User:Chris day/sandbox3

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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) 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]

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

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 == 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 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

tisfy the medical model. Similar to when dentistry abandoned the term 'cavity' for 'carie' to describe a barely visible defect that preceded an actual pitting of the tooth that took the form of a cavity. The alternative term segmental dysfunction is already used for insurance and statistical purposes, so making the transition would be relativley easy, but this terminology does not entail the nerological component of the condition.

Perhaps the lack of scientific recognition of the chiropractor’s meaning of subluxation is because biologists have not given the concept much serious attention. Arguments have been made that the theoretical basis of the maneuvers in chiropractic deserve more scientific investigation, claiming that, with few exceptions, chiropractors are not trained in science or in formal research methods. But chiropractors argue that their concept allows them to see their patients as more than the 'sum of their parts'. They believe that trying to explain all the complex physiological processes that combine to make a human being function in terms of the basic underlying physical and chemical components, misses things that are important for understanding what makes a human being healthy. Perhaps this is why chiropractors have been so reluctant to join their medical counterparts in their pursuit of the scientific answers to disease. They tend to prefer to interest their

well, not really for the article - but in terms of general discussion, there are reasonable ways to go about testing for objective evidence. For example, if a patient has an ovarian cyst - more than one experienced doctor can feel it. I don't say everu docyor, but among GYN oncologists, who are probably the best at feeling pelvic masses on exam, it won't be that only 1/500 experienced ones feel it. So, one way to approach research in this field might be to select a number of chirppractors who are experienced and well trained. Take 20 patients. On a single day - have all the chiropractors, one by one but not in the presence of each other, feel that patient and list just where adjustments are needed, but do no adjusting. Ideally, when testing examination capabilities there is some gold standard, like surgical examination of the ovary or at least an imaging study, but I accept that here there may not be. On the other hand, if we could be free to imagine any research protocol - I'd say take patients who were already scheduled to get CT scans of their backs. Let the group of chiropractors examine them. Then compare the CT scans, and the So, Matt & Gareth – some specific article comments.

Opening too long?

I wonder if the opening paragraphs could be trimmed? Shouldn't it be more like an abstract (~300 words) of the article? The first section could be an overview type section if you think this is still required. Chris Day (Talk) 16:49, 7 December 2006 (CST)

I think Gareth and Nancy would probably be best for this... everything I do adds more words and before we know it we'll have to split the article again! --D. Matt Innis 21:37, 7 December 2006 (CST)

Much better! This is really coming together nicely. You guys are goood! Are we missing anything? --D. Matt Innis 10:54, 9 December 2006 (CST)

Cavitation gif

safferentiation.shtml dysafferentation] gives a great history of research that makes an effort to explain the science behind the concept of subluxation, Sympathetic nervous system response to mechanical stress of the spinal column in rats. shows that there may well be some autonomic response that affects organ systems, and Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease discusses that maybe there is confusion about the etiology of pain - perhaps the reason the patient failed with medical care was misdiagnosis it was somatovisceral in the first place. But I am sure you have a pretty good feel for what is needed for the article on your own.

I can't wait to read it! --D. Matt Innis 12:02, 10 December 2006 (CST)

Non-spinal disorders

OK, first shot - up for brickbats.Gareth Leng 05:13, 13 December 2006 (CST)

I've removed this sentence as I didn't understand it "BJ Palmer reduced the adjustment to 'Hole In One' - the adjustment of only the atlas, while mixers continued to add and refine techniques to find and reduce subluxations." Maybe this should go in the BJP article?

No big loss, nobody uses that terminology anymore. Apparently it is now Specific Chiropractic (specific to the atlas vertebra). --D. Matt Innis 07:38, 14 December 2006 (CST)

swers.com/brickbats&r=67]

Lets get the cancer thing right

It is important that we get this right, at least on a rationale basis:

• There are chiropractors who are willing to use adjustments to treat any disease, including AIDS and cancer, in both children and adults.

I shutter to think that there might be someone out there telling their patient that they are treating their cancer or AIDS as a chiropractor. Having said that, I think it is safe to say that all DCs treat patients that have AIDS and some cancers (provided their are no red flags - metastasis to the spine, osteopenia, etc.). I generally tell thBut what I want to see are the written guidelines of what to treat and not treat. I can't find them in that Mercy book. It may just be that I'm not looking in the right place. Can you show them to me? [If not there, somewhere else? [User:Nancy Sculerati MD|Nancy Sculerati MD]] 16:43, 14 December 2006 (CST)

What about the length?

I do not want to butcher this article, but we have a real problem with the length. This is what I propose: for now- we have previous versions and can always put it back- lets take out all the "Three Rivals" stuff and put it in a new "History of Medicine" or History of Medicne in the US and link it. I'm going to try. Nancy Sculerati MD

I just looked again, and that's not a good solution. I also looked at the biology article, it's 37 kbytes. I really think we have to aim for under 40. Can we do a History of Chiropractic article and link it? We should keep the first stuff on palmer in there. Matt and Gareth- would you each comment, please? Nancy Sculerati MD 17:21, 14 December 2006 (CST)

aid above, Matt, in the text. Nancy Sculerati MD

Where do we go from here

I worked mostly with the lead tonight and a little elsewhere. It's looking pretty empty to me. I'll look at it again tomorrow. --D. Matt Innis 22:39, 15 December 2006 (CST)

Iz/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15042688 this], this, and this. Notice that is talking about using chiropractic for pain in cancer patients, not the cancer itself. This is what your looking for!. I went ahead and looked them up and found this same guy- you goota read this! [1]. Looks like he went overboard:) Though I think it illustrates what I was saying that anyone that says that stuff is risking his license and if someone dies, jail time. At least if he is calling it chiropractic, because chiropractic doesn't cure anything. --D. Matt Innis 08:05, 16 December 2006 (CST)

Otitis media in infants?

Matt, you are adding a lot of speculative things about how DC might turn out to be helpful that I can't live with. That otitis media stuff in infants is one. Colic is another. Generally claiming that "calming a mother" by manipulating the cervical spine of a newborn or infant for a "placebo effect" when for example - most otitis media in infants NEEDS NO TREATMENT and the rare infant that has meningitis almost always ALSO HAS OTITIS MEDIA, and meningitis in its early stages is hard to recognize, and might even begin with the high pitched cry that most people would assume is just colic, especially if the baby has a history of colic - is not something that I can ever approve. This is just the sort of treatment of nonmuskuloskeletal stuff I'm talking about that I consider unethical! We have a problem, Nancy Sculerati MD 10:08, 16 December 2006 (CST) )

Regulation

I will be able to look at my copy of the Mercy guidleines tomorrow to see what pages 215 - 218 are (since they are not online). Hopefully they will clarify some. The state boards are the disciplinary bodies, but I am trying to find some more specific guidelines. North Carolina statute for disciplinary action. --D. Matt Innis 18:28, 17 December 2006 (CST)

North Carolina acceptable care statute. --[[User:D. Matt

Approval template?

All, shouldn't there be a {{ToApprove}} template here, pointing to the version in the history up for approval?

I note that someone put it up for approval on the main article page, and used a different template. Do please use the above template on the talk page. Let's keep the main page as free of administrivia as possible.

trouble spots

My list to work with 1. A thorough patient and family history, review of organ systems and a physical examination are all part of a complete evaluation by a DC, however these are all done in a chiropractic manner and are not equivalent to a medical history and physical as done by a physician. --D. Matt Innis 07:43, 19 December 2006 (CST)

Matt, it's different in priniciple and therefore "not equivalent". Find another word or phrase for different besides "not equivalent" that you can agree with, and let's discuss it. Nancy Sculerati MD

Okay, i just took off the italics so it doesn't look like its POV and I can live with it. There are all kinds of levels of physicals and examinations and I'm sure they are all "not equivalent" even among physicians in the same field. --D. Matt Innis 10:03, 19 December 2006 (CST)

Gareth, straights warn against vaccination because they believe it causes problems. Look at the external links Matt provided. There is no reason not to say this plainly. It is true. Nancy Sculerati MD

Yes you are right Nancy, I've added some refs to the critical views articleGareth Leng 10:28, 19 December 2006 (CST)

2. Ethical DCs do not claim to be able to cure cancer, metabolic disorders such as diabetes, or infectious diseases, although they might treat patients who have these conditions, to relieve pain or provide a feeling of well-being.

This statement seems to give me the feeling that there must be unethical DCs as well. Can we find a little better way of saying it without losing the meaning? --D. Matt Innis 10:03, 19 December 2006 (CST)

Agree with Matt here; there are unethical DCs and there are unethical MDs (Harold Shipman was a mass murderer after all) and hopefully theuy get struck off. The codes of ethics appear to make it clear that even if individual DCS have suvch beliefs they are forbidden to advertise them and must advise patiets (informed consent) accurately of risks and benefits according to current knowledge. I've seen lots of contemporary chiro literature stating very clearly that chiro is not a cure for these and none, from credible sources, that claims it is.Gareth Leng 10:28, 19 December 2006 (CST)

figure out a better way to say it. Gareth will just have to log in from Berlin while we languish here at home! Nancy Sculerati MD

Nancy, that was an off-hand remark of mine. If the article seems too long to you or other editors now, that is a much better reason for us not to lengthen it, right now, than any off-hand generalization I might make. As you can see from that forum message, I'm not sure what to think, and we could use some serious thinking on the general question of article length. --Larry Sanger 18:18, 22 December 2006 (CST)

Quote related question

Matt, how does the quote here:

It wasn't so long ago that a college president suggested, "Rigor mortis is the only thing we can't help!"

relate to the rest of the Chiropractic treatment of non-spinal disorders section? The connection is not obvious to me. Sorry if i am missing the context here. Chris Day (Talk) 17:47, 22 December 2006 (CST)

Intro again-

Sorry to keep coming back to this but it is probably the most important part of the text with respect to 'catching' the reader. At present Subluxation seems to dominate the section to a disproportinate degree. How about something alomng the lines of:

Let's try this

Okay, after reading all of the above that was posted today, and since I rearranged the article and made some changes, how about Nancy you take a shot at it to get your POV back that I may have watered down. Then I will make some comments here on the talk page. Then, Gareth, if you can take Nancy's stuff and my comments and Chris's concerns and put them together from a scientists POV and lets see what we end up with. --Matt Innis (Talk) 00:03, 23 December 2006 (CST)

APPROVED Version 1.0

Discussion for Version 1.0 stopped here. Please continue further discussion under this break.

Image is a copyright violation

That image was lifted from this website. The summary of the photo prettymuch freely admits it was just lifted from a Google Image search. This is a huge no-no, no? Benjamin Lowe 16:40, 14 February 2007 (CST)

Agreed, it has to go. Chris Day (Talk) 16:50, 14 February 2007 (CST)

I'll check into getting it removed properly. Matt Innis (Talk) 22:05, 14 February 2007 (CST)

Rationale for replacement of acronyms and informal abbreviations.

This references recent changes to whole article, where acronyms and abbreviations (DC, MD, GP) were replaced. As I see it, the use of these detracts from the literary quality of the article. These are informal and colloquial terms. They are used, as far as I know, only in North America, and to an outsider seems inappropriate to formal, quality writing which is intended for all of the English speaking world. Do the European and British chiropractors have the degree DC? In South Africa they are awarded a Master in Chiropractic degree, after a tough and long course, and are quite entitled to be called "Dr", but I am not aware of them calling themselves "Dee-sees":) In the UK and Commonwealth countries, Doctors definitely are not MDs (that, over here, is a far higher degree in medicine). After the changes, one has to check that the writing still flows properly, since changing the length of words may make parts "sound odd". I have not noticed any such. --Christo Muller (Talk) 09:01, 20 February 2007 (CST)

AMA section

As per a request by Larry for us to review and rethink the section on the AMA plans], I think we have the choice of either totally eliminating the section or editing it to a more neutral tone. How about everyone take a shot at it and lets see if we can get something that we can all re-approve. Thanks, Matt Innis (Talk) 19:13, 4 March 2007 (CST)

Flexnor Report

Hey All, one thing I have been noticing is the tendency for this article to drift to into a postion that the Flexnor report directly influenced chiropractic. My research does not support this contention. At the turn of the century, a large percentage of physicians were still using homeopathic type remedies but the schools were so disorganized that these were the direct target of the Flexnor report. At the time of the report there were only 3 or 4 chiorpractic schools (at te most). And remember, the list was made at least 6 years before, when the only "drugless" schools would have been Palmer's and Still's osteopathic schools. Palmer had about 21 graduates before he was arrested in 1904. Several of those were MDs (they are not sure of how many). My point being that the Flexnor report was directed mostly at the homeopathic schools. The significance of the flexnor report is that once the homeopathic schools were closed, where did those physicians go? But I am only guessing on that:) Matt Innis (Talk) 19:14, 5 March 2007 (CST)

empiric medicine

Nancy made a sentence that needs more explanation:

• Although many clinical practices in medicine were based on empiric teaching rather than science, other empiric sorts of practices, like chiropractic, were disdained as meritless by the majority of MDs.

This is very true and begs a "why?" Why would there be a double standard? I'm thinking this is because of the attitude of the Palmers toward medicine and the environment of paranoia or mistrust. Any other ideas that we might be able to verify as good reasons. I think DCs would like to think it was all political, but I doubt it was. --Matt Innis (Talk) 20:09, 5 March 2007 (CST)

The AMA

Hi, Nancy. The role of the AMA in furthering medical eduction has always led this section, so I didn't read it as being as negative as you did.

roved with some rewriting, I think that dropping it down to 32 kb will ruin it. Nancy Sculerati MD 10:41, 6 March 2007 (CST)

Thanks, I agree on the limit; think it could be copy edited to tighten, let's see after that.Gareth Leng 12:01, 6 March 2007 (CST)

What most MDs think or thought... I always have problems with such statements mainly because when I try to find evidence it is often ambiguous or contradictory. I came across this for example, from 1989 (the Wilk era), and it doesn't really support a general negative view of chiropractic Cherkin D et al (1989) Family physicians' views of chiropractors: hostile or hospitable? Am J Public Health. 79:636–7 [2]. Similarly survays of collaboration generally show a degree of openness from MDs that is just not consistent with a general negative view. Is there a difference between family practitioners, who might be sympathetic to empirical practise, and academic or hospital based medicine I wonder?Gareth Leng 12:37, 6 March 2007 (CST)

A little JAMA research

I'm going through the full text articles that I can access online from JAMA (the Journal of the American Medical Association) that come up with a search for keyword: Chiropractic. As is my usual wont, I'll stick the references below with my own one or two line summary.

Overall changes

I don't see that we are changing the article in any significant way that I would consider an improvement worth approving over the original one. It seems that the more we rewrite the more we go in circles. I am concerned that what started as changing the word "propaganda" to make the AMA look better has lost its neutrality. -Matt Innis (Talk) 12:01, 7 March 2007 (CST)

Yes, comparing the present version with the approved, it looks as if the present draft has gone walkabout (we trust it comes back more clear-headed:)). The original idea was to reduce the section on the AMA. (Incidentally, the Am Coll of Surgeons had in 1987 already said that it approved of cooperation between surgeons and chiropractors, so the AMA was not the only player).

I've reduced the original AMA section as :

<Book reference>

To see the difference

This is the difference between Christo's version and Gareth's version [3]