Talk:Chiropractic#Review of arguments and community discussion to determine consensus

I've had family members who have joint dysfunction who benefitted from seeing Chiros, and I've been a sort of amateur Chiro myself to some uncles with "bad backs". I don't know precisely how to make this article better, but I wish I did. Lots of people get drug-free pain relief from "back cracks", it's not scientific, but it does work.

But I also have seen deeply unscrupulous practitioners who would probably milk clients for every penny if you gave them the cance. So this is a hard article, but I wish there was a better article. Just as one random example, I'm not sure how much the "straights and mixers" discussion is relevant to modern readers, I think it's more about who sided with B.J. Palmer in the 1930s and paid dues to him. (But I honestly don't know, I haven't read up on this.) Feoffer (talk) 11:41, 23 March 2025 (UTC)

:Physical therapy works. Chiropractic often has that as a component and adds woo. It's the woo which makes Chiropractic what it is. There's also quite a bit of history to cover. Bon courage (talk) 11:47, 23 March 2025 (UTC)

::I know lots of Chiros still are woo, and that's why this is such a hard topic. Bad chiros are INCREDIBLY DANGEROUS, vultures who would prey upon the ignorant and illiterate people. But GOOD chiros are really awesome people who just fix joint dysfunction and never pretend to do anything more. I realize this is an incredibly hard article to get right and we SHOULD lean in favor of warning readers of the dangers of the bad ones.

::But I don't feel like the current article is that good at helping readers distinguish responsible practitioners from snake oil salesmen. It just feels like a really old and dated article that's a little in denial of the modern reality that millions of people get some measure of drug-free pain relief from 'back cracks'.

::But also, it's easy for me to sit back and thrown stones and say "this article should better". I don't honestly know how it should be better. Feoffer (talk) 12:18, 23 March 2025 (UTC)

:::It's not Wikipedia's role to act as a consumer guide or give medical advice. All we can do is summarise what decent sources are saying, giving due consideration to this being one of the WP:FRINGESUBJECTS. Bon courage (talk) 12:21, 23 March 2025 (UTC)

::::I don't disagree with you, I just, as a reader, wish the article was better but honestly don't know how to improve it right now. But just off the top of my head, do 21st century readers really benefit from Straights and Mixers? Aren't they just some BJ Palmer franchise thing? Aren't both of them FRINGE, compared to 21st century practitioners? Shouldn't the article be more about scrupulous vs unscrupulous? Not some antiquated thing?

::::But again, I'm first to admit I don't know what I'm talking about. I have NOT read up on the RSes on Chiropractic, this is just me talking as a reader. Feoffer (talk) 12:31, 23 March 2025 (UTC)

:::::Chiropractic is WP:FRINGE today. There is a rich history to the topic which also needs to be covered. I don't really know what to say: are there some great sources on this topic which have been missed? Perhaps a push to GA could be worth it? Bon courage (talk) 12:34, 23 March 2025 (UTC)

:::::I appreciate that this isn't the kind of POV-pushing from woo-proponents that we usually get, so thank you for acknowledging that we should not oversell this. In order to be encyclopedic, I think it's good to include odd stuff from the history of the topic, so I don't think we should remove things because they no longer get used. I don't know whether there might be some more recent high-quality sources that distinguish between unscrupulous and otherwise, but I'd be willing to consider such additions. (Emphasis on high-quality.) --Tryptofish (talk) 20:19, 23 March 2025 (UTC)

::::::Agreed. My concerns about straight and mixers is more about what we don't cover. Is that still a distinction Chiros make in 2025? I honestly don't know. Were one side or the other more scrupulous than the other according the truly high-quality 2025 sources? I don't know.

::::::My instinct, having studied a lot of early 20th century new religious movements, is that "Mixers" was a term made by BJ Palmer to stigmatize the people who didn't pay him a franchise fee? but I don't know that true.

::::::The article really should reflect that, in some nations at least, it has a genuine benefit, even if patients would be better of getting that treatment from a science-based provider. By analogy, I think of Traditional Chinese Medicine, which is not at all scientific but is still promoted by mainstream sources and does have a measure of benefit. (but with effect sizes on the magnitude of chicken soup). But in 2025, Chiro isn't exactly homeopathy, it's covered by mainstream medical insurance programs in a lot of nations as a way to prevent opioid use for musculoskeletal pain. Our current article makes it seem as if the admittedly pseudoscientific practice is utterly without value, but millions of readers know firsthand that it has SOME merit, even if it's tainted with gobs of dangerous pseudoscience. Feoffer (talk) 13:05, 24 March 2025 (UTC)

:::::::[https://quackwatch.org/chiropractic/edu/schoolphilosophy/ Found some answers]. Feoffer (talk) 11:41, 25 March 2025 (UTC)

::::::::That's 20 years old. Guy (help! - typo?) 17:47, 7 June 2025 (UTC)

:::I think the biggest opportunity is in the introduction - it's too long and goes into too much detail better suited for the appropriate subsections. I've identified several lines that provided information that was really specific tot the US without being labeled as such and moved to the relevant US/Canada subsection. Also, the intro doesn't summarize the chiropractic profession worldwide and the varied levels of legal/medical requirements and regulations. I'm working on a draft of that now. WCNo47 (talk) 04:53, 4 June 2025 (UTC)

::::I've reverted those changes, because they significantly alter the page in terms of making chiro sound more like a legitimate form of healthcare than what the consensus on this talk page currently supports. I think you changed too much at one time, and we need to examine and discuss these changes in talk in more detail. --Tryptofish (talk) 19:58, 4 June 2025 (UTC)

:::::Which changes specifically? I've cited everything from reputable sources including NIH. Reference to D.C in the intro paragraph is also US centric and should be in the appropriate section. Please clarify. WCNo47 (talk) 03:13, 5 June 2025 (UTC)

::::::Especially in light of WP:ONUS, I'd like to suggest that you propose individual changes here in talk, one by one, instead of asking other editors to go through the entire group of changes and break them down one by one. Also, where sourcing is subject to WP:MEDRS, sources generally should not be primary sources, but rather, secondary. As for not making the page US-centric, I agree with that. Finally, please keep in mind all of the discussion above. --Tryptofish (talk) 19:36, 5 June 2025 (UTC)

:::::::Thank you, I'm relatively new to editing, so appreciate the guidance. My motivation here is only to provide a more balanced presentation of the subject based on facts. I am in no way trying to legitimize or equate the practice to that of internal medicine. However, it seems there's consensus here that the article needs some help and is outdated in some key areas. Personally, I don't feel the article appropriately summarizes some key areas including the range of regulation and requirements worldwide, or the extent of practice which I think would be helpful for people trying to learn about the subject. As mentioned previously, the introduction is too long and has us-centric framing. Below is the summary of proposed changes:

:::::::1. Introduction - Move the second paragraph (starting w/ third sentence) to the US/Canada as the references to degrees and positioning as primary care is specific to US.

:::::::2. Within US/Canada, I propose the following:

:::::::a) indicating that Chiropractic is a licensed form of healthcare and covered under most major healthcare insurance providers - these are both factual statements, supported by multiple sources including NIH which is not a primary source. This may be viewed as legitimizing it, but it's a factual statement that can be further qualified if others feel necessary.

:::::::b) Practices - As others have noted with the article being outdated, I think it's important to highlight the extent of acceptance in some countries over the years. For example, some top healthcare networks in the US, including Northwestern University Medical Center in Chicago have chiropractors on staff. Understanding that there is a range of philosophies, I think it's important that people are aware of qualified practitioners focusing vs. the ones that claim that chiropractic can cure allergies.

:::::::3) More coverage of the range of government regulation across the world. WCNo47 (talk) 03:22, 6 June 2025 (UTC)

::::::::That's my read as well. By 2025, in major US medical systems, Chiropractors are essentially mainstream physical therapists who have training in manual therapy. But you don't have to search too hard before finding a chiropractor who will test your blood for toxins. Feoffer (talk) 12:59, 6 June 2025 (UTC)

:::::::::I can see some value in keeping some of the second-paragraph material in the lead section, because a perennial complaint about this and related pages has come from new editors who simply want to argue that chiro should be treated as equivalent to medicine because "its practitioners have degrees". As for insurance coverage, that's not the same thing as licensure to practice. For me, that comes down to the details of how we word it. If insurance coverage is a fact, then I'm OK with stating a fact, but I want to avoid language that implies anything that goes beyond the fact. I'm in favor of making the page more global, and being more specific about what happens where. So for me, a lot of what comes next boils down to what the specific language would be. --Tryptofish (talk) 19:42, 6 June 2025 (UTC)

::::::::::The language I used in my original edit was factual amd why I sought clarification originally. Nothing should have implied more than the facts which are, (supported secondary sources) 1. chiropractors are in staff at major healthcare institutions such as the VA and Northwestern Medical Center (and others) 2. it is a licensed form of healthcare per NIH and state licensing boards - all 50 states have licensing requirements. Agree it's not the same as insurance but that wasn't my point - but related is 3. Is covered by all major medical insurance. This would accurately represent the topic.

::::::::::Happy to edit in smaller sections and note each. WCNo47 (talk) 01:57, 7 June 2025 (UTC)

:::::::::::To expand on what I meant about discussing specific language, I'd rather not go back and review the language in your original edit. As you can see from the many comments below, that earlier language doesn't stand a chance of getting consensus. So, instead, I'd like you to take that previous language, revise it thoughtfully based on the feedback other editors have already given, and then propose revised language, specific wording, section-by-section, here on the talk page. It will almost certainly need to be revised further in talk before being ready for mainspace. It's a slow process, but it should not be circumvented. --Tryptofish (talk) 19:37, 7 June 2025 (UTC)

::::::::::::Sure, I understand. However, I don't see anything in the comments below that is specific to my edits. That's said, here's my most recent edit that was reverted. I felt this added more of a global perspective than the prior and clarified the intent - to distinguish between DC and MD/DO by limitations. It was flagged as using a 'chiro source', but I cited several sources that were not.

::::::::::::This was for the second paragraph after the 3rd sentence:

::::::::::::Chiropractors typically hold a professional degree in chiropractic, such as a Doctor of Chiropractic (D.C.), and may be referred to as "doctor" in clinical settings. However, their training and scope of practice differ significantly from that of medical or osteopathic physicians. Chiropractors are generally not authorized to prescribe medications or perform surgery, though limited prescribing rights exist in a few jurisdictions. While some chiropractors identify as primary care providers, their clinical education typically does not meet the internationally recognized requirements for comprehensive primary medical care. WCNo47 (talk) 21:31, 7 June 2025 (UTC)

:::::::::::::About the comments below, those directly below, from JzG/Guy, were directed at you specifically, and the subsequent talk sections raise issues that are generally relevant.

:::::::::::::So for that edit about the second paragraph, you made this edit: [https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=prev&oldid=1294455119], which was reverted: [https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=next&oldid=1294455119]. I personally don't have any issues with the wording you reproduced above, but I can't speak for other editors. The changes you made were relatively minor. But the edit summary for the revert indicated that the issue was the changes you made in cited sources, not in the text. I see that you removed a source from the Science-Based Medicine website, which I see as a mainstream source, which is good, but a blog, which is less good as a source, so that's kind of a wash. You replaced it with a source from the Journal of Allied Health (a minor journal, but to my knowledge not a predatory one), and I see that as neither better nor worse. You added a source from the Journal of Pain and Symptom Management, which I think is fine, and one from Chiropractic & Manual Therapies, which I think triggered the revert, because it's a within-POV source, especially because that one replaced another one from Science-Based Medicine, which you removed. You then added sources from the World Federation of Chiropractic and Chiropractic & Manual Therapies, so, on balance, yes, you shifted the sources strongly in the direction of chiro-promoting sources, and I think the revert was valid for that reason.

:::::::::::::Today, you made this edit: [https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=1294461726&oldid=1294457200]. You cited this source: [https://pmc.ncbi.nlm.nih.gov/articles/PMC7574492/]. You wrote the citation template with NIH as the publisher and PubMed as the website. That's not a POV problem, but you just did it wrong. The journal is actually Chiropractic & Manual Therapies, not PubMed, which is just the website for searching. The authors are at various universities etc., not NIH (click on "author information" at the source). I just made this edit, to correct the citation: [https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=1294598122&oldid=1294593271]. I suggest that you look at what I did there. --Tryptofish (talk) 17:51, 8 June 2025 (UTC)

::::::::::::::Got it, thanks for the clarification, I'll take another look and update with that in mind. WCNo47 (talk) 04:57, 9 June 2025 (UTC)

::::A lot of that is years of back and forth between believers and the reality-based community. Guy (help! - typo?) 17:48, 7 June 2025 (UTC)

:The best way to make the article better is to ensure that no in-universe claim is taken at face value. The basis of chiropractic is 19th Century quackery. The fact that there is some legitimacy to manual therapy does not validate the claims of innate, ability to cure organic disease, or obscure the dangers of the chiropractic hangman's twist, to name but a few issues.

:No, chiropractors are not "mainstream physical therapists". There are two worlds of chiropractic: straights and mixers. Straights are quacks, pure and simple. Mixers are sometimes not quacks. But virtually all are trained at schools that teach innate and other obvious nonsense. Guy (help! - typo?) 17:43, 7 June 2025 (UTC)

::Agree, I think we can acknowledge the facts I noted below without acknowledging that chiropractic is 'mainstream'. While there could be arguments that it's more mainstream in some counties than others and get into back and forths about what constitutes 'mainstream', the term itself may unintentionally equivocate the practice to other, established, evidence-based mainstream medical practices. WCNo47 (talk) 19:31, 7 June 2025 (UTC)

[https://quackwatch.org/chiropractic/edu/schoolphilosophy/ Quackwatch classifies] modern chiros as falling into three groups: "evidence based chiropractors, traditional straight chiropractors, and super straight chiropractors." I recently made a bold creation of a heading for the evidence-based group, and it was reverted as a little too bold, which I completely understand.

What would people think about creating such a section? I admit that we have to be very careful here, as getting it wrong could have real health consequences for readers. My background is history of folklore and religion, I know very little about chiropractic after the 1920s. Feoffer (talk) 09:05, 10 May 2025 (UTC)

:Thanks for being gracious about this, I appreciate it. As the editor who reverted, I stated my primary concerns in my edit summary: [https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=1289627579&oldid=1289555281]. Beyond what I said in my edit summary, I'd really like to know what other editors think about this. --Tryptofish (talk) 20:59, 10 May 2025 (UTC)

::It seems a bit odd, and whatever we say about evidence needs to be from WP:FRIND sources (so not chiropractic journals). Bon courage (talk) 14:24, 6 June 2025 (UTC)

:::"Evidence-based chiropractors" is sourced to Quackwatch, not some FRIND chiro source. Feoffer (talk) 14:31, 6 June 2025 (UTC)

::::No, but the material reverted was sourced to such journals. Bon courage (talk) 14:32, 6 June 2025 (UTC)

:::::oh, okay! I follow you. I 100% understand rationale behind the rv. Feoffer (talk) 14:40, 6 June 2025 (UTC)

• Skimming for recent sources, I do wonder if we're not a bit out-of-date about this. Although it's an in-universe source, doi:10.1186/s12998-021-00401-5 implies there have recently been some high-profile tensions within the chiropractic world and fallout from attempts evidence-based approach. A good step might be to assemble recent pertinent sources on this. Bon courage (talk) 15:22, 6 June 2025 (UTC)
• :That's my (completely naïve) impression of the RSes as well. It seems the last decade (or half-decade tbh) has seen chiro make major strides towards being just boring old physical therapists who are good at manual therapy. But obviously, still LOTS of straggler snake-oil salesmen that we need to help protect readers from. ESPECIALLY when we consider a GLOBAL readership. Feoffer (talk) 15:43, 6 June 2025 (UTC)
• ::It's the same issue as osteopathy though, as soon as you abandon the woo you lose any reason to use the label and just become "physical therapists" without the woo. For obvious reasons, the people in high positions in the labelled profession don't want this as it would be self-destruction. Bon courage (talk) 16:06, 6 June 2025 (UTC)
• :::Based on a very limited survey, my impression is that by the 2020s, evidence-based US chiros have become eager to "lose the woo" in exchange for state-licensure and coverage of their treatment by mainstream medical insurance. But there's no dout that dangerous, unscrupulous anti-science practitioners are still a real problem. Feoffer (talk) 16:46, 6 June 2025 (UTC)
• ::::Then they become physical therapists and lose everything distinctive about chiropractic except perhaps retaining the label as a vestige, as has (almost) happened in the US with DOs. The thing that makes Chiropractic what it is, is the woo. I would resist an emphasis on 21st century America professional practice as central to the topic, it's a very minor aspect (except of course to practitioners wanting to spin this page). Bon courage (talk) 04:27, 7 June 2025 (UTC)
• :::::I so agree that ideally everyone would see a professional who had no woo in their educational ancestry. But remember, we have to be a resource for people in harsh conditions who may not have much opportunity of choice for their care. If everyone had access to DOs to perform manual therapy, we could just recommend that. But the reality is that millions of US people depend on chiropractic for minor manual therapy. Feoffer (talk) 15:13, 7 June 2025 (UTC)
• ::::::Remember what we are here to do. This is an encyclopedia, not a self-help guide or a directory. We don't recommend, or disrecommend (is that a word?), anything. We are not here to help people find treatment of any kind, be that affordable, efficacious, or both. Girth Summit _(blether) 15:18, 7 June 2025 (UTC)
• ::::::{{tq|we have to be a resource for people in harsh conditions}} ← absolutely not, Wikipedia is not some kind of directory and absolutely does not give medical advice. Summarise the knowledge; identify and contextualize the woo; job done. Bon courage (talk) 15:19, 7 June 2025 (UTC)
• ::::::And the osteopath-specific part of DO education is woo. Bon courage (talk) 15:31, 7 June 2025 (UTC)

:Evidence-based chiropractic is like evidence-based homeopathy: an oxymoron. If you follow the evidence, you become a physical therapist, not a chiropractor. Guy (help! - typo?) 17:46, 7 June 2025 (UTC)

::I mean, that's not what Quackwatch says. It's not my verbiage, it's from a RS. I fully admit I too was a little surprised to see that designation, but I know almost nothing about modern chiropractic, so I just follow the RSes. Feoffer (talk) 13:30, 9 June 2025 (UTC)

• In the US: What major medical insurance covers Chiro? When did they start? How many chiro appts per year?
• What are the estimates for deaths potentially caused by cervical manipulation? literally how many are we talking about?
• This sentence is weird: "Systematic reviews of controlled clinical studies of treatments used by chiropractors have found no evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain." It doesn't work, except perhaps for the thing it claims to work on. Clearly it works on SOME level, or insurances wouldn't be paying for it, right?
• "Chiropractic has two main groups" Quackwatch says there's a third group, "Evidence-based".
• Summarize treatment techniques on the page?

More later Feoffer (talk) 14:31, 6 June 2025 (UTC)

:I've commented about insurance in #How can we improve this article, above. --Tryptofish (talk) 19:44, 6 June 2025 (UTC)

:agreed, these would be good additions. I'd suggest pulling in updated studies from reputable journals though to support your 3rd point WCNo47 (talk) 14:32, 7 June 2025 (UTC)

:RE: point 3, the Chiropractic associations do not limit their claims to treatment of back pain - they claim efficacy for respiratory conditions, infections, etc. This is fully explained, with quotations, in the cited source. Resist the temptation to assume that insurance only pays for treatments that work - insurance companies pay for homeopathic remedies as well. MrOllie (talk) 14:39, 7 June 2025 (UTC)

::This is a great caution, but it oversimplifies things a bit. Medicare, which to my understanding is sort of the US's national healthcare such as it is, doesn't cover homeopathy, but it does cover back cracks from non-doctor back crackers. Are they doctors? no. But it's probably not fair to equate them with homeopathy either -- when is the last time memory water let out a big crack and someone regained joint function? Feoffer (talk) 14:55, 7 June 2025 (UTC)

:::Back-cracking is quackery too.[https://edzardernst.com/2017/05/the-cracking-sound-during-spinal-manipulation-much-to-do-about-nothing/] Bon courage (talk) 15:06, 7 June 2025 (UTC)

::::It can be Quackery, no doubt. But it can also be mainstream medicine, as is well established in the form of manual therapy that DOs perform. Feoffer (talk) 15:17, 7 June 2025 (UTC)

:::::What 'back cracking'? Citation needed. Bon courage (talk) 15:21, 7 June 2025 (UTC)

::::::You tell me, I thought it was colloquial English for joint adjustment Feoffer (talk) 15:32, 7 June 2025 (UTC)

:::::::No, it's doing a move to make a loud cracking sound. Bon courage (talk) 15:52, 7 June 2025 (UTC)

:::I think that if chiropractors' manipulations regularly let out big cracks, followed by people regaining joint function, there would be plenty of high-quality studies documenting that. Now, more seriously - why would we cover the US in particular, rather than worldwide? Why would we even attempt to cover which medical insurances would pay for it - it doesn't tell us anything about the subject itself, and we're not a directory that people should be turning to to find out where they can get treatment (regardless of whether it's effective or not). And 'might work on back pain' is a bit of a red flag here, in the same way that it is for acupuncture. Nothing really works, so it can't be shown to any degree of confidence that anything is any more or less effective than anything else - it's just noisy data without much signal. Girth Summit _(blether) 15:11, 7 June 2025 (UTC)

::::{{tq| Why would we even attempt to cover which medical insurances would pay for it}} To gauge its relative cultural acceptance across nations, whether it works or not.

::::The comparison to acupuncture seems unfair. SOME fraction of Chiropractic appears to have discarded its pseudoscientific roots and embraced evidence-based practices. That's not my opinion, that's QuackWatch's. Feoffer (talk) 15:36, 7 June 2025 (UTC)

:::::I think it's more accurate to say some chiropractors are attempting to dump the woo, but since the woo is the chiropractic-specific stuff this leaves them in a 'whither chiropractic?' quandary, which is why there is such a schism in the cult. We could usefully document that. Bon courage (talk) 15:55, 7 June 2025 (UTC)

::::::Maybe I misread the sources, but aren't the non-woo chiros just becoming the functional equivalents of PTs who can perform manual adjusts without needing a DO's prescription pad to give drugs? Manual therapy for joint dislocation is not at all fringe, you realize. If you go to the ER with a dislocated shoulder, the MD will "pop" it back into place. Feoffer (talk) 16:05, 7 June 2025 (UTC)

:::::::Manual therapy is not chiropractic. Bon courage (talk) 16:40, 7 June 2025 (UTC)

::::::::It's noted as such in multiple places in the article. We should probably have something that addresses the differences between chiro, PT, manual therapy and OMT that D.Os use. WCNo47 (talk) 19:21, 7 June 2025 (UTC)

::::::::It looks to me, based on RSes, that a faction of chiropractors, the "evidence-based practitioners", are discarding the woo in favor of becoming mere providers of manual and physical therapy. There is absolutely no sign that all chiropractors are discarding woo -- they're still embracing it. Which is why this article is so hard to get right. Feoffer (talk) 13:14, 9 June 2025 (UTC)

:::::'Which medical insurance companies pay for it' does not tell us anything about something's cultural acceptance - you'd want a source specifically discussing its cultural acceptance for that purpose. Girth Summit _(blether) 08:18, 8 June 2025 (UTC)

::::::Well, I was thinking primarily of nations that have a national health service or a semi-private version of it. Private plans absolutely will offer whatever their customers want, even if it is pure woo. But Medicare and UK NHS aren't sending people to homeopaths. Feoffer (talk) 13:01, 9 June 2025 (UTC)

:::::::Even if government-operated insurance programs do not have the same commercial motivations as private companies, they are still influenced by all manner of political considerations, so we have to be very careful not to implicitly equate them to scientific evaluations. --Tryptofish (talk) 19:30, 9 June 2025 (UTC)

:::::::You sure about that? - NHS Centre for Integrative Care. MrOllie (talk) 19:34, 9 June 2025 (UTC)

::::::::Wow, thank you for that source! I humbly retract ALL of the above arguments, it's an honor to be so utterly and decisively refuted. Feoffer (talk) 13:14, 10 June 2025 (UTC)