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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
“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)
[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)
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]
"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)
Although 14% of chiropractic patients are children, chiropractors have done almost no robust research in this area. Chiropractic & Osteopathy (June 2010)
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)
“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)
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)
“…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)
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)
“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)
“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]
“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.”
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)
"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)