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"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

 

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Chiropractic

Safe for children?

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"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)

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"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)

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"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)

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"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)

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"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)

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"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)

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"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)

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"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)

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[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)

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"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)

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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)

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"...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)

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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)

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 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)

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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]

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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 (

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“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)

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"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)

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“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)