MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Influenza kills thousands of people every year. Immunisation could prevent many of these deaths. Those at particularly high risk, e.g. young children, individuals aged 65 and older and people with severe diseases in their medical history, are therefore encouraged to get immunised. Nova Scotia health officials have just started their annual flu shot campaign. Now they are warning about some anti-flu vaccine literature being distributed by a chiropractor.

The leaflets from local chiropractic clinics suggest that flu shots increase the risk of a child ending up in hospital and link Alzheimer’s disease to flu shots. When questioned about this, the chair of the Nova Scotia College of Chiropractors defended this misinformation and claimed the author of the pamphlet did his homework. “Chiropractic is really pro information. Look at the positive, look at the negative, look at both sides, get your information and make the appropriate decision that’s right for you,” he said.

However, Dr. Robert Strang, Nova Scotia’s chief public health officer, said the message is wrong and added that the pamphlet is not based on medicine and is confusing to the public. “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based,” he said.

The stance of many chiropractors against immunisations is well known and has long historical roots. Campbell and colleagues expressed this clearly: Although there is overwhelming evidence to show that vaccination is a highly effective method of controlling infectious diseases, a vocal element of the chiropractic profession maintains a strongly antivaccination bias… The basis seems to lie in early chiropractic philosophy, which, eschewing both the germ theory of infectious disease and vaccination, considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae. Although rejected by medical science, this concept is still accepted by a minority of chiropractors. Although more progressive, evidence-based chiropractors have embraced the concept of vaccination, the rejection of it by conservative chiropractors continues to have a negative influence on both public acceptance of vaccination and acceptance of the chiropractic profession by orthodox medicine.

No doubt, there will be comments following this post claiming that many chiropractors have now learnt their lesson and have considerably revised their stance on vaccination. This may well be true. But far too many chiropractors still post hair-raising nonsense about vaccination. Take this guy, for instance, who concludes his article (just one example of many) on the subject with this revealing paragraph: Our original blood was good enough. What a thing to say about one of the most sublime substances in the universe. Our original professional philosophy was also good enough. What a thing to say about the most evolved healing concept since we crawled out of the ocean. Perhaps we can arrive at a position of profound gratitude if we could finally appreciate the identity, the oneness, the nobility of an uncontaminated unrestricted nervous system and an inviolate bloodstream. In such a place, is not the chiropractic position on vaccines self-evident, crystal clear, and as plain as the sun in the sky? 

As long as dangerous cranks are tolerated by the vast majority of chiropractors and their professional organisations to mislead the public, I have to agree with Dr Strang: “It’s discouraging, but unfortunately there are a range of what I call alternative-medicine practitioners who espouse a whole bunch of views which aren’t evidence based.”

33 Responses to Vaccination: chiropractors “espouse views which aren’t evidence based”

  • Brad Lohrenz, the chair of the Nova Scotia College of Chiropractors should be removed from office and publicly diciplined. I am all for educating patients about their spine, health and PREVENTION, and the one thing in medicine that is pure health and prevention is VACCINATION! It’s a no brainer!
    The antivaccination chiropractors have been dealt with here in Australia and the registration board has made its position clear! Canada needs to do the same!

  • How accurate is the statement ?:

    “Influenza kills thousands of people every year. Immunisation could prevent many of these deaths. ”

    While I don’t agree with everything Mercola says – he writes among other things ———

    that

    “this quote taken directly from the flu vaccine FLULAVAL’s package insert3 (which you likely never see when getting the flu shot) for the 2009-2010 formula:

    ” FLULAVAL is an influenza virus vaccine indicated for active immunization of adults 18 years of age and older against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine. This indication is based on immune response elicited by FLULAVAL, and there have been no controlled trials demonstrating a decrease in influenza disease after vaccination with FLULAVAL.”

    But you can read more there– I have not checked every reference but it worth looking at them.
    http://articles.mercola.com/sites/articles/archive/2009/09/26/flu-vaccine-exposed.aspx

    • The osteopath Joe Mercola, promoter of quackery, peddler of alternative therapy/supplements and rabid anti-vaccinationist, wants us to get the idea that because the producers of Flulaval have followed rules and declared in writing that the particular product labelled FLULAVALhas not been tested in clinical trials, NO flu-vaccine has been tested at all. This is a typical trick of disinformation and part of his FUD-agenda against all vaccinations.
      Our friend “George” has after all these years on EE’s blog for some reason not yet been able to grasp the simple fact that any health related information coming from Joe Mercola and his propaganda machine is not to be trusted. Of course there is the odd truth in between but Joe Mercola is driven by a multi-million dollar money making scheme lubricated and fuelled by screwy sCAM-populism. I would go so far as to declare J. Mercola to be a public-health threat.

      • The problem is that the vaccine industry is worse than Mercola —–

        Of course I dont agree with everything Mercola writes – but several points are valid.

        Finally the statement “there have been no controlled trials demonstrating a decrease in influenza disease after vaccination with FLULAVAL.” is not reliable?

    • Typical Mercola weaselry. See how he references “controlled trials”? These are never done with vaccines for ethical reasons.

      The CDC has a factual article which uses qualifiers and figures, something few quacks do. http://www.cdc.gov/flu/about/qa/vaccineeffect.htm

      • This is on the CDC website.

        “How are benefits of vaccination measured?

        Public health researchers measure how well flu vaccines work through different kinds of studies. “Randomized studies,” in which people are randomly assigned to receive either vaccine or placebo (i.e., salt water solution), and then followed to see how many in each group get the flu, are the “gold standard” (best method) for determining how well a vaccine works. The effects of vaccination measured in these studies is called “efficacy.””

        How can this statement be true regarding the flu vaccine if the studies are not carried out for ethical reasons?

        • But of course this type of logical thinking could not be applied to ANY other form of therapy.

          ““Observational studies” are studies in which subjects who choose to be vaccinated are compared to those who chose not to be vaccinated. This means that vaccination of study subjects is not randomized. The measurement of vaccine effects in an observational study is referred to as “effectiveness.” Randomized studies are expensive and are not conducted after a recommendation for vaccination has been issued, as withholding vaccine from people recommended for vaccination would place them at risk for infection, illness and possibly serious complications. For that reason, most U.S. studies conducted to determine the benefits of flu vaccination in the elderly are observational studies.”

          Come on Prof Ernst please tell me how the this vaccination is evidence based.

        • you vaccinate and you measure the immune response. this does not necessarily require an RCT, I think.

          • The same thing homeopaths say.

            “We give nosodes and the we …observe that there is an immune response……..”

            So Homeopathy works…?

          • it’s hardly about saying so!
            it’s about showing data that prove the effect!
            can you show mw data that nosodes change anything other than the cash-flow of the manufacturer?

      • Correct —– there are non controlled studies testing the flue vaccines –

        If I remember well – according to Ernst only controlled studies or reviews or controlled studies count as serious evidence.

        I remember criticizing homeopaths for relying on observational studies. Hm,

      • Hi Guy,

        I was wondering what are your thoughts on the post i have put at the end of this comment section?

        Many thanks

    • Very interesting, This is from the 2 studies done.
      “Flulaval has not been evaluated for carcinogenic or mutagenic potential, or for impairment of fertility.”
      “In 2 randomized, active-controlled trials of Flulaval, the immune responses, specifically HI antibody titers to each virus strain in the vaccine, were evaluated in sera obtained 21 days after administration of Flulaval. No controlled trials demonstrating a decrease in influenza disease after vaccination with Flulaval have been performed.”

      “Across both studies, serum HI antibody responses to Flulaval met the pre-specified seroconversion criteria for all 3 virus strains, and also the pre-specified criterion for the proportion of subjects with HI titers ≥1:40 for both influenza A viruses. In both trials, both Flulaval and the comparator vaccine did not meet the pre-specified criterion for the proportion of subjects with HI titers ≥1:40 for the influenza B virus. The clinical relevance of this finding on vaccine-induced protection against illness caused by influenza type B strains is unknown.”

      Poor science for a vaccine wouldn’t you say prof.?

      Especially when

      Adverse Events Associated With Influenza Vaccines

      “Anaphylaxis has been reported after administration of Flulaval. Although Flulaval contains only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have severe egg allergy. Allergic reactions include hives, angioedema, allergic asthma, and systemic anaphylaxis [see Contraindications (4)].

      The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated.

      Neurological disorders temporally associated with influenza vaccination such as encephalopathy, optic neuritis/neuropathy, partial facial paralysis, and brachial plexus neuropathy have been reported.

      Microscopic polyangitis (vasculitis) has been reported temporally associated with influenza vaccination.”

      “The following additional adverse events have been identified during postapproval use of Flulaval. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their incidence rate or establish a causal relationship to the vaccine. Adverse events described here are included because: a) they represent reactions which are known to occur following immunizations generally or influenza immunizations specifically; b) they are potentially serious; or c) the frequency of reporting.

      Blood and Lymphatic System Disorders: Lymphadenopathy.

      Eye Disorders: Conjunctivitis, eye pain, photophobia.

      Gastrointestinal Disorders: Dysphagia, vomiting.

      General Disorders and Administration Site Conditions: Chest pain, injection site inflammation, rigors, asthenia, injection site rash, influenza-like symptoms, abnormal gait, injection site bruising, injection site sterile abscess.

      Immune System Disorders: Allergic edema of the face, allergic edema of the mouth, anaphylaxis, allergic edema of the throat.

      Infections and Infestations: Pharyngitis, rhinitis, laryngitis, cellulitis.

      Musculoskeletal and Connective Tissue Disorders: Muscle weakness, back pain, arthritis.

      Nervous System Disorders: Dizziness, paresthesia, hypoesthesia, hypokinesia, tremor, somnolence, syncope, Guillain-Barré syndrome, convulsions/seizures, facial or cranial nerve paralysis, encephalopathy, limb paralysis.

      Psychiatric Disorders: Insomnia.

      Respiratory, Thoracic, and Mediastinal Disorders: Dyspnea, dysphonia, bronchospasm, throat tightness.

      Skin and Subcutaneous Tissue Disorders: Urticaria, localized or generalized rash, pruritus, periorbital edema, sweating.

      Vascular Disorders: Flushing, pallor.”

      If this bit had the word chiropractic in it instead of vaccine????

      “Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their incidence rate or establish a causal relationship to the vaccine. Adverse events described here are included because: a) they represent reactions which are known to occur following immunizations generally or influenza immunizations specifically; b) they are potentially serious; or c) the frequency of reporting.”

  • AS a very young child living in Canada in the early 1950’s I recall that my Chiropractor Father would not allow his children to be vaccinated against Polio. Many years later I asked him for his reasons for this stance and he told me that the early vaccines had not proven to be entirely without very grave adverse effects and so he wasn’t going to take the chance. I believe other vaccinations were in a similar early period of development. This , of course, does not justify the sort of gross anti-vaccination propaganda promoted by some of the profession’s contemporary members.

  • How can the use of this vaccine be classed as evidence based?
    “No controlled trials demonstrating a decrease in influenza disease after vaccination with Flulaval have been performed.”

  • Professor Ernst wrote: “No doubt, there will be comments following this post claiming that many chiropractors have now learnt their lesson and have considerably revised their stance on vaccination.”

    It looks like the UK’s Anglo European College of Chiropractic (AECC) has revised its stance on vaccination, but has chosen to step away from evidence-based public health policy. Back in July of this year, its website declared:

    QUOTE

    “we endorse and recommend the NHS vaccination programme”

    http://edzardernst.com/2014/07/why-so-many-chiropractors-advise-against-immunisation/#comment-60172

    This is the archived link to the relevant AECC page:
    http://web.archive.org/web/20140410173038/http://www.aecc.ac.uk/clinic/whatischiro.aspx

    However, the current AECC link appears to be devoid of any mention of its former endorsement and recommendation of the NHS vaccination programme:
    http://www.aecc.ac.uk/clinic/whatischiro.aspx

    I’ve searched the AECC’s website to see if its position on vaccinations has been moved to another page, but can’t find anything about it.

    Does anyone know if the AECC has changed its stance on vaccinations in the last three months?

    • Looking at the EVIDENCE for flu vaccines surely you cannot argue the fact that its evidenced based. There are no trials. It doesn’t seem to create a response for type b. It doesnt work so well on the over 65’s and shouldn’t be given to children. Its seems to be based on observational studies and there are a wide range of side effects. If this thread was about any form of CAM you would do nothing but tear it to pieces.

  • Well, if EE doesn’t want his flu vax, as he has stated elsewhere on this “blog”, why can’t others say and do the same? Just sayin’.

    • as so often you are not quite telling the truth: I never said that I did not WANT my flu jab!

      • Or to look at it another way: My business is with automobiles – the use of which carries a 1 in 20000 risk of death annually according to the Bandolier website
        Now only recently I was contemplating a journey by car some distance away until I realised that my time would be better spent doing other things. Clearly I must be taking the hypocritical stance of refusing to take the risk of a car journey because, being an automotive professional, I’m only too well aware of the risks involved; just as I am sure that you, Professor Ernst understand the exact risk of specific vaccinations.
        Clearly that is, if you follow the SkepdocProf school of logic.
        Which thankfully I don’t.

      • Oh, OK. I got it. You WANTED your flux vax jab, you just didn’t WANT to go get it. So you didn’t actually get it. Understood. Your choice. No problem. If someone else doesn’t WANT it, well, then, that’s a problem. No choice.

        • I am not in the business to curtail people’s choice. I aim to provide reliable evidence for them to make responsible choices.
          I missed the flue jab last year [the 1st year I am entitled to one] because of family circumstances – not that it is any of your business, of course.
          If you are as good at manipulating backs as with manipulating the words of others such that they get a meaning you want [and others never intended], you must be an excellent chiro! did you learn that in chiro-school? in any case, keep up the ‘good work’ of misleading anyone who makes the mistake to listen to you.

  • Well if you take two people, one gets the flu stab and the other doesn’t get the flu stab, and neither gets the flu, then how do you know that the person who got the stab did not get the flu because of the vax jab? Answer is that you don’t. You can apply that to one or a hundred or a thousand people. There is just no way of knowing. There has never been proof, that the flu jab ever prevented a single case of the flu. No one can prove that something didn’t happen. Everything you read and produce as “evidence” is just a statistical guess.

    So get jabs if you want to. Or don’t get jabs if you don’t want to. I am good with either. Just sayin’.

    • Try constructing a Venn diagram of vaccination. If you manage to complete it then perhaps it will dawn on you why your fallacious argument is so pathetic.

  • Oh, Pete, it is the Venn diagram that has you convinced that you won’t get the flu? So, when the folks line up at the local drug store for their flu jabs, the store always gives them a Venn diagram to show that they won’t get the flu. When I ask friends if they got their flu vax jab, they all immediately whip out their very own Venn diagram to show me that they now are immune to the flu. In every box of flu vax, there is a little piece of paper that has the warnings, side effects, cautions and, of course, a Venn diagram as proof that they are now protected from the flu. So tell me, Pete, I am assuming that you get your flu jab, right? So if you don’t get the flu, how do you know that it was due to the flu vax stab? No credit goes to your own natural immunity?

    Apparently, it is not effective in the elderly. Maybe that’s why EE fails to show up at the drug store.

    http://healthimpactnews.com/2014/government-study-flu-vaccine-not-effective-for-elderly-death-rates-increased/

    http://www.sciencedirect.com/science/article/pii/S0264410X0600764X

    • @ SkepdocProf – Pete 628 is being protected from the flu by the placebo effect. Since there is no evidence of the flu vac being effective, it obviously is magic. Pete 628’s anti-science belief in the magical “medicines” and outdated witchcraft (magical diagrams from the 1800’s) just fuel other anti-science apologists, con the public into believing they are safe from the dread dangers of influenza – and threaten the very fabric of modern society. The public must be protected from this quackery, which steals money from the unsuspecting masses (specifically targeting the elderly) every fall.

      • Well said, JM. The drumbeats to get a vaxx for everything has all the drug chains dancing to the bank. It is like a religion. EE is proof that you don’t need the flu jab and still won’t get the flu.

        • And entertainingly said Mr. SkepdocProf! I really believe that you honestly do not see why statements such as “like a religion” or ” EE is proof that you don’t need the flu jab and still won’t gt the flu” are logically absurd to anyone who buys into the idea of The Enlightenment
          You sir, are my favourite “guilty pleasure” – and I mean this very much in a “pre – enlightenment” sense.

  • Happy to help you!

  • Here is an interesting point of view:

    Margaret McCartney: What use is mass flu vaccination?
    BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6182 (Published 20 October 2014) Cite this as: BMJ 2014;349:g6182

    Margaret McCartney, general practitioner, Glasgow

    margaret@margaretmccartney.com

    It’s flu vaccination season again. People over 65 and those aged six months to 65 years who have a clinical risk factor (such as heart disease, asthma with regular inhaled steroid use, or chronic kidney disease) are eligible for the vaccine, along with people who live in residential care homes, pregnant women, and carers. Health and social care workers in direct contact with patients are also being encouraged to have the vaccine. But does it work?1 2 3 4

    For each healthy adult, a Cochrane review found that vaccination saved an average of just 0.04 days off work and concluded that no evidence supported it as a routine public health measure.5 And among over 65s, Cochrane reviews found only poor quality data and were unable to draw conclusions of any benefit, thus recommending more trials.6 As for children, Cochrane again found the available studies to be of poor quality: the number needed to vaccinate to prevent one case ranged from seven (live vaccine) to 28 (inactivated vaccine),7 and effectiveness varied greatly depending on the season.8

    The evidence is uncertain among people with asthma9; however, flu vaccination does seem to usefully reduce exacerbations in people who have chronic obstructive pulmonary disease.10 And a review of flu vaccination trials for healthcare workers who looked after older people in long term residential care found no meaningful difference in the number of cases of laboratory confirmed flu, admissions to hospital, or deaths from respiratory infections in residents.11

    So, why are we vaccinating so many people in whom we have no proof that it works? We should surely be doing randomised controlled trials of the vaccine in healthy over 65s and healthcare workers, at least.

    The NHS has a “Flu Fighter” campaign to encourage uptake and offer incentives for staff to bare their biceps. In return for vaccination, hospitals have offered their staff entry into cash prize draws, as well as chocolates, lollipops, cakes, biscuits, stickers that read “I’m a Flu Fighter,” and even an extra day’s annual leave, some freedom of information requests have shown. But will those days off work be offset by the average 0.04 days saved through vaccination?

    Treating children is one thing; treating adults like children is quite another. The Department of Health wants trusts to achieve a 75% uptake in flu vaccination for staff,1 when it would be better off ensuring that resources are used where they can do some good. I would have the vaccination if a high quality trial showed that it was worth it for me or my patients. But flu vaccination is offered millions of times every year at huge opportunity cost; given so much uncertainty, this policy is impossible to justify.
    Notes

    Cite this as: BMJ 2014;349:g6182

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