title: Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates.
abstract: BACKGROUND
  Spinal manipulation therapy (SMT) is a popular though controversial practice. The debates surrounding efficacy and risk of SMT are only partially evident in popular discourse.
  
  
  OBJECTIVE
  This study aims to investigate the presence of critiques and debates surrounding efficacy and risk of SMT on the social media platform Twitter. The study examines whether there is presence of debate and whether critical information is being widely disseminated.
  
  
  METHODS
  An initial corpus of 31,339 tweets was compiled through Twitter's Search Application Programming Interface using the query terms "chiropractic," "chiropractor," and "spinal manipulation therapy." Tweets were collected for the month of December 2015. Post removal of tweets made by bots and spam, the corpus totaled 20,695 tweets, of which a sample (n=1267) was analyzed for skeptical or critical tweets. Additional criteria were also assessed.
  
  
  RESULTS
  There were 34 tweets explicitly containing skepticism or critique of SMT, representing 2.68% of the sample (n=1267). As such, there is a presence of 2.68% of tweets in the total corpus, 95% CI 0-6.58% displaying explicitly skeptical or critical perspectives of SMT. In addition, there are numerous tweets highlighting the health benefits of SMT for health issues such as attention deficit hyperactivity disorder (ADHD), immune system, and blood pressure that receive scant critical attention. The presence of tweets in the corpus highlighting the risks of "stroke" and "vertebral artery dissection" is also minute (0.1%).
  
  
  CONCLUSIONS
  In the abundance of tweets substantiating and promoting chiropractic and SMT as sound health practices and valuable business endeavors, the debates surrounding the efficacy and risks of SMT on Twitter are almost completely absent. Although there are some critical voices of SMT proving to be influential, issues persist regarding how widely this information is being disseminated.
authors.affiliation: Health Law Institute, Department of Law, University of Alberta, Edmonton, AB, Canada.
authors.forename: Alessandro R
authors.identifier: http://orcid.org/0000-0001-5018-423X
authors.initials: AR
authors.lastname: Marcon
authors.forename: Philip
authors.identifier: http://orcid.org/0000-0002-6470-7721
authors.initials: P
authors.lastname: Klostermann
authors.forename: Timothy
authors.identifier: http://orcid.org/0000-0001-5471-6184
authors.initials: T
authors.lastname: Caulfield
keywords: Twitter; alternative medicine; chiropractic; infodemiology; manipulation therapy; social media; spinal manipulation