"What do you suppose takes place in the minds of children who have monthly or even weekly treatment for 'subluxations', 'leg-length inequalities', 'energy imbalances' or other delusional concepts…?"
George Magner, 'Chiropractic: The Victim's Perspective', p.124
This page was last updated on 16th November 2013.
"Many chiropractors continue to base their treatments on the 'detection' and 'correction' of 'subluxations', ill-defined and unproven spinal lesions unknown to the medical profession. Nevertheless, chiropractors 'adjust' these subluxations with any number of treatments, including manual therapy. Thus, the physician whose patient is receiving manual therapy from a chiropractor might be wholly unaware that the chiropractor is actually adjusting these non-existent subluxations. These adjustments cannot effectively treat back pain or any other condition or disease. In fact, no better example of this can be found than the International Chiropractors Association Council on Chiropractic Pediatrics, which will be holding, in conjunction with Canadian chiropractors, its annual convention in Montreal this coming October. There will be presentations on adjustments for breastfeeding infants and for pelvic instability in pregnant patients. (Chiropractors purport to detect and correct subluxations in children, too, including neonates.) Although apparently not a subject for this conference, the Council also promotes use of the Webster technique, an adjustment of the sacral subluxation purported to have many positive effects including facilitation of 'optimal fetal positioning'. Physicians should also be aware that many chiropractors are against vaccination. Anti-vaccination advocates have been invited to be presenters at previous chiropractic pediatrics conferences sponsored by this same organization. I suggest that the prudent family physician contemplating referring any patient to a chiropractor be fully informed about chiropractic practice before doing so and that reliance on chiropractors for that information might not present a complete picture. Jann J. Bellamy JD, President of the Campaign for Science-Based Healthcare, in a letter published in Canadian Family Physician (October 2013)
"Chiropractors should be banned from manipulating the skeletons of children until they can prove it helps instead of harms, AMA [Australian Medical Association] President Dr Steve Hambleton has said. Speaking in the wake of disputed claims that the vertebrae of a four-month-old baby was fractured during chiropractic treatment, Dr Hambleton said there should be a stop to chiropractic procedures on children unless there is scientific evidence that they are beneficial...In addition to claims that some chiropractors are seeking to treat children from a very young age - some as young as just a few months old – several have been linked to the activities of anti-vaccination groups. Dr Hambleton said...there was no scientific support for the subluxation theory advanced by some chiropractors that correct spinal alignment boosts the immune system and obviates the need for vaccination." Adrian Rollins, Australian Medical Association (7th October 2013)
"Doctors are calling for chiropractors to stop treating children after a Melbourne infant's neck was broken during a chiropractic adjustment that went horribly wrong. Melbourne paediatrician Chris Pappas said he cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis - a wry neck, which is usually harmless in babies. He said the infant, who was rushed to Monash Medical Centre for treatment, was lucky to make a full recovery. ''It was a very fine line. Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia. Everybody was very nervous about this little baby,'' he said. The infant's case has inflamed tensions between doctors and chiropractors who are increasingly marketing treatments for childhood illnesses, including ear infections and asthma. Some chiropractors also claim that joint injuries sustained before and during birth can cause reflux, constipation, sleeping and breastfeeding problems. This has angered doctors who say chiropractic treatment of infants is unnecessary and puts them at risk of injuries and missed diagnoses. Fairfax has seen evidence that chiropractors have been entering hospitals, including maternity wards and surgical wards, to treat patients without permission...Spinal surgeon John Cunningham described such behaviour as a ''gross breach of professional ethics'' and said although birth trauma sounded plausible, a newborn's spine is very flexible and adapts to the birth process well. ''True spinal issues related to the birth process are incredibly rare,'' he said. President of the Australian Medical Association Dr Steve Hambleton said the board needed to either produce evidence supporting chiropractic treatments for children or rule paediatric care out of their scope of practice. ''The AMA is not aware of any evidence that chiropractic manipulative treatment of infants and children offers any benefit at all,'' he said. ''The board stood up recently and said chiropractors needed to stop talking about vaccinations, which is out of their scope of practice. That's the first time we've heard some positive evidence-based recommendations from the board, so let's start talking about children.'' A spokeswoman for the board said its chairman, Dr Phillip Donato, was unavailable for interview." Julia Medew, Amy Corderoy, The Age [Australia] (29th September 2013)
"Most of the information in this post was obtained from a closed, Australian chiropractic Facebook group. After much deliberation with friends, I have decided that the public interest far outweighs the interests of a group which cannot legitimately claim privacy, with a member list tallying 624, so far. Public safety is paramount to the self-serving interests of these chiropractors who flagrantly breach codes of conduct, health policies, and any semblance of professional courtesy, in their chase for legitimacy, based on the unwarranted treatment of magic, invisible conditions (subluxations); this is a legitimacy they do not deserve. The first time I came across the habit of chiropractors conducting their secret treatments in hospitals was in my recent series on anti-vaccine chiropractors...Helen Alevaki is the President of the Chiropractors' Association of Australia Victoria branch...In a post from the chiropractic group, Alevaki admits to sneaking into maternity wards under the guise of being a friend of the baby's parents, who are indeed her customers, to check brand new babies. About a week after that admission I was startled by another thread, in which a stream of chiropractors admitted to conducting their business inside our hospitals...I think what this practice really shows is the utter disdain held for evidence-based medicine by these chiropractors. Policies and procedures are implemented for good reason: the health and safety of the patient is paramount, and a good part of this is made possible by the maintenance of accurate health records, and with the collegiality of evidence-based health teams working together in the interests of the patient's health. To have magic-reliant cowboys stroll into this environment, in secret, with curtains drawn, shows the lack of respect they have for other practitioners, and their own codes of conduct, which amazingly claim ethics as one of their central tenets. Remember, these people are aiming to take their place beside trained medical professionals as primary health care providers. They don't even have the decency to consult with a real doctor; the same doctors of whom they are so disdainful, yet whose courtesy title they crave. The Friends of Science in Medicine have provided a statement regarding the information presented above. I didn't bother contacting the Chiropractors' Association of Australia, again. I wouldn't have expected them to reply anyway, as you have already seen.
Friends of Science in Medicine statement:
The highly unprofessional and potentially dangerous practices documented here demonstrate just how undisciplined is this "profession" despite the government's initiative to protect the public by having all chiropractors registered nationally. Their adherence to ethical standards of practice is the responsibility of the Chiropractic Board of Australia. A rapid and firm response from this Board following these revelations will be expected and monitored by Friends of Science in Medicine and no doubt many other professional bodies emphasising the importance of having credible scientific evidence of clinical effectiveness underpin the delivery of health care in Australia.
Importantly, not one chiropractor in that closed group...cautioned against this activity. Not one. Present and former CAA board members joined in, promoted, and condoned the activity. This speaks volumes. Tell me: what does it take to deregister a chiropractor these days? And, why do we allow them to use the courtesy title, 'Dr'?" Reasonable Hank blogspot (28th September 2013)
On Vaccination and Chiropractic: when ideology, history, perception, politics and jurisprudence collide
"The Palmers espoused anti-vaccination opinions in the early part of the 20th century, rejecting the germ theory of disease in favor of a worldview that a subluxation-free spine, achieved by spinal adjustments, would result in an unfettered innate intelligence; this, along with other healthful lifestyle choices, would allow a person to thwart disease by marshaling the body's natural recuperative abilities...because a significant portion of the chiropractic profession has aligned itself against one of the most successful health care initiatives of the past 100 years, the issue of chiropractic and vaccination will continue to be a source of contention, scrutiny and perhaps even animosity between chiropractic and medicine." Journal of the Canadian Chiropractic Association (September 2013: 57(3): 205–213)
"Why, we may well ask, are so many chiropractors against immunisations? The answer might be found in the history of chiropractic. Their founding fathers believed and taught that "subluxations" are the cause of all human diseases. To uphold this ridiculous creed, it was necessary to deny that infections play an important role in many illnesses. In other words, early chiropractors negated the germ theory of disease. Today, of course, they claim that all of this is ancient history – but the stance of many chiropractors against immunisations discloses fairly clearly, I think, that this is not true. Many chiropractic institutions still teach obsolete pseudo-knowledge and many chiropractors seem unable to totally free themselves from such obvious nonsense." Edzard Ernst MD (22nd August 2013)
"Chiropractors who perform spinal manipulations on children either believe in Palmer's nonsensical, unscientific principles of chiropractic, or, if they have tried to modernise their medical philosophy, continue treating patients despite the fact that what they're doing hasn't been shown to work or has been shown not to work. They're either deceiving themselves or they're deceiving their patients; in either case they're undermining their case for legitimacy as a genuine medical therapy and putting patients at risk unnecessarily." Argument Magazine (15th August 2013)
"In his 2002 paper in the Journal of the Canadian Chiropractic Association, Dr. R.J. Ferrence argues that in many cases worldwide, including in organizations like the American Chiropractic Association., the International Chiropractic Association and the World Chiropractic Association, support for childhood vaccinations is non-existent and anti-vax rhetoric -- like a focus on the dangers of vaccines and not the benefits -- is normal practice. The sole dissenter from this is the Canadian Chiropractic Association [CAA], which states unequivocally on its website: "The CCA accepts vaccination as a cost-effective and clinically efficient public health preventative procedure for certain viral and microbial diseases, as demonstrated by the scientific community." So, despite a traditional aversion to the idea that germs cause disease, as well as growing anti-vax sentiment in the chiropractic community, the CCA defends the importance of vaccination as an important public health measure. Curiously, the Ontario College of Chiropractic developed a standard for vaccination (S-015) in 2004 but it was later revoked in 2011. What is clear is that while the leading advocate for chiropractic in Canada states clearly that it supports childhood vaccination, the chiropractic community is not fully behind these efforts. Many chiropractors continue to cling to the chiropractic subluxation theory of disease, that the spine is the mediator of all disease and through its manipulation better health can be achieved...Recently, an update of a Cochrane Review on spinal manipulation for low back pain, the mainstay of chiropractic business, found it "...no more effective for acute low back pain than inert interventions." With the last bastion of credibility of chiropractic care slipping from their fingers, we should be cautious when turning to chiropractors for advice on childhood infectious disease." Michael Kruse, Huffington Post Canada (15th May 2013)
[Australian] chiropractors can make up the entirety of their annual 12½ hours of formal medical education - which they must undertake in order to continue practising - from known anti-vaccination proponents. The head of the Australian Medical Association, Steve Hambleton, said the Chiropractic Board of Australia is failing in its duty to protect the public by allowing the courses. One such course, which counts towards eight hours of education, is run by US anti-vaccination author Tim O'Shea...Another course is run by a US group that advises parents ''fear is an outmoded response to childhood infectious disease'', and they should focus on diet, homeopathy and acupuncture. Still more are taught by chiropractors associated with the Australian Vaccination Network, which campaigns against immunisation. Immunisation has saved hundreds of millions of lives. About 1.5 million deaths among children under five in 2008 alone were from diseases that could have been prevented by routine vaccination, says the World Health Organisation. Dr Hambleton said the courses put the public at risk. ''The chiropractic board's primary role is not to promote the profession, it's to protect the public, and they should step up and make sure they do that,'' he said...The vice-president of Friends of Science in Medicine, Alastair MacLennan, said it was appalling that chiropractors were claiming to treat children for a broad range of childhood conditions, let alone claiming they removed the need for vaccination...A spokesman for the Chiropractic Board of Australia...[said]...It has now released a statement advising chiropractors to avoid giving advice about vaccination as it is not their area of expertise." Amy Corderoy, Health Editor, Sydney Morning Herald (9th March 2013)
"The head of the Australian Medical Association said the government should stop funding chiropractic treatments, saying the growth in spending on children raises serious concerns. Treating children with chiropractic treatments could put their lives at risk if heavy force is used in spinal manipulation, or if the treatment is adopted at the expense of traditional medicine, maternal and child health experts say. Funding for chiropractic treatments for children aged up to 14 has increased by nearly 185 per cent in the past five years, Fairfax Media can reveal. The biggest increase has been in girls aged up to four, where subsidies have jumped 300 per cent. It is part of a boom in government-funded alternative medicine treatments subsidised under the Medicare chronic disease scheme. In 2010, the government spent $10 million on chiropractors and osteopaths. By 2012, this had increased to $15 million. Alastair MacLennan, an emeritus professor of obstetrics and gynaecology at the University of Adelaide, said it was appalling that chiropractors treat children "I absolutely believe it's child abuse," said Professor MacLennan, who is also the vice-president of Friends of Science in Medicine." Amy Corderoy, Health Editor, Sydney Morning Herald (8th March 2013)
A question was posed to me this week: can chiropractic treatments help with scoliosis?...I looked. And I am appalled. There is nothing - nothing, not a shred of evidence - that chiropractic can help scoliosis...[chiropractors] have illustrated that their own profession has neglected children. They have essentially no evidence that any of their treatments work for any pediatric condition. However, at the rate they're going, the tiny dribble of studies being published isn't going to come close to a decent, reliable body of literature any time soon. A single issue of Pediatrics contains far more studies looking at far more children than the entire accumulated published experience of the entire chiropractic profession...Chiropractic professionals need to decide. Is treating children part of our practice? If so, they should insist on quality information to guide their practice to effectively help pediatric patients. Until they have that knowledge, they ought to tell parents that, honestly, they have no idea what they're doing." Roy Benaroch, MD, Paediatrician, MedPage Today (28th February 2013)
Criticism of a Cochrane Review of manipulative therapies for infant colic: “If we read it [the plain language summary] carefully, this article seems to confirm that there is no reliable evidence to suggest that manipulative therapies are effective for infant colic. In the analyses, the positive effect disappears, if the parents are properly blinded; thus it is due to expectation or placebo. The studies that seem to show a positive effect are false positive, and spinal manipulation is, in fact, not effective. The analyses disclose another intriguing aspect: most trials failed to mention adverse effects. This confirms the findings of our own investigation and amounts to a remarkable breach of publication ethics (nobody seems to be astonished by this fact; is it normal that chiropractic researchers ignore generally accepted rules of ethics?). It also reflects badly on the ability of the investigators of the primary studies to be objective. They seem to aim at demonstrating only the positive effects of their intervention; science is, however, not about confirming the researchers’ prejudices, it is about testing hypotheses. The most remarkable thing about the new Cochrane review is, I think, the in-congruence of the actual results and the authors’ conclusion. To a critical observer, the former are clearly negative but the latter sound almost positive. I think this begs the question about the possibility of reviewer bias.” Edzard Ernst (27th December 2012)
"...chiropractors will pretend that they support vaccination, but it is lip service only. I've been at a trade show where the professional society for chiropractors was handing out blatantly anti-vaccination material, but when challenged it was all weasel words and "we think parents should have a choice"...I've been told that the Chiropractors' Association of Australia doesn't set the rules for what chiropractors can say or do, this is the responsibility of the Chiropractic Board of Australia, so I thought I would have a look to see what the Board had to say about vaccination. I have been assured that there is strong advocacy for vaccination in the rules and requirements that this national regulatory body applies to chiropractors...in summary:
1. The Chiropractors' Association of Australia, the professional body for the discipline, is opposed to vaccination.
2. The Chiropractic Board of Australia, the overseeing regulatory body, only mentions immunisation once in its Code of Conduct, and that is to give a vacuous suggestion that chiropractors should be aware of immunisation.
3. The Chiropractic & Osteopathic College of Australasia, another professional body, suggested to the Board that the Code of Conduct should require chiropractors to support vaccination as a public health issue and be vaccinated themselves. These recommendations were ignored by the Board.
4. The Board says that chiropractors should not deny the value of vaccines in their advertising.
5. Recommended professional education about vaccination is provided by someone who tells the same lies we have been hearing from anti-vaccination liars for years.
Now, tell me again how the Chiropractic Board of Australia supports vaccination and chiropractors have moved away from their historical position on the germ theory of disease and are now becoming something like a real medical profession worthy of respect..." Peter Bowditch, Australian Skeptics (10th December 2012)
“Chiropractors are treating newborns on the first day they emerge from a ‘cramped uterus’, but doctors warn parents are risking damaging babies, and that there's no evidence of any benefit.” Article by Tory Shepherd, The Punch, News Australia (20th July 2012)
“The aim of this overview was to critically evaluate the evidence of effectiveness for spinal manipulation in any paediatric condition…None of the systematic reviews generated conclusive evidence to suggest that spinal manipulation is an effective treatment for any paediatric condition. Collectively these data failed to demonstrate that spinal manipulation is a useful therapy for paediatric complaints. The safety of spinal manipulation in paediatrics is also less than clear.” Paul Posadzki and Edzard Ernst, Focus on Alternative and Complementary Therapies [FACT] (March 2012)
“With [its] Federal Government launching a new system of policing the burgeoning "complementary medicine" industry, leading Australian scientists and doctors have come out with guns blazing against chiropractic teaching and practice...Among those who have stepped into the fray are vaccine expert Ian Frazer, immunologist John Dwyer and paediatrician Jenny Couper, all of whom have raised objections to the chiropractic care of children.” Report in The Australian (2nd July 2011)
"The reluctance of chiropractors to change, in the face of a lost court case, the evidence and public opinion, is disconcerting…my friend and co-author Simon Singh was sued by the British Chiropractic Association (BCA) for writing in the Guardian that the BCA was "happily promoting bogus treatments" for a range of childhood conditions. The case ended with victory for Simon, not least because there is no good evidence that chiropractic spinal manipulation does more good than harm for paediatric conditions. But it seems that the children who should have been in the centre of all this are not among the winners in this dispute…The reluctance of chiropractors to get their act together, despite a lost court case, scientific evidence, and mounting negative public opinion, is more than a little disconcerting. Perhaps you think I am exaggerating? Consider this: the UK College of Chiropractors still has a ‘paediatric facility’. And not only that, this weekend they will hold a Paediatric Chiropractic Symposium in London. I think I can rest my case.” Professor Edzard Ernst, The Guardian (12th June 2012)
[Australia] Between 2006 and 2010 the government paid nearly $19 million in subsidies for chiropractic treatments alone, including more than $280,000 on children aged up to 14. Alastair MacLennan, a critic of alternative medicines and Head of Discipline of Obstetrics and Gynaecology at the University of Adelaide, said the government should only fund evidence-based treatments. ''The government should not be wasting the public's money subsidising something that is basically a religion without an evidence base,'' he said. ''Medicine is costly enough.'' Professor MacLennan said even the less harmful chiropractors only did ''good placebo work'', but others who were anti-vaccination or treated pregnant women or children could be dangerous. The Age (30th May 2011)
“Chiropractic, one of the several popular so-called complementary and alternative medicines(1), should never be applied to children. It simply isn’t based on credible scientific evidence...Chiropractic maintains that most, if not all diseases, are due to some kind of misalignment of the vertebrae of the spine. The proposed underlying “subluxations” could be corrected by a special manipulation with a “high velocity, low amplitude thrusts” which reconstitute the flow of a mysterious “universal intelligence”. A significant proportion of orthodox chiropractors still hold this view. The reality is that such chiropractic “subluxations” of the spine simply do not exist and that spinal manipulations have no bearing on general diseases unrelated to the spine…There is simply no evidence based on proper clinical trials that spinal manipulation can ameliorate children conditions such as attention deficit hyperactivity disorder (ADHD), nocturnal enuresis, infant colic, asthma, or boost to the immune system. (6) Conversely there is extensive documentation of serious adverse effects caused by chiropractic spinal manipulations. (7, 8)…Chiropractors who perform spinal manipulations on children, for conditions they should know cannot be cured by spinal manipulations, either believe the nonsensical principles of chiropractic – and this would amount to mere self-deception – or are deceiving parents of children.” Marcello Costa, MD, Professor of Neurophysiology, Dept. of Physiology at Flinders University, Adelaide, Australia (31st March 2011)
Document submitted to the Australian Federal Health Minister requesting closure of the Royal Melbourne Institute of Technology’s Chiropractic Paediatric Clinic
The request has been made on the basis that the Royal Melbourne Institute of Technology (RMIT) Chiropractic Paediatric Clinic is “teaching inappropriate and potentially dangerous techniques that target pregnant women, babies, infants and children”. The 20-page document submitted by Loretta Marron, a long standing campaigner against pseudosciences in health, includes expert opinion from high profile and well-regarded Professors of Medicine relating to supposed efficacy of chiropractic; identifies the claims made by lecturers and graduates from RMIT and other chiropractic teaching institutions; identifies the relevant codes of conduct that are breached by graduates; identifies research relating to spinal manipulation on a wide range of health conditions; refers to the General Chiropractic Council (UK) on comments on ‘subluxations’ and evidence-based practices; refers to the HCCC anti-vaccination campaign, which is supported by over 120 chiropractors; refers to a recent US-based court case which limits chiropractic diagnoses to biomechanical conditions of the spine and musculoskeletal system; and recommends that the competency and education standards for chiropractors be reviewed. (16th March 2011) [PDF]
Medical researchers Professor Shaun Holt and Andrew Gilbey have issued a strong warning against parents taking their children to see a chiropractor for any reason. Many chiropractic practices and organizations, in New Zealand and overseas, advocate routine spinal manipulation in infants and children, for conditions ranging from ear infections, colic and asthma to ADHD and even cancer. "There is no plausible explanation why high-velocity manipulation of the spine can help children with these medical conditions, it is an extraordinary claim" said Professor Holt. "Given that this is a multibillion dollar industry, the lack of good research that has been undertaken is staggering. There is also evidence that many chiropractors advise against routine childhood immunizations, which is irresponsible.” Andrew Gilbey said that “there are some serious safety concerns related to the unnecessary use of x-rays and the manipulation of childrens’ spines and so we advise parents to instead consult their family doctor who has been trained to recognize and treat a wide range of medical problems. In Canada, an undercover researcher reported that 4 out of 5 chiropractors found serious problems with the spine of a child and said that these required urgent chiropractic treatment, whereas an experienced paediatric orthopedic surgeon who also examined the girl found her to be perfectly healthy.” Holt and Gilbey's advice echoes similar warnings issued by paediatricians overseas. The Australian Medical Association has stated that chiropractic care for children is a waste of money and inappropriate. They advise parents who are worried about any aspect of their children's health to consult a medical doctor. Infonews New Zealand (14th October 2010)
"Parents should be made aware of possible risks associated with chiropractic treatment of children, particularly the services offered by 'pediatric chiropractors'. A 2009 survey of chiropractors and parents of chiropractic pediatric patients, conducted by the International Chiropractic Pediatric Association, revealed that “the indicated primary reason for chiropractic care of children was ‘wellness care’” (Alcantara 2009). The reasons given for such care would indicate that normal spines of healthy children are being manipulated for “subluxation correction.” There is no credible evidence to support the contention that subluxation correction will restore or maintain health or that such subluxations even exist (College 1996; Mirtz 2009)... A 1993 risk–benefit analysis of spinal manipulative therapy (SMT) for relief of lumbar or cervical pain, published in Online Neurosurgery, advised neurosurgeons that “potential complications and unknown benefits indicate that SMT should not be used in the pediatric population” (Powell 1993)...Although spinal manipulation is often recommended as a treatment for back pain, this recommendation does not often apply to children. When the U.S. Department of Health and Human Services published guidelines suggesting that spinal manipulation might be helpful in treating low back pain without radiculopathy (sciatic pain) when used within the first month of symptoms, its recommendations did not apply to children younger than eighteen years of age “since diagnostic and treatment considerations for this group are often different than for adults” (Bigos 1994)...All things considered, it’s an understatement to say that “pediatric chiropractic care is often inconsistent with recommended medical guidelines” (Lee 2000). Recommendation of any complementary alternative medicine (CAM) therapy that has a risk–benefit ratio that is not acceptable and is not supported in medical literature may make a referring physician liable for negligence if the referral causes harm by delaying necessary conventional treatment (Cohen 2005). For this reason, and with the best interest of children in mind, few physicians would consider referring a child to a chiropractor." Samuel Homola, DC, Skeptical Inquirer (September/October 2010)
“…a lack of evidence for chiropractic in children has been noted since the 1940s, and almost the same lack of evidence persists today...Mainstream medicine has changed its practice on the basis of evidence. Will chiropractors do the same?” Margaret McCartney MD, Financial Times (13th June 2010)
What about the claim that chiropractic treatment helps ADHD? Jean Mercer, PhD, takes a critical look at the paper ‘The chiropractic care of children with Attention Deficit/Hyperactivity Disorder: A retrospective series’ (Alcantara, J., & Davis, J.,) which was published in 2010 in Explore: The Journal of Science and Healing (pp. 173-182). Psychology Today (13th June 2010)
Although 14% of chiropractic patients are children, chiropractors have done almost no robust research in this area. Chiropractic & Osteopathy (June 2010)
Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review
Concludes: “To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.” Fay Karpouzis, Rod Bonello and Henry Pollard. Chiropractic & Osteopathy (2nd June 2010)
The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?
“With this review, we have detected a paradox within the chiropractic profession: Although the major reason for pediatric patients to attend a chiropractor is spinal pain, no adequate studies have been performed in this area. It is time for the chiropractic profession to take responsibility and systematically investigate the efficiency of joint manipulation of problems relating to the developing musculoskeletal system.” Lise Hestbaek and Mette Jensen Stochkendahl, Chiropractic & Osteopathy(2nd June 2010)
“It is hardly surprising then that there is no evidence to support treatment of conditions such as ear infections, given that the theory these treatments are based on is unsound. There is also no good evidence that such subluxations even exist, no plausible mechanism connecting such problems with the immune system (or any evidence of such a mechanism), and no plausible explanation of how spinal manipulations should affect such disparate parts of the body as the ear and the digestive system….There is a very real concern that children are being denied the best medical treatment due to the publication (and public consumption) of newspaper articles and web sites that make extraordinary claims regarding the use of alternative therapies such as chiropractic for treatment of a host of health problems. Parents should be as informed as possible when making health decisions for their children and it does not help matters that misinformation is so prevalent in the media today.” Centre for Inquiry (18th May 2010)
“I don’t know of any reason to believe that it might be necessary to refer a child to a pediatric chiropractor or to use spinal manipulation on a child prior to onset of adolescence. “Wellness care” in the form of “subluxation correction” is unnecessary and scientifically indefensible, and it places children at risk.” Samuel Homola DC, Science Based Medicine (3rd May 2010)
“What Bronfort should have concluded was not that there was inconclusive evidence but that there was no evidence for the use of chiropractic for otitis media.” Zeno’s blog (16th April 2010)
“Once again, we see alt-med promoters putting the cart before the horse. Chiropractors have an incredibly unlikely hypothesis, without any good clinical data to sugest that chiropractic can reverse breech presentation other than the claims of some chiropractors that they have a 95% success rate, with no evidence to document such a fantastic claim. They think that preventing fantastical subluxations in the mother prevents them in the baby and that babies born with these magical disorders require--of course!--chiropractic adjustment. In the meantime, in New Zealand, chiropractors are subjecting pregnant women to what is almost certainly a useless procedure and even studying it in a clinical trial. Quackademic medicine marches on.” Orac at Science Blogs (9th April 2010)
"With so little training and clinical experience in treating pregnant women and their babies, and with a limited treatment method that consists primarily of spinal manipulation, I cannot imagine how chiropractors can manage pregnancies or treat newborn babies and children." Samuel Homola, D.C. (Chirobase)
“In 2001, Patrick Cristopher Rolland was a candidate for the Master of Technology in Chiropractic Degree from Technikon Witwaterstrand, South Africa. His master's thesis was The Effect of Chiropractic Manipulative Therapy on Children With Attention Deficit Hyperactivity Disorder. …Despite [its] shortcomings, does this study validate the notion that spinal manipulation or chiropractic care can be a useful adjunct to the management of ADHD in children? No. The parents' responses were positive — but the parents knew that the study subjects were enrolled in the study. Bias is unavoidable. The teachers' responses (who presumably did not know the childrens' participation) were unchanged. Liz Ditz blogspot (20th December 2009)
Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials
"Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials." Ernst, E. Int J Clin Pract. (September 2009) [pdf]
"Previous research has shown that professional chiropractic organisations 'make claims for the clinical art of chiropractic that are not currently available scientific evidence…'. The claim to effectively treat otitis seems to be one of them. It is time now, I think, that chiropractors either produce the evidence or abandon the claim." Edzard Ernst in a letter to the International Journal of Clinical Practice (September 2009)
"None of the studies showed that real manipulation was more effective than sham-manipulation in improving lung function or subjective symptoms. It is concluded that, according to the evidence of the most rigorous studies available to date, spinal manipulation is not an effective treatment for asthma." Ernst, E. Respir Med. (29th July 2009)
"Although the content of the British Chiropractic Association's list is important, its omissions are perhaps even more so. At least three relevant randomised controlled trials and two systematic reviews are missing from it. Arguably, these are the most rigorous papers in this area, but they fail to show that chiropractic is effective. The omissions are all the more curious as the association apparently knew of these articles." Edzard Ernst, British Medical Journal (9th July 2009)
Professor Edzard Ernst challenges chiropractic organisations to either provide convincing evidence for chiropractic treatment of paediatric conditions or to change their websites' messages: "Chiropractors seem to believe that infants and children routinely require spinal adjustments. Their professional organizations' statements leave little doubt about this…..The following are 5 examples:
THE BRITISH CHIROPRACTIC ASSOCIATION — "As children grow, chiropractic can help not only the strains caused by the rough and tumble of life but also with some of the problems that children can suffer in their first years: Colic—sleeping and feeding problems—frequent ear infections—asthma—prolonged crying."; THE
CHIROPRACTIC ASSOCIATION OF IRELAND — "Even today's 'natural' childbirth methods can affect an infant's spine. Preliminary studies suggested that colic, unusual crying, poor appetite, ear infections or erratic sleeping habits can be signs of spinal distress";
THE McTIMONEY CHIROPRACTIC ASSOCIATION — Irritability, fractiousness, feeding problems, continuous crying, sleeps little, difficult to settle, colic, sickness and wind — all of these could indicate that there is a misalignment in the baby's skeletal system and that the baby is uncomfortable as a result";
THE NEW ZEALAND CHIROPRACTOR ASSOCIATION — "Parents and teachers often report children dramatically improve their attention span with Chiropractic care. Others report Chiropractic care as being the main reason for improved academic performance";
THE SCOTTISH CHIROPRACTORS ASSOCIATION — "Chiropractors are able to examine and evaluate a child's spine to determine if they can help problems such as colic, asthma, bedwetting, eczema and sleeping difficulties. Chiropractors advise that a child's spine be checked for subluxations and postural distortions before any symptoms are even present.""
Pediatrics, Vol. 122 No. 5 November 2008, pp. 1161 (doi:10.1542/peds.2008-2620)
"Medical doctors and even some chiropractors agree that chiropractic manipulation should never be done on young children. Most of a newborn's bones aren't even bone yet — they're partly cartilage. One chiropractor tried to tell me a newborn's neck is stretched up to 2 1/2 times normal length during the birth process, which is anatomically impossible. There is NO credible evidence that the birth process harms babies' spines or that chiropractic benefits children in any way." Article by Harriet Hall, MD, James Randi Educational Foundation (20th October 2008)
"Parents are wasting money on unnecessary chiropractic care for young children which is not achieving any medical result, says the Australian Medical Association (AMA). Early chiropractic treatment for children under 10 is "quite inappropriate", says AMA state president Peter Ford, because there is no medical evidence to suggest it works. Dr Ford urged parents concerned about their child's spine to consult a doctor or pediatrician and, if necessary, a specialist." Adelaide Now news report (17th October 2008)
SUMMARY: "There has been no substantive shift in this body of knowledge during the past 3 1/2 years. The health claims made by chiropractors with respect to the application of manipulation as a health care intervention for pediatric health conditions continue to be supported by only low levels of scientific evidence. Chiropractors continue to treat a wide variety of pediatric health conditions. The evidence rests primarily with clinical experience, descriptive case studies and very few observational and experimental studies. The health interests of pediatric patients would be advanced if more rigorous scientific inquiry was undertaken to examine the value of manipulative therapy in the treatment of pediatric conditions. Gotlib A, Rupert R. Chiropractic and Osteopathy (September 2008) [pdf]
"Consumer advocates and victims of chiropractic have asked to meet with Canadian legislators and the Minister of Health to propose the following guidelines: ONE: INFANTS AND CHILDREN: Highest neck manipulation should never be done in infants and children for claims to treat such conditions as ear infections, tonsillitis, infantile colic, asthma and gastro-intestinal disorders nor as an alternative to scientific immunization against diseases such as polio, tetanus, measles, mumps, German measles or chicken pox. The Chiefs of Paediatrics of our Canadian Hospitals have all condemned such claims by chiropractors…" Article by Harriet Hall, MD, Science Based Medicine (1st July 2008)
The Chiropractors Registration Board of Victoria has proposed chiropractic standards that attack core beliefs and practices of subluxation-based chiropractic. The draft document, which is intended to apply to children up to the age of about 13, states that "Non-indicated, unreliable and invalid diagnostic tools, instruments or methods and unnecessary diagnostic imaging procedures are to be avoided." It specifies:
(1) Routine radiographic examination and re-examination of pediatric patients is not recommended without clear clinical justification. X-ray examinations should not be performed solely for the detection of biomechanical disorders of the spine, such as vertebral subluxations, postural analysis or for the monitoring of spinal curves or posture, unless for monitoring progressive scoliosis;
(2) The use of . . . surface electromyography (SEMG) or thermography, is not considered appropriate in the diagnosis of childhood conditions;
(3) There is currently an overwhelming lack of good quality scientific evidence to support the use of spinal manipulation in the treatment of most "Type O" conditions.
"Type O" stands for organic/visceral disorders (diseases) as opposed to "type M" (musculoskeletal/biomechanical disorders). SEMG and thermography have no legitimate diagnostic value, but many subluxation-based chiropractors use them to sell patients long courses of unnecessary treatment.
(June 2008) [See the link's second news item.]
Article by Stephen Barrett, MD, Chirobase (28th May 2008)
A systematic review was performed to examine the usefulness of manual therapy (chiropractic, massage therapy, osteopathy, and mobilisation) for the treatment of adolescent scoliosis. The review found no positive data on the efficacy of manual therapy as treatment for adolescent scoliosis. Scoliosis (January 2008)
"The ability to adequately define and, subsequently, to evaluate improvement in several paediatric illnesses is problematic for physicians and even more problematic for chiropractors who do not have equivalent training in medical diagnosis……Further, well-designed studies are needed to evaluate the chiropractic belief that musculoskeletal dysfunctions can be located and treated in children with nonmusculoskeletal conditions." Canadian Paediatric Society (February 2007)
“Considering the diversity of MT [manual therapy] approaches in this area, research on outcome and harm for one treatment approach cannot be applied to all. And absence of evidence with regard to efficacy is not evidence of absence. It is clearly time for the advocates of MT in children to describe and delineate their approach and provide society and the profession with high-quality research evidence to substantiate claims of efficacy and safety. Until that time, as a clinician, I will continue to educate parents based on the lack of available evidence regarding outcome and the potential for harm. And most importantly, as a parent I will not expose my children to such interventions.” Peter A. Huijbregts, PT, DPT, OCS, FAAOMPT, FCAMT, The Journal of Manual & Manipulative Therapy Vol. 14 No. 1 (2006) [pdf]
An article criticising the rejection of vaccinations by chiropractors as based on "philosophy" and not scientific evidence: "The chiropractic anti-vaccination position was established by D. D. Palmer by likening vaccines to "filthy animal poisons". Palmer's views resulted not from any objective analysis of scientific data, but from a visceral rejection of anything he perceived to be associated with the medical profession of the day. His anti-immunization position was a narrowly dogmatic one that did not allow for any scientific advancements or the introduction of new data. In the face of now overwhelming evidence to show that vaccination is a highly effective public health procedure, Palmer's modern followers have turned to whatever sources they can to support chiropractic's archaic anti-immunization position. However, our preliminary analysis suggests that current chiropractic anti-immunization arguments rely heavily on highly biased and selective misrepresentations of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely "philosophical", not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths and false information to support this position." Journal of Manipulative and Physiological Therapeutics (June 2005)
Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)
A systematic review examining the effectiveness of chiropractic treatment of the KISS-syndrome (kinetic imbalance due to sub-occipital strain) in infants with positional preference, plagiocephaly (flattening of one side of the skull), and colic. It found no evidence that chiropractic spinal manipulation would be of any benefit to infants with KISS-syndrome, especially due to its potential risks. Ned Tijdschr Geneeskd. (26th March 2005) [Article in Dutch]
Concludes that there is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms. Canadian Coordinating Office for Health Technology Assessment (November 2003) [pdf]
"The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic." Stephen Hughes, Northwick Park Hospital, and Jennifer Bolton, Director of Research, Anglo European College of Chiropractic (UK) Archives of Disease in Childhood (2002)
Concludes that chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. Archives of Disease in Childhood (February 2001)
Effect of chiropractic intervention on small scoliotic curves in younger subjects: a time-series cohort design
Concludes that full-spine chiropractic adjustments with heel lifts and postural and lifestyle counselling are not effective in reducing the severity of scoliotic curves. Journal of Manipulative Therapeutics (2001)
"Pediatric chiropractic care is often inconsistent with recommended medical guidelines. National studies are needed to assess the safety, efficacy, and cost of chiropractic care for children." Archives of Pediatric and Adolescent Medicine (2000)
A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma
Concludes that in children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit. The New England Journal of Medicine (October 1998)
"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. Reasons for this are examined." Pediatrics (American Academy of Pediatrics)
"Many chiropractors advise against immunization….. Regardless of the reason, opposition to proven public health measures is irresponsible and can cause serious harm both to patients and to our society as a whole. Attitudes toward immunization offer a way to measure whether rank-and-file chiropractors wish to practice as cultists or scientists." Article by Stephen Barrett, M.D. (Chirobase)
"The strengths of this study include being population based, the high response rate, and collection of data on partial respondents (considered to be proxies for non-respondents) that included information on the behaviours of interest…..Chiropractors who deal with immunization-related issues frequently were found to be significantly less pro-vaccination than those who do so less often. Scrutiny of the beliefs data indicates that despite a majority accepting immunization as an effective means of curbing infectious diseases, many responses are consistent with common misconceptions. The single most common behaviour was to advise on freedom of choice about immunization…..Conclusions: Similar proportions of chiropractors advise patients in favour or against immunization. A small minority deals with immunization issues frequently. Behaviours can be understood in the context of beliefs." Margaret L. Russella, H. Stephen Injeyanb, Marja J. Verhoefa, Michael Eliasziwa, Vaccine [pdf]
Statement of the chiefs of the departments of pediatrics and pediatric hospitals in Canada (Haslam RHA and others,1994)
“We wish to express our great concern over unscientific claims being made by Canadian chiropractors regarding the proper care of infants and children. These claims come from official statements from both the Canadian and Ontario Chiropractic Associations. Chiropractic treatment for such conditions as ear infections, infantile colic, newborn jaundice, spinal scoliosis and tonsillitis, amongst others, are being recommended in at least one major textbook being used at the Canadian Memorial Chiropractic College in Toronto. We call upon the governments of Ontario and Quebec, which have the only two chiropractic schools in Canada, to evaluate the courses being taught and the claims being made by the graduates of these schools regarding the treatment of infants and children. Contrary to the information being provided to parents and to the general public:
1. Chiropractic spinal manipulation is NOT required as a preventive therapy to maintain a child's health.
2. Chiropractic spinal manipulation is NOT an alternative for pediatric immunization. Books sold at the Canadian Memorial Chiropractic College in Toronto are anti-immunization in nature.
3. Chiropractic does NOT alter the course of, nor does it prevent in any way, childhood illness such as ear infections, asthma attacks, bed-wetting, or infantile colic.
4. Chiropractic use of x-rays of infants and children to diagnose so called vertebral subluxations is unscientific and of no value whatsoever. These x-rays can contribute, without any benefit to the child, to the future risk in the child of cancers and genetic damage. Parents should never allow their children's spines to be x-rayed by a chiropractor.
5. There is no scientific evidence whatsoever that the so-called chiropractic spinal adjustment results in any correction to a child's spine. These adjustments are ineffective and useless.
6. School boards should not authorize, and parents should not allow their children to attend, elementary school screening programs organized by chiropractors to detect scoliosis or any other postural deformities in children. Postural deformities of children such as scoliosis, kyphosis, or unequal leg lengths are not effectively treated by manipulation. In the great majority of instances, what a chiropractor may diagnose as scoliosis in a child is in fact a minor variation in a perfectly normal spine.
7. Parents should regard with extreme skepticism claims made by some other parents that their infants or children have been cured by chiropractic adjustments for such conditions as infant colic, recurrent ear infections, learning disorders, asthma, chronic abdominal cramps, or bed-wetting. However well meaning, such personal testimony is unreliable and is not a substitute for scientific fact. Parents should read the June 1994 issue of Consumer Reports magazine in which the clear recommendation is made not to allow any chiropractor to solicit children for chiropractic treatment.
8. We understand the concern of parents in regard to ear infections that they may feel their child has taken many antibiotics or may require a surgical procedure. These concerns should not lead the parents to believe that chiropractic adjustments, which have the emotional appeal of being medication free or "natural" are an alternative to what may very well be in the best overall interests of the child.
9. We welcome the scientific guidelines of the Orthopractic Manipulation Society International, under which manual therapy can be given in a responsible manner to adults who may require such care. We welcome warnings made in these guidelines about the unscientific use of x-rays and unscientific claims about treating pediatric conditions. We would encourage parents to seek their own personal care from their physical therapists, physicians, and chiropractors who adhere to the scientific guidelines of the Orthopractic Manipulation Society International.
10. The musculo-skeletal problems of infants and children can be managed in a safe, scientific, and responsible manner by the family physician, the orthopedic specialist, the physical therapist, and with medical consultation, those chiropractors who adhere to the orthopractic guidelines.
11. We believe it to be irresponsible, and a total waste of our limited financial resources for the governments of Ontario, Manitoba, Saskatchewan, Alberta and British Columbia to be providing millions of dollars of public funds for chiropractors to treat infants and children. This public fiscal support gives parents the false impression that society endorses the treatments. We call upon these governments to immediately suspend all chiropractic payments in the pediatric age group, i.e., up to 18 years.”