MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

If you start reading the literature on chiropractic, you are bound to have surprises. The paucity of rigorous and meaningful research is one of them. I am constantly on the look-out for such papers but am regularly frustrated. Over the years, I got the impression that chiropractors tend to view research as an exercise in promotion – that is promotion of their very own trade.

Take this article, for instance. It seems to be a systematic review of chiropractic for breastfeeding. This is an interesting indication; remember: in 1998, Simon Singh wrote in the Guardian this comment “The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.” As a consequence, he got sued for libel; he won, of course, but ever since, chiropractors across the world are trying to pretend that there is some evidence for their treatments after all.

The authors of the new review searched Pubmed [1966-2013], Manual, Alternative and Natural Therapy Index System (MANTIS) [1964-2013] and Index to Chiropractic Literature [1984-2013] for the relevant literature. The search terms utilized “breastfeeding”, “breast feeding”, “breastfeeding difficulties”, “breastfeeding difficulty”, “TMJ dysfunction”, “temporomandibular joint”, “birth trauma” and “infants”, in the appropriate Boolean combinations. They also examined non-peer-reviewed articles as revealed by Index to Chiropractic Literature and conducted a secondary analysis of references. Inclusion criteria for their review included all papers on breastfeeding difficulties regardless of peer-review. Articles were excluded if they were not written in the English language.

The following articles met the inclusion criteria: 8 case reports, 2 case series, 3 cohort studies and 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. The findings revealed a “theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding.”

Based on these results, the authors concluded that chiropractors care of infants with breastfeeding difficulties by addressing spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex.

Have I promised too much?

I had thought that chiropractors had abandoned the subluxation nonsense! Not really, it seems.

I had thought that systematic reviews are about evidence of therapeutic effectiveness! Not in the weird world of chiropractic.

I would have thought that we all knew that ‘chiropractors care of infants with breastfeeding difficulties’ and do not need a review to confirm it! Yes, but what is good for business deserves another meaningless paper.

I would have thought that the conclusions of scientific articles need to be appropriate and based on the data provided! It seems that, in the realm of chiropractic, these rules do not apply.

An appropriate conclusion should have stated something like THERE IS NO GOOD EVIDENCE THAT CHIROPRACTIC CARE AIDS BREASTFEEDING. But that would have been entirely inappropriate from the chiropractic point of view because it is not a conclusion that promotes the sort of quackery most chiropractors rely upon for a living. And the concern over income is surely more important than telling the truth!

7 Responses to Chiropractic: beware the promotion masquerading as research

  • Prof. Ernst wrote: “1998, Simon Singh wrote in the Guardian…”

    A small correction, it was in 2008 that he wrote the Guardian article.

    Prof. Ernst wrote: “An appropriate conclusion should have stated something like THERE IS NO GOOD EVIDENCE THAT CHIROPRACTIC CARE AIDS BREASTFEEDING.”

    Interestingly, the Anglo European College of Chiropractic hosts a Combined Chiropractic and Midwifery Newborn Clinic which it describes as “a specialist centre for you and your baby, chiropractors and midwives have pooled their knowledge and experience with the goal of providing more effective ways to help mothers and babies establish successful breastfeeding”. See here:
    http://www.aecc.ac.uk/news/2013/02/28/combined-chiropractic-and-midwifery/

    Apparently the individual sessions last an hour, are free, and “babies who have attended are six times more likely to be able to feed successfully after treatment”:
    http://9564e6cf93ec0c618a68-4f22a039f96a487025fe8e71cbbe8130.r40.cf3.rackcdn.com/News%20and%20Events/Media%20Centre/Press%20releases/AECC%20suppport%20breastfeeding%20awareness%20week.pdf

    However, robust research data in support of that claim appear to missing.

    • The problem isn’t that “robust research data in support of that claim appear to missing” it’s that any and all research data indicate that chiropractic cannot help with breastfeeding.

      • @ notaduck

        Well they must have some minimal research data compiled from their observations to allow them to claim that “babies who have attended are six times more likely to be able to feed successfully after treatment”. Of course, if they examined the phenomena more deeply then they’d risk discovering that their initial assumptions were faulty – in which case they’d need to find a very convincing reason to justify keeping their ‘specialist centre’ open. Indeed, if chiropractors applied the scientific method of investigation correctly, their entire house of cards would collapse.

        • “Indeed, if chiropractors applied the scientific method of investigation correctly, their entire house of cards would collapse.”

          As it should.

  • I would like to know if what chiropractors do to babies’ necks, risks severe damage.
    I’ve heard for adults, neck manipulations are dangerous. But babies?
    I wouldn’t let a chiropractor go at a baby’s neck – doubt it would help, and might be harmful.

      • Yes, I heard about that episode and how the chiropractic board decided it wasn’t the chiropractor’s doing.
        That seemed suspicious to me, like self-defense on the part of the chiropractic profession.
        Similarly, I read about someone who died because a licensed naturopath didn’t do the right things when she was having a severe asthma attack. The naturopath is still practicing, in a different place. Apparently the naturopathic licensing board didn’t do anything about it.
        And when these practitioners are given a pass from their regulatory board, people may take that to mean it was OK, when it’s more like a Cat Regulatory Board deciding the ethics of mouse hunting.
        I didn’t find any research about chiropractic neck manipulations on babies.
        It’s an instinctively horrifying thought, though one can’t come to conclusions just based on emotional reactions. The problems with breastfeeding that they’re treating these babies for, perhaps don’t really need to be treated, even if the babies are actually stiff-necked and not just cranky or something.

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