MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Here is the abstract of a paper that makes even the most senior assessor of quackery shudder:

Objective:

The purpose of this report is to describe the manipulation under anesthesia (MUA) treatment of 6 infants with newborn torticollis with a segmental dysfunction at C1/C2.

Clinical Features:

Six infants aged 4 1/2 to 15 months previously diagnosed with newborn torticollis were referred to a doctor of chiropractic owing to a failure to respond adequately to previous conservative therapies. Common physical findings were limited range of motion of the upper cervical spine. Radiographs demonstrated rotational malpositions and translation of atlas on axis in all 6 infants, and 1 had a subluxation of the C1/C2 articulation.

Interventions and Outcome:

Selection was based on complexity and variety of different clinical cases qualifying for MUA. Treatment consisted of 1 mobilization and was performed in the operating room of a children’s hospital by a certified chiropractic physician with the author assisting. Along with the chiropractor and his assistant, a children’s anesthesiologist, 1 to 2 operating nurses, a children’s radiologist, and in 1 case a pediatric surgeon were present. Before the mobilization, plain radiographs of the cervico-occipital area were taken. Three infants needed further investigation by a pediatric computed tomography scan of the area because of asymmetric bony conditions on the plain radiographs. Follow-up consultations at 2, 3, 5, or 6 weeks were done. Patient records were analyzed for restriction at baseline before MUA compared with after MUA treatment for active rotation, passive rotation, and passive rotation in full flexion of the upper cervical spine. All 3 measurements showed significant differences. The long-term outcome data was collected via phone calls to the parents at 6 to 72 months. The initial clinical improvements were maintained.

Conclusion:

These 6 infants with arthrogenic newborn torticollis, who did not respond to previous conservative treatment methods, responded to MUA.

___________________________________________________________________

After reading the full text, I see many very serious problems and questions with this paper; here are 14 of the most obvious ones.

1. A congenital torticollis (that’s essentially what these kids were suffering from) has a good prognosis and does not require such invasive treatments. There is thus no plausible reason to conduct a case series of this nature.

2. A retrospective case series does not allow conclusions about therapeutic effectiveness, yet in the article the author does just that.

3. The same applies to her conclusions about the safety of the interventions.

4. It is unclear how the 6 cases were selected; it seems possible or even likely that they are, in fact, 6 cases of many more treated over a long period of time.

5. If so, this paper is hardly a ‘retrospective case series’; at best it could be called a ‘best case series’.

6. The X-rays or CT scans are unnecessary and potentially harmful.

7. The anaesthesia is potentially very harmful and unjustifiable.

8. The outcome measure is unreliable, particularly if performed by the chiropractor who has a vested interest in generating a positive result.

9. The follow-up by telephone is inadequate.

10. The range of the follow-up period (6-72 months) is unacceptable.

11. The exact way in which informed consent was obtained is unclear. In particular, we would need to know whether the parents were fully informed about the futility of the treatment and its considerable risks.

12. The chiropractor who administered the treatments is not named. Why not?

13. Similarly, it is unclear why the other healthcare professionals involved in these treatments are not named as co-authors of the paper.

14. It is unclear whether ethical approval was obtained for these treatments.

The author seems inexperienced in publishing scientific articles; the present one is poorly written and badly constructed. A Medline research reveals that she has only one other publication to her name. So, perhaps one should not be too harsh in judging her. But what about her supervisors, the journal, its reviewers, its editor and the author’s institution? The author comes from the Department of Chiropractic Medicine, Medical Faculty University, Zurich, Switzerland. On their website, they state:

The Faculty of Medicine of the University of Zurich is committed to high quality teaching and continuing research-based education of students in health care professions. Excellent and internationally recognised scientists and clinically outstanding physicians are at the Faculty of Medicine devoted to patients and public health, to teaching, to the support of young researchers and to academic medicine. The interaction between research and teaching, and their connection to clinical practice play a central role for us…

The Faculty of Medicine of the University of Zurich promotes innovative research in the basic fields of medicine, in the clinical application of knowledge, in personalised medicine, in health care, and in the translational connection between all these research areas. In addition, it encourages the cooperation between primary care and specialised health care.

It seems that, with the above paper, the UZH must have made an exception. In my view, it is a clear case of scientific misconduct and child abuse.

19 Responses to A chiropractic paper that, in my view, is nothing less than the promotion of child abuse

  • Did you even read the paper or did you just provide a synopsis from Clay’s write up in SBM?

  • Yes i read it.

    Since some of your “points” were actually addressed in the paper it’s logical to question if you actually read the paper.

    Since your blog came a few days after Clays blog (almost 4 months after the paper was published) and your blog didnt really address anything new, its logical to think his blog prompted you to write your blog…and thus question if you actually read the paper or you simply gave a synposis of his points of concern.

    • I did not feel like explaining why the author’s addressing some of my points was totally inadequate. I think my points and are valid. I discuss the paper now because I was recently asked to write a short report about it that will be part of an official complaint to the UoZ [not that any of this is any of your business]. so please, give me a break with any more moronic allegations.

    • much more to the point: if you have read it, have you understood it; and if you have understood it, do you agree that it describes chiropractic child abuse? if not, why not?

      • The above actions do not appear to qualify as child abuse as it’s typically defined. I don’t know the laws in Switzerland on the topic but it’s unlikely to qualify as child abuse.

        “Child abuse: A complex set of behaviors that include child neglect and the physical, emotional, and sexual abuse of children. Although most people think first of physical abuse when they hear the term child abuse, physical abuse makes up only a small percentage of reported cases. Physical abuse is defined as physical injury inflicted upon the child with cruel and/or malicious intent, although the law recognizes that in some cases the parent or caretaker may not have intended to hurt the child; rather, the injury may have resulted from excessive discipline or physical punishment. Physical abuse includes punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child. Injuries that can be fatal include severe head trauma, shaken baby syndrome, trauma to the abdomen or chest, scalding, burns, drowning, suffocation, and poisoning. Child abuse should always be reported, investigated, and stopped.”

        https://www.medicinenet.com/script/main/art.asp?articlekey=8452

      • Prof Ernst, There is no such thing as “Chiropractic Child Abuse”. If you think that this is “Child Abuse”, you must report it to the most relevant police authority and court to prosecute. Otherwise, you are wasting your time and ours by posting such an item on your site. I await the courts opinion.

        • you are not very good at reading, aren’t you?
          I stated ‘in my view’.

          • In my view, Picasso is highly overrated.
            In my view, UK voters were manipulated into voting for Brexit.
            In my view “American Cheese” is more plastic than cheese.
            In my view, this is child abuse.

            Hopefully you see how the child abuse ‘view’ is a bit different than the others. Child abuse is a pretty serious accusation. If you can reasonably come to the conclusion that a medical practice is child abuse, wouldn’t ethics (or just basic human decency) require that you report it to authorities?

            Or were you just kidding about the child abuse thing? If that’s the case, researchers believe and most people think that ‘in my view’ is a great weasle-phrase.

          • as I stated above some time ago, I am involved in reporting this to the proper authorities. so stop wasting my time.

          • In my view, jm is an imbecile, however, this is supported by his/her/ze/zi/its ridiculous posts devoid of logic and reason. What can one expect from someone who scrapes the skin to cause a bruise and calls it healing?

        • @GibleyGibley on Thursday 11 April 2019 at 01:55

          I realise you are untroubled by the idea that logic and reason must apply to all life, let alone healthcare, but I will try to make it easy for even you to understand. Your thinking is the same as the imbecile (ie, chiro) who lives across the corner from me. I have trouble talking to him because he makes little sense.

          “Prof Ernst, There is no such thing as “Chiropractic Child Abuse”.”

          Let’s go to first principles; it is up to the person dispensing the ‘treatment’ to provide its justification, and, as there is none, physically assaulting a child for no reason is child abuse. If there is any evidence (real evidence, not of the chiro persuasion), then provide it. We all know you can’t.

          “If you think that this is “Child Abuse”, you must report it to the most relevant police authority and court to prosecute.”

          This is only relevant to demonstrate two things; an inability to write basic English, and a lack of understanding of the legal system. No surprise though in the chiro fantasy world.

          “Otherwise, you are wasting your time and ours by posting such an item on your site. I await the courts opinion.”

          Ditto.

          Not only do Kiwis butcher the English language, many also fail to understand some of the basic premises of science. My wife’s grandmother, who worked for Rutherford, must be tearing at the lid of her coffin to smack morons like you.

  • If you think child abuse has taken place you are obligated by LAW to report to the police. Please do so ASAP.

    If it is just a case of a dramatic headline i suggest you avoid the phrase “child abuse”

    I have not yet read the paper and my comment has nothing to do with the quality of work presented.

  • “In my view” is something like “doctor of chiropractic”, or “my refined palpating-skill allows me to locate the intervertebral lesion which is the source of your health problem…” or “a spinal manipulation is $45.00…and worth it!”…….All great weasel phrases.

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