A team of chiropractic researchers conducted a review of the safety of spinal manipulative therapy (SMT) in children under 10 years. They aimed to:
1) describe adverse events;
2) report the incidence of adverse events;
3) determine whether SMT increases the risk of adverse events compared to other interventions.
They searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. Eligible studies were case reports/series, cohort studies and randomized controlled trials. Studies of high and acceptable methodological quality were included.
Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown.
The authors concluded that the risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.
Thanks to their ingenious methodology, the authors managed to miss 11 of the 13 studies included in the review by Vohra et al which reported 9 serious adverse events and 20 cases of delayed diagnosis associated with SMT. Another review reported 15 serious adverse events and 775 mild to moderate adverse events following manual therapy. As far as I can see, the authors of the new review make just one reasonable point:
We recommend the implementation of a population-based active surveillance program to measure the incidence of severe and serious adverse events following SMT treatment in this population.
In the absence of such a surveillance system, any incidence figures are not just guess-work but also a depiction of the tip of a much bigger iceberg. So, why do the authors of this review not make this point clearly and powerfully? Why does the review read mostly like an attempt to white-wash a thorny subject? Why do they not provide a breakdown of the adverse events according to profession? The answer to these questions can be found at the very end of the paper:
This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.
This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and funding from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.
I have often felt that chiropractic is similar to a cult. An investigation by cult members into the dealings of a cult is not the most productive of concepts, I guess.
I am currently studying DD Palmer’s TEXTBOOK OF THE SCIENCE, ART, AND PHILOSOPHY OF CHIROPRACTIC. It is a 1 000 page volume full of ignorance, repetition, allegation, pomp, overstatement and utter nonsense. I strongly advise everyone to stay well clear of it.
However, skimming through this accumulation of flimflam, I was repeatedly reminded of the origin of the anti-vax stance to which so many chiropractors still subscribe. Yes, I did mention this before: Far too many chiropractors believe that vaccinations do not have a positive effect on public health.
In his book, originally published in 1910, Palmer tried (unsuccessfully, I fear) to explain the basic principles of chiropractic. Most chiropractors would have read at least some of this ‘textbook’. It therefore stands to reason that Palmer’s views still colour those of today’s chiropractors.
Here are a few quotes about immunisation directly from the book:
- On May 14, 1796, Jenner first committed the crime of vaccination…
- No person is improved by being poisoned by either smallpox or vaccination.
- [Vaccination] is the biggest piece of quackery and criminal outrage ever foisted upon any civilized people. Medical ignorance by which criminal outrages are murdering our children all over this country…
- Vaccination and inoculation are pathological; Chiropractic is physiological.
- Compulsory vaccination is an outrage and a gross interference with the liberty of the people in a land of freedom.
The question is, where did Palmer get this from? What is the reason for his anti-vax attitude? Reading the book, I get the impression that it might have been based on two main pillars: 1) his amazing ignorance and blinkered view on most things and 2) his deep antipathy of conventional medicine. To show you a little of the latter, here are just two further quotes:
- It is a pity that the medical profession are possessed of arrogance instead of liberality; that instead of encouraging and fostering advanced ideas, they stifle and discourage advancement; that they only adopt advanced ideas when they are compelled to do so by public opinion.
- The physician believes in his prescriptions; the pharmacist in the hidden power of drugs – superstitious therapeutics.
To this, I am tempted to add: … and chiropractors believe in the drivel written by DD Palmer over 100 years ago.
In the Republic of Ireland, chiropractors are not regulated and there is no legislation governing the profession. That means anyone who feels like it can call him/herself a chiropractor and start treating or advising patients regardless of what condition they may be suffering from. The ‘CHIROPRACTIC ASSOCIATION OF IRELAND‘ (CAI) is the professional organisation that represents chiropractors in the country. The purpose of the CAI is to maintain professional standards, liaise with various government and health bodies, and to be a professional voice for Chiropractic.
Recently, the CAI has warned that a proposed law banning practitioners of so-called alternative medicine (SCAM) from claiming they can treat cancer without any medical evidence could have “unintended and unforeseen” consequences for its members. The CAI wrote to health minister Simon Harris claiming that a lack of “clarity” in the bill could have serious implications for chiropractic patients and chiropractors.
I am inclined to agree: the bill would reduce the cash-flow of many charlatans trying to make a fast buck on the desperation of cancer patients. But most probably, Tony Accardi, the president of the CAI, did not have this in mind when he said that, if patients with cancer inform a medical practitioner they are seeing a chiropractor, it may be construed that the chiropractor is “attempting to treat the cancer even though [it] may be for neck/back pain or overall wellbeing”.
As the evidence is hardly convincing that chiropractic is effective for neck/back pain or wellbeing (see numerous previous posts on this blog), we might well ask what else chiropractors have to offer for cancer patients. This website, for instance, is one of many that makes concrete claims:
Chiropractic treatment can benefit cancer patients in many ways. It can reduce stress, increase mobility, and optimize function, and generally improve quality of life.
By easing headaches and nausea, and relieving muscle tightness and neuropathy pain, chiropractic can help patients follow through with their treatment plans, which may even help extend their lives.
Chiropractors treating cancer patients approach patient care in much the same way as other primary care providers by:
- Gathering a comprehensive health history
- Conducting a thorough physical exam
- Ordering necessary diagnostic tests
- Deciding on an appropriate treatment plan
The chiropractic course of treatment often includes spinal manipulation and adjustments that provide patients with pain relief as well as overall improvement in function.
Chiropractic care can also be a viable alternative to pain medication for cancer patients. Although the use of medication is common in the management of a patient’s pain, it’s estimated that at least half of all cancer patients do not receive tolerable relief from their pain. Chiropractic care can address this issue, potentially even decreasing a cancer patient’s dependence on pain medication.
Cancer treatment has historically been focused on treating the disease itself. While doctors of chiropractic don’t treat cancer directly, they function very effectively as part of an integrated care plan to help the patient obtain the best treatment results possible.
The CHIROPRACTIC CANCER FOUNDATION FOR CHILDREN go even further:
Dr. Garvey has a strong belief in the human body’s innate ability to combat cancer cells and other diseases. He has first-hand experience with cancer since Dr. Garvey, himself, was diagnosed with Leukemia at the age of eleven. Stress and poor circulation can undermine the body’s natural healing powers and interfere with the central nervous systems’s ability to communicate effectively. At the foundation, we believe that chiropractic adjustments and other natural healing techniques can mitigate or reverse stresses that lead to poor health and even life threatening diseases such as cancer.
The claims can thus be summarised as follows:
- reduce the stress suffered by cancer patients,
- increase their mobility,
- optimize their function,
- improve their quality of life,
- alleviate cancer pain,
- serve as an alternative to pain medication,
- decrease cancer patients’ dependence on pain medication,
- the ‘innate’ (vital force which, according to DD Palmer is stimulated by chiropractic adjustments of spinal subluxations) can combat cancer.
Considering the above-mentioned dispute, it is only fair to ask: where is the evidence that chiropractic achieves the above (or indeed anything else)? I have to admit, I don’t find any sound evidence for any of these claims. But, of course, I might be biased or blind.
So, if anybody knows of compelling evidence to support the above claims, it would be helpful to let me have it. Meanwhile, it might be an excellent idea for the Irish government to go ahead with their plan of banning practitioners of so-called alternative medicine (SCAM) from claiming they can treat cancer without any medical evidence, don’t you think?
About 85% of German children are treated with herbal remedies. Yet, little is known about the effects of such interventions. A new study might tell us more.
This analysis accessed 2063 datasets from the paediatric population in the PhytoVIS data base, screening for information on indication, gender, treatment, co-medication and tolerability. The results suggest that the majority of patients was treated with herbal medicine for the following conditions:
- common cold,
- digestive complaints,
- skin diseases,
- sleep disturbances
The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events.
The authors concluded that the results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.
If you are a fan of herbal medicine, you will be jubilant. If, on the other hand, you are a critical thinker or a responsible healthcare professional, you might wonder what this database is, why it was set up and how exactly these findings were produced. Here are some details:
The data were collected by means of a retrospective, anonymous, one-off survey consisting of 20 questions on the user’s experience with herbal remedies. The questions included complaints/ disease, information on drug use, concomitant factors/diseases as well as basic patient data. Trained interviewers performed the interviews in pharmacies and doctor’s offices. Data were collected in the Western Part of Germany between April 2014 and December 2016. The only inclusion criterion was the intake of herbal drugs in the last 8 weeks before the individual interview. The primary endpoint was the effect and tolerability of the products according to the user.
And who participated in this survey? If I understand it correctly, the survey is based on a convenience sample of parents using herbal remedies. This means that those parents who had a positive experience tended to volunteer, while those with a negative experience were absent or tended to refuse. (Thus the survey is not far from the scenario I often use where people in a hamburger restaurant are questioned whether they like hamburgers.)
So, there are two very obvious factors other than the effectiveness of herbal remedies determining the results:
- selection bias,
- lack of objective outcome measure.
This means that conclusions about the clinical effects of herbal remedies in paediatric patients are quite simply not possible on the basis of this survey. So, why do the authors nevertheless draw such conclusions (without a critical discussion of the limitations of their survey)?
Could it have something to do with the sponsor of the research?
The PhytoVIS study was funded by the Kooperation Phytopharmaka GbR Bonn, Germany.
Or could it have something to do with the affiliations of the paper’s authors:
1 Institute of Pharmacy, University of Leipzig, Brüderstr. 34, 04103, Leipzig, Germny. firstname.lastname@example.org.
2 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 573, Bonn, Germany. email@example.com.
3 Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
4 ClinNovis GmbH, Genter Str. 7, 50672, Cologne, Germany.
5 Bayer Consumer Health, Research & Development, Phytomedicines Supply and Development Center, Steigerwald Arzneimittelwerk GmbH, Havelstr. 5, 64295, Darmstadt, Germany.
6 Kooperation Phytopharmaka GbR, Plittersdorfer Str. 218, 53173, Bonn, Germany.
7 Institute of Pharmaceutical Biology, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438, Frankfurt, Germany.
8 Chair of Naturopathy, University Medicine Rostock, Ernst-Heydemann Str. 6, 18057, Rostock, Germany.
WHAT DO YOU THINK?
Chiropractors have a thing about treating children, babies and infants – not, I suspect, because it works but because it fills their bank accounts. To justify this abuse, they seem to go to any lengths – even to extrapolating from anecdote to evidence. This recently published case-report, for instance, described the chiropractic care of a neonate immediately post-partum who had experienced birth trauma.
The attending midwife noted the infant had an asynclitic head presentation at birth and as a result was born with an elongation of the occiput due to cranial molding, bilateral flexion at the elbows and shoulders with decreased range of motion in the cervical spine with tongue and lip tie. Oedema of the occiput with bruising was notable along with hypertonicity of cervical musculature at C1, hypertonicity (bilaterally) of the pectoral and biceps muscles, blanching and tension of lip tie, decreased suck reflex and tongue retraction with sucking, fascial restrictions at the ethmoid bones, at the occipital condyles (bilaterally), as well as at the shoulders and clavicles, bilaterally. An anterior subluxation of left sphenoid was noted.
The infant was cared for with chiropractic including a sphenobasilar adjustment. Following this adjustment, significant reduction in occipital edema was noted along with normal suck pattern and breastfeeding normalized.
The authors concluded that this case report provides supporting evidence that patients suffering from birth trauma may benefit from subluxation-based chiropractic care.
Oh no, this case report provides nothing of the sort! If anything, it shows that some chiropractors are so deluded that they even publish their cases of child abuse. The poor infant would almost certainly have developed at least as well without a chiropractor having come anywhere near him/her. And if the infant had truly been in need of treatment, then not by a chiropractor (who has no knowledge or training in diagnosing or treating a new-born), but by a proper paediatrician.
Every now and then, I come across a SCAM paper that is so ‘far out’ that, when reading it, my mind wants to boggle. This one (recently published in ‘Medical Acupuncture’) is about ‘paediatric scupuncture’ – no, not acupuncture performed by kids – it’s acupuncture for kids. The temptation to show you the full, unaltered abstract is too strong to resist:
Background: Approaching pediatric acupuncture from a spiritual perspective is the most effective means for providing a valuable holistic relatively noninvasive approach to pediatric acupuncture, as well as preventive treatments for the repulsion of disease and the correction of Qi (i.e., vital energy) imbalances.
Objectives: Parents may be taught to apply acupressure to their children with an excellent response, especially when given with loving kindness.
Materials and Methods: Methods include the use of acupressure, laser techniques, and acupuncture for children who do not display fear toward the shallow insertion of needles.
Results: Owing to the young age of the patients, children will display fast and effective positive responses to therapy, just as they are susceptible to negative effects in similar timeframes. Children will respond faster than adults to such treatments, which can also increase immune system functionality and bolster resistance to invasive forms of Qi imbalances and disease. Such treatments will also relieve pain and distress and improve concentration and mental attitudes in children. Difficult conditions such as attention-deficit/hyperactivity disorder (ADHD) and attention deficit disorder (ADD) can also be effectively treated through a spiritual approach to pediatric acupuncture.
Conclusions: Pediatric acupuncture from a spiritual perspective provides a specific, safe, and effective therapy for a wide variety of painful and nonpainful conditions through Qi balancing in children. Moreover, parents may be taught to apply acupressure to their children with an excellent response, especially when given with loving kindness. Such techniques not only resolve acute symptoms but also provide preventive measures and enable parent–child relationships to thrive. Overall, medical acupuncture from a spiritual perspective is one of the best complementary therapies in pediatrics.
Of course, you now wonder who is the genius able to produce such deep wisdom. It is Dr. Steven K.H. Aung. He says of himself that he is a pioneer in the integration of western, traditional Chinese and complementary medicine. His efforts have helped to make Alberta and Canada an active centre in the field of integrated and complementary medicine. His unique approach to medicine, combined with the remarkable compassion he brings to all that he does, has made him a highly respected teacher, researcher and physician.
Doctor Aung’s affiliations are impressive:
- Clinical Professor, Departments of Medicine & Family Medicine Faculty of Medicine and Dentistry, University of Alberta (Edmonton, Alberta, Canada)
- Adjunct Professor, Faculty of Rehabilitation Medicine, University of Alberta (Edmonton, Alberta, Canada)
- Chief instructor, examiner and curriculum consultant for the Medical Acupuncture Program (MAP), Faculty of Medicine and Dentistry, Continous Professional Learning, University of Alberta (Edmonton, Alberta, Canada)
In addition, he holds visiting professor appointments at:
- Beijing University of TCM and Research Institute,
- Capital University of Medical Sciences (Beijing),
- Heilongjiang University of TCM (Harbin, China),
- Showa University School of Medicine (Tokyo),
- California Institute for Human Science (Encinitas, California),
- Royal Melbourne Institute of Technology (Melbourne, Australia).
And now my mind truly boggles!
On this blog and elsewhere, I have repeatedly claimed that as early as 2002 I published data to show that UK homeopaths advise their patients against vaccinations.
So sorry, but this not entirely true!
The truth is that I had forgotten about this article published 1995 in the British Journal of General Practice. As it is quite short and reveals several interesting facts, allow me to provide it here in full:
Homoeopathic remedies are believed by doctors and patients to be almost totally safe. Is homoeopathic advice safe, for example on the subject of immunization? In order to answer this question, a questionnaire survey was undertaken in 1995 of all 45 homoeopaths listed in the Exeter ‘yellow pages’ business directory. A total of 23 replies (51%) were received, 10 from medically qualified and 13 from non-medically qualified homoeopaths.
The homoeopaths were asked to suggest which conditions they perceived as being most responsive to homoeopathy. The three most frequently cited conditions were allergies (suggested by 10 respondents), gynaecological problems (seven) and bowel problems (five). They were then asked to estimate the proportion of patients that were referred to them by orthodox doctors and the proportion that they referred to orthodox doctors. The mean estimated percentages were 1 % and 8%, respectively. The 23 respondents estimated that they spent a mean of 73 minutes on the first consultation.
The homoeopaths were asked whether they used or recommended orthodox immunization for children and whether they only used and recommended homoeopathic immunization. Seven of the 10 homoeopaths who were medically qualified recommended orthodox immunization but none of the 13 non-medically qualified homoeopaths did. One non-medically qualified homoeopath only used and recommended homoeopathic immunization.
Homoeopaths have been reported as being against orthodox immunization and advocating homoeopathic immunization for which no evidence of effectiveness exists. As yet there has been no attempt in the United Kingdom to monitor homoeopaths’ attitudes in this respect. The above findings imply that there may be a problem.
The British homoeopathic doctors’ organization (the Faculty of Homoeopathy) has distanced itself from the polemic of other homoeopaths against orthodox immunization, and editorials in the British Homoeopathic Journal call the abandonment of mass immunization ‘criminally irresponsible’ and ‘most unfortunate, in that it will be seen by most people as irresponsible and poorly based’.’ Homoeopathic remedies may be safe, but do all homoeopaths merit this attribute?
Yes indeed! These findings indicate that there may be a problem with non-medically trained homeopaths in the UK. It is good to see that now (24 years later) the NHS has taken note of it. At the same time, it is not at all good to see that non-medically trained homeopaths and their professional organisations have managed to remain in complete denial of it.
Yes, chiropractic spinal manipulation shows promise to alleviate symptoms of infant colic! At least, this is the result of an overview of systematic reviews of so-called alternative medicines (SCAMs) for infant colic. Here I focus merely on the part that deals with chiropractic spinal manipulation. The authors of the overview come to this result based mainly on the statement:
Spinal manipulation was assessed in six reviews [22, 23, 25,26,27,28]. Two multiple CAM reviews assessed manipulation but did not pool the results [22, 25]. Both found three trials to be effective [68, 69, 72, 73, or] with the exception of one .
And here are the references they cite (all the primary studies are on chiropractic manipulation):
22.Perry R, Hunt K, Ernst E. Nutritional supplements and other complementary medicines for infantile colic: a systematic review. Pediatrics. 2011;127:720–33.
23.Bruyas-Bertholo V, Lachaux A, Dubois J-P, Fourneret P, Letrilliart L. Quels traitements pour les coliques du nourrisson. Presse Med. 2012;41:e404–10.
24.Harb T, Matsuyama M, David M, Hill RJ. Infant colic—what works: a systematic review of interventions for breast-fed infants. J Pediatr Gastroenterol Nutr. 2016;62(5):668–86.
25.Gutiérrez-Castrellón P, Indrio F, Bolio-Galvis A, et al. Efficacy of Lactobacillus reuteri DSM 17938 for infantile colic. Systematic review with network meta-analysis. Medicine. 2017;96(51):e9375.
26.Dobson D, Lucassen PLBJ, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database of Systematic Reviews. 2012;(Issue 12. Art. No.: CD004796)
27.Gleberzon BJ, Arts J, Mei A, McManus EL. The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. J Can Chiropr Assoc. 2012;56(2):128–41.
28.Carnes D, Plunkett A, Ellwood J, et al. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open. 2018;8:e019040.
68.Wiberg J, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled trial with a blinded observer. J Manip Physiol Ther. 1999;22(8):517–22.
69.Mercer C. A study to determine the efficacy of chiropractic spinal adjustments as a treatment protocol in the Management of Infantile Colic [thesis]. Durban: Technikon Natal,Durban University; 1999.
70.Mercer C, Nook B. The efficacy of chiropractic spinal adjustments as a treatment protocol in the management of infantile colic. In: Presented at: 5th Biennial Congress of the World Federation of Chiropractic. Auckland; 1999. p. 170-1.
71.Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomized controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. 2001;84(2):138–41.
And here is the relevant part of the overview’s conclusion:
Spinal manipulation shows promise to alleviate symptoms of colic, although concerns remain as positive effects were only demonstrated when crying was measured by unblinded parent assessors.
I have several concerns about this new overview:
- My comments on the Canes paper are here and do not need repeating.
- My comments on the Dobson paper (according to the overview authors, it is the best of all the reviews) are also available and need no repeating.
- Reference 22 is a systematic review I did together with the lead author of the new overview while she was one of my co-workers at Exeter. It is not focussed on spinal manipulation, but on all SCAMs. Here is the relevant passage from our conclusions regarding spinal manipulation: The evidence for … manual therapies does not indicate an effect.
How the review authors could come to the verdict that spinal manipulation shows promise is thus more than a little mysterious. If we consider the following, it gets positively bewildering. Even the most rudimentary of searches on Medline will deliver a 2009 systematic review by myself entitled ‘Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials‘. It was the first systematic review on the subject but was not included in the new overview.
I do not know.
Here are my conclusions from this paper:
Collectively these RCTs fail to demonstrate that chiropractic spinal manipulation is an effective therapy for infant colic. The largest and best reported study failed to show effectiveness (11). Numerous weaknesses of the primary data would prevent ﬁrm conclusions, even if the results of all RCTs had been unanimously positive.
And here is what my review stated about the three primary RCTs assessed in all the other review authors:
The trial by Wiberg et al. (10) did not attempt to blind the infants’ parents who acted as the evaluators of the therapeutic success. The paper provides little details about the recruitment process, but it is fair to assume that patients were asked to participate in a trial of spinal manipulation. Thus one might expect a degree of disappointment in parents of the control group whose children did not receive this treatment. This, in turn, could have impacted on the parents’ subjective judgements. In any case, there is no control for placebo effects which can be very different for a physical intervention compared with an oral placebo – dimethicone was administered as a placebo and the authors stress that it is ‘no better than placebo treatment’.
The RCT by Olafsdottir et al. (11) is by far the best-reported study of all the included RCTs. In many ways, it is a replication of Wiberg’s investigation (10) but on a larger scale with twice the sample size. It is the only study where a serious attempt was made to control for the placebo effects of spinal manipulations. For these reasons, its results seem more reliable than those of the other RCTs.
The RCT by Browning and Miller (12) is a comparison of two manual techniques both of which are assumed by the authors to be effective. Thus it is essentially a non-inferiority trial. Yet, it is woefully underpowered for such a design. Even if it had the necessary power, its results would be difﬁcult to interpret because none of the two interventions have been proven to be effective. Thus, one would still be uncertain whether both interventions are similarly ineffective or effective. As it stands, the result simply seems to demonstrate that symptoms of infant colic lessen over time possibly as a result of non-speciﬁc therapeutic effects, the natural history of the disease, concomitant treatments, social desirability or a combination of these factors.
So, what should we conclude from all this? I am not sure – except for one thing, of course: I would not call the evidence for chiropractic spinal manipulation promising.
RE: Review of chiropractic spinal care for children under 12 years
The Australian Medical Association (AMA Victoria) appreciates the opportunity to respond to the Safer Care Victoria (SCV) consultation on chiropractic manipulation of children under 12 years.
The AMA is pleased that SCV has decided to review this practice which is manifestly unsafe and unwarranted.
Chiropractic spinal manipulation on children has received recent media attention and prompted community concerns about its safety, appropriateness and the professional duties of those undertaking it. Most notably, in February this year medical experts and the Victorian Government condemned the controversial practice of infant spine manipulation after footage emerged of a Melbourne chiropractor treating a two-week old baby on the chiropractor’s own site.
Treatment of infants and very young children
We are aware that chiropractors are treating children for problems such as “infantile colic” by manipulative therapies. There is no credible evidence for this, it is a dangerous practice in itself and it potentially impedes the proper assessment and management of an infant. Additionally, it preys on often tired parents by the promise of a frequently false unequivocal diagnosis and false “quick fix”. This is plainly unconscionable and dangerous behaviour.
In preparing our response, we engaged with doctors across many specialities who have offered valuable insights into the matters being considered as part of this review. It is our very firm view that the risk of undertaking spinal manipulation on small infants is of no benefit and is potentially extremely dangerous. Newborn babies are extremely fragile and AMA Victoria warns that damage done to a baby or infant may not be immediately obvious to parents, and may not manifest until many years later. This is supported by a study conducted by the American Academy of Pediatrics  which found serious adverse events may be associated with paediatric spinal manipulation.1
Another critical issue is that it is very unlikely that parents are providing informed consent to such procedures. For parents to provide informed consent, they would need to be fully advised of the risks including, for example:
• the diagnosis of “infant colic” is a catch all for a range of symptoms with different aetiologies;
• the potential drastic short and long term consequences of spinal manipulation on their baby;
• there are no scientific safety and efficacy studies undertaken; and
• there is no credible scientific evidence for manipulation.
Chiropractors should also be directing parents to general practitioners for the proper holistic assessment and care of the child and family.
Additionally, infants and very young children cannot provide assent for a procedure for which there is no evidence they require and which may leave them with long term consequences. Consideration of whether such potentially dangerous therapies, which are not underpinned by a strong evidence-base, should be supported by private health insurance rebates is also warranted.
Treatment of children under 12 years of age
Although there is limited evidence that some musculoskeletal treatments are effective in adults, there is no credible scientific evidence that manipulation, mobilisation or any applied spinal therapy in children under 12 years of age is warranted or safe.
AMA Victoria does not support clinical interventions unless there is scientific evidence that such treatments are useful in treating the illness. AMA Victoria also supports patients being fully informed on the illness and the risks and benefits to any treatment. When the risks are to be borne by a non-assenting child, the requirement of evidence and consent is especially important.
AMA Victoria strongly advocates that chiropractic (and other health professionals) spinal care for children under 12 years of age is dangerous, unwarranted and must cease immediately.
If you would like to discuss any aspect of our response, please contact Ms Nada Martinovic, Senior Policy Advisor on (03) 9280 8773 or firstname.lastname@example.org.
Associate Professor Julian Rait OAM AMA VICTORIA PRESIDENT
1 Sunita, V., et al., Adverse Events Associated with Pediatric Spinal Manipulation: A Systemic Review, Pediatrics, 2007: 119; 275-283.
I am truly delighted that the AMA Victoria agrees with many points I have tried to make previously (see for instance here, here and here). The statement is unsurpassed in its directness and strength. My congratulations to Prof Raith – very well done!
Let’s hope that professional bodies of other regions and counties will swiftly follow suit with equal clarity.
The UK-based homeopathic pharmacy AINSWORTH has attracted my attention several times already. Amongst other things, Tony Pinkus, the director of the firm, once accused me of having faked my research and I suspected him of violating the basic principles of research ethics in his study of homeopathy for autism.
In a big article, the Mail informs the reader that:
- AINSWORTH sell a guide (entitled ‘The Mother & And Child Remedy Prescriber’ and decorated with the codes of arms of both the Queen and Prince Charles) informing young mothers that homeopathy ‘will strengthen a child’s immune system more ably than any vaccine’.
- The guide also claims that infections like mumps and measles can be treated homeopathically.
- AINSWORTH sells homeopathic remedies used as vaccines against serious infections such as polio, measles, meningitis, etc.
- AINSWORTH’s guide claim that homeopathy ‘offers the clearest answer as to how to deal with the prevention of disease’.
- The guide claims furthermore that homeopathy is ‘a complete alternative to vaccination’.
- It even lists 7 homeopathic remedies for measles.
- AINSWORTH claim that homeopathy provides ‘natural immunity’.
- AINSWORTH sell products called ‘polio nosode’, and ‘meningeoma nosode’.
The Mail quotes several experts – including myself – who do not mince their words in condemning AINSWORTH for jeopardising public health. The paper also calls for AINSWORTH’s two royal warrants to be removed.
AINSWORTH, Buckingham Palace, and Clarence House all declined to comment.