpretation of the science on my own authority as a physiologist and neuroscientist. I don't think I've tried to do more, and actually I don't know what else there is to do. Researching the topic independently would certainly be original research, and if anything is not in the record then I don't see any route to verifying any statement that could be contentious. If I'm misreading the literature or omitting anything significant, then I'm happy to be told or for others to add. I am absolutely opposed to representing opinions that, for whatever reason, are not verifiably reported in significant publications. So I'm going to have to write a chiropractors rebuttal to the criticisms about vaccination. I agree with Larry that that's the right thing to do, Matt can say if I get it right.Gareth Leng 12:22, 14 March 2007 (CDT)
I'll do my best. You guys are doing fine without my input. I haven't seen anything I disagree with yet. --Matt Innis (Talk) 12:35, 14 March 2007 (CDT)
Peered reviewed articles
I believe that the Critical View of Chiropractic should be sympathetic to the critical view- not more than sympathetic and should of course strive for neutrality. Here are some references. I will place some quotes, but assume that Gareth has access to full test. If text wanted and not available, e-mail me privately . These are mostly taken from chiropractic and alternative medicine journals, rather than Medical journals.Nancy Sculerati MD 13:03, 14 March 2007 (CDT)
1)CHIROPRACTIC ANTIVACCINATION ARGUMENTS. By: Busse, Jason W.; Morgan, Lon; Campbell, James B.. Journal of Manipulative & Physiological Therapeutics, Jun2005, Vol. 28 Issue 5, p367-373, 7p; DOI: 10.1016/j.jmpt.2005.04.011; (AN 1744481)
Quote from end of article "If you peel away all the arguments about the safety and effectiveness of immunizations, you will find at the core of this debate, chiropractic philosophy." It is therefore informative to briefly review aspects of historical chiropractic philosophy as may relate to current views on vaccination. Chiropractic Philosophy: Chiropractic was founded by David D. Palmer and developed by his son Bartlett Joshua (BJ).The Palmers held that infectious disease was the result of spinal subluxations, and BJ in particular wrote extensively about how infectious diseases and other ailments (including cancers) can readily be cured by removal of the subluxation. For example, BJ wrote in 1909': Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox, I can prove to you where, in one, you will fmd a subluxation and you will fmd the same condition in the other ninety-nine. I adjust one and retum his functions to normal and you could do the same with the other ninety-nine. Although sometimes referred to as "chiropractic phil- osophy," the doctrines originally espoused by the Palmers and maintained by modem fundamentalist chiropractors cannot be considered to constitute a true philosophy in that they are not subject to change. It is more correct to categorize historical chiropractic philosophy as a belief system, in that any true philosophy should be dynamic and is accountable to a methodological pursuit of knowledge. The historical belief system of chiropractic, as advocated by the Palmers, does not allow for the acceptance of vaccination. According to DD Palmer: It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison.. .No one wilj ever pollute the blood of any member of my family unless he cares to walk over my dead body to perform such an operation. Historical chiropractic belief systems provide a number of benefits, however, including simplistic answers to complex problems and provision of a "unique" service among health care providers resulting in decreased com- petition. Because flindamentalist practitioners do not "cure" or "treat conditions aside from subluxations, which may or may not be symptomatic, treatment frequency and duration are entirely determined by the practitioner. Consequently, the result of adhering to a belief system of practice that can be applied rapidly, and administered to each and every presenting patient on an ongoing, and often frequent, basis, has obvious financial implications. This scenario may offer some insight as to why some chiropractors adopt historical belief systems that entail negative views toward vaccina- tion. As written by a third-year chiropractic student at CMCC," "I feel that chiropractic in Canada needs to go more towards a philosophical subluxation approach or we may no longer exist as a separate health profession. There is too much competition for patients at the evidence-based end of things." CONCLUSION The chiropractic antivaccination position was estab- lished by DD Palmer by likening vaccines to "filthy animal poisons."* Palmer's views resulted not from any objective analysis of scientific data, but from a rejection of anything he perceived to be associated with the medical profession of the day." His anti-immunization position was a narrowly dogmatic one that did not allow for scientific advancements or the introduction of new data. In the face of now overwhelming evidence to show that vaccination is an effective public health procedure. Palmer's modem followers have turned to whatever sources they can to support chiropractic's archaic anti- immunization position. However, our preliminary discus- sion suggests that current chiropractic anti-immunization arguments rely heavily on biased and selective misrepre- sentations, or omissions, of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely "philosophical," not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths, and false information to support this position."
2)Is Autism a Brain Disorder or a Gut Disorder? By: Fallon, Joan. Today's Chiropractic, May/Jun2005, Vol. 34 Issue 3, p50-54, 3p; (AN 17081408)(my critque-one of many examples of the poor level of scientific understanding and alarmist advice the chiropractic literature is permeated with)
Focuses on the concept that autism is caused by the mercury-based preservative in vaccines, which is causing brain damage in children. Conflicting findings that have prevailed in the literature with respect to the potential of vaccines as a causative factor in autism. Certain findings, that have pointed to a live measles virus in the gastrointestinal tracts of children with autism. Anecdotal reports of regressive autism following administration of one or more vaccinations. Parents' report of developmental problems from birth pointing to autism.
3)Managing Chronic Migraines, Daily Headaches, and Fibromyalgia. By: Murphy, Dan. American Chiropractor, Apr2005, Vol. 27 Issue 4, p19-19, 2/3p; (AN 17003908)
My summary- suggests that glutamate kills brain cells and that vaccines contain glutamate (MSG), vaccines are not major point, I submit this as evidence-again-of the level of the discussion and scholarship in the literature.
4)Your Child's Best Shot: A Parent's Guide to Vaccination, Second Edition (Book). By: Ferrance, Randy J.. Journal of the Canadian Chiropractic Association, Sep2004, Vol. 48 Issue 3, p241-241, 3/4p; (AN 14693967) Book review of a Pediatrician's Guide to Vaccine in a Chiropractic Journal. The review is favorable, but points out that chiropracters are likely to take offense that it is not anti-vaccine. (I include this as more evidence that the anti-vaccination bias is an integral part of Chiropractic)
5) Vaccinations: how about some facts for a change? By: Ferrance, Randy J.. Journal of the Canadian Chiropractic Association, Sep2002, Vol. 46 Issue 3, p167, 6p, 1bw; (AN 7683511)
Scholarly essay, written by Canadian Chiropractor. Rational view that is not reflective of the "pseudoscience" and "conspiracy theories" rampant in many of the US publications cited.
Published notices of meetings of Chiropracters that mention Vaccines or advocate General Health Care
1) From Alternative Health Watch: I show this notice of evidence of the Profession's support for public education that vaccines are dangerous for children. The World Chiropractic Alliance will hold its annual International Summit, Friday, April 15 to Saturday, April 16, 2005, in Washington, DC. "The event will offer a variety of presentations by many top chiropractic speakers, including Dr. Ben Lerner, author of the best-selling "Body by God;" Dr. Christopher Kent, renowned chiropractic researcher and president of the Council on Chiropractic Practice; Dr. Jay Holder, developer of the Torque Release Technique (TRT) and president/co-founder of the American College of Addictionology and Compulsive Disorders; Dr. Madeline Behrendt, whose groundbreaking research on chiropractic and infertility made national headlines; Matthew McCoy, editor of the Journal of Vertebral Subluxation Research; Barbara Loe Fisher, founder and president of the National Vaccine Information Center; Leona Fischer, one of only two members of the Veterans Affairs Chiropractic Advisory Committee to vote in favor of direct access for chiropractors; and Terry A. Rondberg, president of the World Chiropractic Alliance and Chiropractors for Wellness."
National Vaccine Information Center [1] OUR MISSION: The National Vaccine Information Center (NVIC) is a national, non-profit organization dedicated to preventing vaccine injuries and deaths through public education and defending the right to informed consent to vaccination.
WCA to sponsor 'Children's Health Day International'. Health Watch, 7/7/2004, Vol. 9 Issue 25, p1-3, 3p; (AN 13729413)
The event will be preceded by an aggressive public relations and publicity campaign to generate awareness of the program so that participating doctors will benefit from increased exposure in their communities. It will position chiropractors as the only major health care providers offering drug-free children's health care.
The drug-free aspect of chiropractic is particularly important today, since parents are increasingly alarmed by news of the dangers of many drugs and vaccines, the overuse and abuse of antibiotics for otitis media and other common children's ailments, the misuse of Ritalin and growth hormones, and the lack of proper testing of drugs given to children.
The World Chiropractic Alliance (WCA) strongly supports the right of parents to seek and obtain chiropractic care for all their children, regardless of age or presence or absence of symptoms. It has been in the forefront of the campaign to provide the full data needed for parents to make an informed decision about vital health care issues involving their children.
The care of children is consistent with recommended chiropractic guidelines, as set forth in the Council on Chiropractic Practice "Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice," included in the National Guideline Clearinghouse.
This document, which has been widely embraced by the chiropractic profession, states: "Since Vertebral Subluxation may affect individuals at any age, Chiropractic care may be indicated at any time after birth. As with any age group, however, care must be taken to select adjustment methods most appropriate to the patient's stage of development and overall spinal integrity. Parental education by the Subluxation-centered Chiropractor concerning the importance of evaluating children for the presence of vertebral Subluxation is encouraged."
Ample documented evidence is available that chiropractic care is safe for children and can have beneficial effects on health and fitness from newborn to adult stages. However, many people still don't realize that chiropractic can benefit children. An over emphasis on chiropractic for back pain in adults has given the public a limited view of chiropractic, once that the WCA tries to expand by its public education program.
Published essays(in Journals) by Chiropractors that reveal general philosophy to avoid standard medical care
1)Parenting in the Chiropractic Philosphy. By: Bell, Katie K.. Today's Chiropractic, Apr/May2006, Vol. 35 Issue 2, p42-46, 4p; (AN 21370296) informal discussion of home births, lack of rotine medical care, choice in which vaccines (despite law)
Published articles by Chiropractors in which unfounded treatments are advocated
Doctors Finding New Ways to Help autistic children. By: Stechschulte, Pattie. Today's Chiropractic, Sep/Oct2003, Vol. 32 Issue 5, p42, 5p; (AN 11051135)
Multiple statements that are given as facts-about food allergies, about treating otitis media with tympanograms. Nancy
Found the link for that one. [2] -Matt Innis (Talk) 14:40, 14 March 2007 (CDT)
Anyone see this ref?
i found this when checking for PMID numbers for the otitis media links. It seems to be a thorough and recent overview of all the data. Chris Day (Talk) 14:32, 14 March 2007 (CDT)
Ernst E., (2003) Chiropractic manipulation for non-spinal pain--a systematic review. N Z Med J. 116(1179):U539. PMID 14513080
AIMS: Chiropractic manipulation is mostly used for spinal problems but, in an increasing number of cases, also for non-spinal conditions. This systematic review is aimed at critically evaluating the evidence for or against the effectiveness of this approach. METHODS: Five electronic databases were searched for all randomised clinical trials of chiropractic manipulation as a treatment of non-spinal pain. They were evaluated according to standardised criteria. RESULTS: Eight such studies were identified. They related to the following conditions: fibromyalgia, carpal tunnel syndrome, infantile colic, otitis media, dysmenorrhoea and chronic pelvic pain. Their methodological quality ranged from mostly poor to excellent. Their findings do not demonstrate that chiropractic manipulation is an effective therapy for any of these conditions. CONCLUSIONS: Only very few randomised clinical trials of chiropractic manipulation as a treatment of non-spinal conditions exist. The claim that this approach is effective for such conditions is not based on data from rigorous clinical trials.
Evidence that Chiroprctors promote themselves as physicians in all but name
My critical view of Chiropractic- Although in the US the term physician (at least in most states) is restricted to individual licensed to practice medicine, many chiropractors see themselves as able to treat all health disorders. Although they (generally) do not call themselves physicians, the term "doctor", which is a near synonym in healthcare that is not legally restricted is often used-including in published official journals. Although these doctors do not claim to give drugs or practice surgery, they argue that these are not required for good health care and advocate advoidance of medical care. Physician, Nurses, and other health science professionals are alarmed at what they see as a fraudulent assertion that Chiropractic is an efficacious method of comprehensive primary health care, particularly since of segment of the Chiropractic profession appears to be involved in an aggressive campaign to promote themselves as primary care doctors for general health.
references to support the above:
Cambron, Jerrilyn A. DC, PhD a; Cramer, Gregory D. DC, PhD b; Winterstein, James DC c PATIENT PERCEPTIONS OF CHIROPRACTIC TREATMENT FOR PRIMARY CARE DISORDERS. Journal of Manipulative & Physiological Therapeutics. 30(1):11-16, January 2007.
Objective: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat.
Methods: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients. Results: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions. Conclusions: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.
Gaumer, Gary PhD a; Gemmen, Eric b CHIROPRACTIC USERS AND NONUSERS: DIFFERENCES IN USE, ATTITUDES, AND WILLINGNESS TO USE NONMEDICAL DOCTORS FOR PRIMARY CARE. Journal of Manipulative & Physiological Therapeutics. 29(7):529-539, September 2006. Objective: To determine the differences in attitudes and other determinants of care-seeking behavior between persons who have used chiropractic services and persons who have not. A second objective is to determine the interest in members of these 2 groups in choosing nonmedical doctors for providing routine services. Methods: In 1998, a nationwide telephone survey of randomly selected households in the United States was done, including 400 adults who have used chiropractic services and 400 adults who have not. Survey participants were asked about their use, knowledge, and attitudes about chiropractic care, attitudes about personal role in health care, current source of obtaining usual and routine care, and willingness to consider use of nonmedical doctors as the usual source of such care. The analysis compares persons who have used with those who have not used chiropractic services by using a [chi]2 test to determine significance of differences between the responses of the 2 groups. A multivariate analysis is done of willingness to use alternative providers for routine care. Results: Persons who have seen a doctor of chiropractic before have different attitudes and preferences about health and health care than others who have never seen a doctor of chiropractic. Almost all of persons in both groups have medical doctors that they use for routine care, and a sizeable portion of both groups would be willing to consider using a nonmedical doctor for this role. Although willingness to use a chiropractor in this role is much higher among persons who have used a chiropractor before, both groups would prefer physician assistants and nurse practitioners to chiropractors in this role. Conclusion: For persons participating in this survey, unwillingness to accept the idea of a chiropractor in a primary care role may be largely due to poor knowledge about chiropractic care.
herd immunity
While it is an important phenomenon ...it's very thin ice -- it will stop working if more people stopped getting vaccinated. -Tom Kelly (Talk) 15:51, 14 March 2007 (CDT)
- This doesn't really fit here but it seems like vaccines are a hot topic on this talk page.