Keep Chiropractors Away From Children

May 18, 2010

Recent articles published by a variety of Canadian newspapers have promoted chiropractic treatments for children suffering from colic, ear infections, and digestive problems.  These include a Canadian Press piece " Chiropractors treat infants: Gentle touch is key when taking care of babies " as well as an editorial in the Winnipeg Free Press by a chiropractor himself: " Recent results speak for themselves "

Such articles do a great disservice to children, their parents, and the practice of medicine in Canada, as report Clifford W. Beninger and Lauren O’Driscoll of the Centre for Inquiry Committee for the Advancement of Scientific Skepticism in the following article.

There is no reliable evidence to suggest these chiropractic treatments for children are at all effective, and futhermore they are based on a pseudoscientific theory.  In particular, there have been recent publications stating that corrections of spinal "subluxations" (misalignments of the spine), especially of the upper neck vertebrae close to the base of the skull, can dramatically improve ear infections in children (Doctor of Chiropractic R.Froehle 1996).  However, these "peer-reviewed" studies have been published mainly in non-mainstream chiropractic rather than scientific journals, as they all suffer from serious methodological and analytical problems that ensure they would never be published in reputable journals. 

As claimed by Froehle (1996), children diagnosed with ear infections who had previously been treated with antibiotics needed more chiropractic "treatments" in order to improve, when compared to children who had no prior exposure to antibiotics. However, in the words of Froehle herself with regard to this study: "Because the subjects in this study constituted a sample of convenience... no inference regarding extrapolation to the target or general population may be drawn ." (emphasis ours). 

In addition, all the treatments in this study were carried out by the same chiropractor, whereas in a proper scientific study this should have been done by a randomly selected group of different chiropractors.  Other studies such as that of Doctor of Chiropractic K. Erickson and colleagues (2006) as well as L. Saunders (2004) detail chiropractic treatment of a single patient with ear infection - effectively a sample size of one - which statistically and scientifically means absolutely nothing. 

As a result, two recent articles in reputable scientific journals state: "The subcommittee made no recommendations for complementary and alternative medicine as a treatment for OME (ear infection) based on a lack of scientific evidence documenting efficacy..."  (medical doctor R. Rosenfeld and colleagues 2004) and "Only very few randomized clinical trials of chiropractic manipulation as a treatment for non-spinal conditions exist. The claim that this approach is effective for such conditions (as ear infection) is not based on data from rigorous clinical trials." (Professor of Complementary Medicine, E. Ernst 2003).

In the WFP article Dr. Chatzoglou states

Where the article falls short, however, is the author then proceeds to interview so-called experts to provide a counter-point. Now, these are people who are not chiropractors, have no training in chiropractic and minimal knowledge of chiropractic research, who are of the opinion that there is zero evidence to support these claims

However, sound science and the scientific method (which generally seem to elude the ability of chiropractors to employ), as well as the expert opinion of true medical doctors, are the real cornerstones for the treatment of disease that we have today.  Anyone who attempts to refute this is ignoring the vast body of evidence and, albeit unintentionally, misleading the public.

In the world of mainstream medicine, new treatments undergo a rigorous review process before they are allowed on the market. If a new treatment or medication is not proven to be effective in carefully controlled clinical trials, then it is not approved for general use. Unfortunately, as we can see from above, this is not the case with the few published studies on the effectiveness of chiropractic spinal manipulations for the treatment of non-spinal ailments such as ear infections.  In Britain, after considerable scrutiny was placed on the dubious claims made by chiropractors, the General Chiropractic Council, the country's regulatory body for chiropractors, recently commissioned a comprehensive report on the scientific evidence for chiropractic care. Result: for pediatric care, there was good evidence that chiropractic treatment was of no use in the treatment of infant colic, and no reliable evidence at all regarding treatment of ear infections.
 
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.

Since the mystic D.D. Palmer founded chiropractic in the 19th century, medical science and biology have made considerable progress in isolating the pathways of disease, and the body's response to it. No such progress has been made in chiropractic theory, which continues to cling to thoroughly outdated "vitalistic" notions.

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.  

Author Bios

Clifford W. Beninger
Clifford W. Beninger grew up in Sudbury, Ontario and completed a H.B.Sc. and M.Sc. in biology at Carleton University and in 1990 began his Ph.D. at the University of Ottawa, but conducted the research at the Canadian Forestry Service natural products lab in Sault Ste Marie Ontario. Since completion of his Ph.D. in Biology with a specialization in Chemical Ecology, he has worked for the USDA and University of Guelph on a variety of research projects.  He has 31 publications in peer-reviewed journals such as Chemical Ecology, Biochemical Systematics and Ecology and Food Chemistry.  Dr. Beninger currently lives in Ottawa and works as a consultant.  He is a member and science adviser of the Committee for the Advancement of Scientific Skepticism at CFI Canada.

Lauren O’Driscoll
Originally from Calgary, AB., Lauren O'Driscoll recently completed a BSc degree in criminology and psychology at the University of Toronto and a BSc- Psychology Honours degree at Macquarie University (Sydney, Australia). She has a number of years of research experience in both academic and clinical settings. Though her interests are fairly broad (pertaining to psychology and science more generally), Ms. Driscoll's research background is primarily within the area of social psychology. She is a member of the Committee for the Advancement of Scientific Skepticism at CFI Canada.

The Committee for the Advancement of Scientific Skepticism (CASS) is a national team which critically examines scientific, technological and medical claims in public discourse. Working with our expert advisers we address factual inaccuracies and misinformation in public debates by promoting evidence-based science. To achieve these ends CASS works within the infrastructure of Centre for Inquiry (CFI) Canada to co-ordinate campaigns with them and other interested parties.

References

Erickson, K. 2004. Case study in integrative medicine: Jared C. A child with recurrent otitis media and upper respiratory illness.  Explore 2: 235-237.
 
Ernst, E. 2003. Chiropractic manipulation for non-spinal pain – a systematic review. The New Zealand Medical Journal. 116:

Froehle, R.M. 1996. Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors.   Journal of Manipulative and Physiological Therapies 19:168-177.

Rosenfeld, R.M. Culpepper, L., Doyle K.J., Grundfast, K.M.  Hoberman, A., Kenna, M.A., Lieberthal, A.S., Mahoney, M., Wahl, R.A., Woods, C.R. and Yawn, B. 2004. Clinical practice guideline: Otitis media with effusion. Otolaryngology–Head and Neck Surgery 130:s95-s118.

Saunders, L.  2004. Chiropractic treatment of otitis media with effusion: a case report and literature review of the epidemiological risk factors that predispose towards the condition and that influence theoutcome of chiropractic treatment.  Clinical Chiropractic 7:168-173.

Comments:

#1 allena (Guest) on Tuesday May 18, 2010 at 12:10pm

I see chiro as similar to massage: it feels damn good, and it’s covered by my insurance. my older children also love how it feels. i’ve never bought into the bull* but I tell you what, it really really loosens you up and feels SO SO good.

is there evidence it could do HARM?

#2 Bill (Guest) on Tuesday May 18, 2010 at 12:15pm

I just recently found out that Windsor, Ontario’s Mayor’s wife is a chiropractor.  My friend who went to her told me that she was also telling people not to get vaccinations.  Although this is hearsay, I think it warrants investigation.

This upsets me greatly.  What can legally be done to stop this?

#3 asanta on Tuesday May 18, 2010 at 1:36pm

Allena, yes there is evidence of harm especially if the chiropractor is allowed to manipulate the neck. It has been known to cause paralysis and death. Take a look at the website ‘what’s the harm.com’.

#4 Stormy Fairweather (Guest) on Wednesday May 19, 2010 at 7:51am

This may well become a case example of evolution in action.

It may not be as simple as natural selection, but killing your kid through ignorance works nearly as well for removing the ‘idiot’ gene.

#5 J. (Guest) on Wednesday May 19, 2010 at 8:08am

There is probably no highly effective medical treatment that intervenes in the actual mechanisms of specific medical conditions that does not also carry serious risks. Chiropractic has no specific benefits but may have beneficial non-specific effects such as gratification, emotional support and relief of tension and anxiety but it is not harmless. Using it on babies is very troubling. Government should be supporting research into the risks of such “natural” and “harmless” practices and forbidding it’s use on children.

#6 Zara (Guest) on Wednesday May 19, 2010 at 10:32am

I personally love articles like this… they prove that anti-chiropractic, pro-medical all the way supporters are realizing that their hold on their once-blind following is slipping away…

“True medical doctors” do not know everything about the body or the way it functions. Medical doctors absolutely do not possess the sole understanding of disease; they do not hold all the keys to health; and they certainly are not the only ones who are capable of advancing health care.

The world is not the same place now as it was last week, let alone in 2004 (which is the most recent date of research these authors cite) – and we should celebrate that fact. There are choices in health care now that save lives and help prevent disease that were only beginning to be discovered a few years ago.

Perhaps there isn’t scientific evidence for how chiropractic can really help patients… yet. Chiropractic research lacks the powerful research capital from pharmaceutical companies that the medical profession enjoys. Should this mean that we never explore repeated incidents of one treatment helping a different condition than what it was designed to treat?

The blinders are coming off a public that once felt medicine was the only answer, and they are beginning to exercise their freedom to choose in the health care arena.

#7 Leigh (Guest) on Friday May 21, 2010 at 8:40am

Sorry, Zara you are an idiot. It is exactly this kind of anti-intellectual nonsense that is perpetuating the market for snake oil.

I find it hard not to read comments such as yours as having a “us and them” feel. Here is an idea: educate yourself about evidence based reasoning and a little high school science. Then come back if you still think the “blinkers are coming off” or if you now realise it is pure ignorance that people like you are promulgating. People are simply NOT EQUIPPED to make informed decisions when it comes to healthcare issues it has been shown time and time again.

This said it is a free world - if you want to throw your money away on some risky (yes risky) spinal subluxations that do precisely NOTHING (above that of a usual massage) go ahead. The thrust of the article was to simply keep your damn kids away from nonsense until they are old enough to make the stupid choice themselves.

#8 12345 on Friday May 21, 2010 at 2:11pm

As someone that has done my research and examines how others do their’s, I have found a peer-reviewed journal article that examines chiropractic care on 697 infants 12 weeks and younger.

http://www.ncbi.nlm.nih.gov/pubmed/18722196

The study found that chiropractic is a safe and effective form of therapy for children of this age.

Yes, everyone is entitled to make their own decisions about health care in any form that they believe in, but take into account that chiropractors have one of the lowest malpractice insurance rates of any practitioner in the health care industry.

If you find yourself with a little extra time, this is a good source as well:

http://www.ncbi.nlm.nih.gov/pubmed/17604553

Just a little food for thought…

#9 spindoc (Guest) on Friday May 21, 2010 at 7:13pm

12345,

Looked at your study. Stopped after the first paragraph as it was not a very useful study.


Suggest you base you opinions on studies that state they are prospective randomized and double-blind to eliminate as much bias as possible.

you can find sites to help you learn how to properly assess medical articles. For example

#10 spindoc (Guest) on Friday May 21, 2010 at 7:18pm

The BMJ link on how to read a paper did not get posted.

Here is what it says:


BMJ 1997;315:305-308 (2 August)
Education and debate
How to read a paper: Assessing the methodological quality of published papers
Trisha Greenhalgh, senior lecturer a

a Unit for Evidence-Based Practice and Policy, Department of Primary Care and Population Sciences, University College London Medical School/Royal Free Hospital School of Medicine, Whittington Hospital, London N19 5NF

Before changing your practice in the light of a published research paper, you should decide whether the methods used were valid. This article considers five essential questions that should form the basis of your decision.


Question 1: Was the study original?

Only a tiny proportion of medical research breaks entirely new ground, and an equally tiny proportion repeats exactly the steps of previous workers. The vast majority of research studies will tell us, at best, that a particular hypothesis is slightly more or less likely to be correct than it was before we added our piece to the wider jigsaw. Hence, it may be perfectly valid to do a study which is, on the face of it, “unoriginal.” Indeed, the whole science of meta-analysis depends on the literature containing more than one study that has addressed a question in much the same way.

The practical question to ask, then, about a new . . . [Full text of this article]


Question 2: Whom is the study about?

Question 3: Was the design of the study sensible?

Question 4: Was systematic bias avoided or minimised?
Randomised controlled trials
Non-randomised controlled clinical trials
Cohort studies
Case-control studies

Question 5: Was assessment “blind”?

Question 6: Were preliminary statistical questions dealt with?
Sample size
Duration of follow up
Completeness of follow up
Summary points

 

 

Assessing methodological quality of published papers
  Michael Gossop, John Marsden, and Peter Daish
  BMJ 1998 316: 151. [Extract] [Full Text]

#11 Zara (Guest) on Tuesday May 25, 2010 at 12:34pm

Oh, come on, Leigh… Your buttons are a little too easy to push. Seriously though, do you honestly think you’re going to convince someone by insulting them?

Just because you say something doesn’t make it so, but, I’ll play…

I would be happy to read your evidence-based research that has been published in a peer-reviewed publication accepted in the medical community that proves chiropractic is risky… or that people are not equipped to make informed choices for themselves.

#12 Clifford W. Beninger (Guest) on Monday May 31, 2010 at 8:50am

I think what is key here is that chiropractors should provide a form which is required for medical doctors as “informed consent”.  As in the Nette case she was never informed that manipulation of her upper spine could result in stroke which left her tetraplegic. A four year degree from the CMCC is a doctor in name only…

#13 Clifford W. Beninger (Guest) on Monday May 31, 2010 at 9:00am

Response to 12345.  Your “peer-reviewed” studies are all published in chiropractic journals. They are not recognized as having any scientific validity.

#14 G Mladenovic (Guest) on Wednesday June 02, 2010 at 8:54pm

It is really important that your selected chiropractor has the fine bedside manner that basically means that he/she should be capable to make the environment comfortable for the patients, by talking to them in a very pleasant tone.
Looking for Chiropractors in Adelaide? Visit us at Chiropractor Adelaide and know about what you have to know about Chiropractic Care.

#15 asanta on Sunday June 06, 2010 at 12:15am

#14 you are a quack. If the best you can offer is a fine bedside manner, you have meager offerings. The medical community values verifiable knowledge and results. You are also publishing spam by submitting advertising.

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