Shares

Sigh. I’ve got déjà vu…all over again.

In May of 2018, I discussed an excellent article in The National Post by Sharon Kirkey that effectively showed infant chiropractic for the absurd and potentially dangerous nonsense that it is. I also evaluated the Canadian Chiropractic Association (CCA) president’s meager rebuttal. But Ka, as the old one’s say, is like a wheel, and its one purpose is to turn, and in the end it always comes back to the place where it had started.

Last week, Kirkey published another piece on the subject of infant chiropractic, with a rather memorable title: “This. Hurts. Babies: Doctors Alarmed at Weekend Courses Teaching Chiropractors How to Adjust Newborn Spines“. In the article, she points out the sad fact that while Australia is protecting young infants from unnecessary chiropractic adjustments, and associated exposure to all manner of anti-medical propaganda, Canadian babies are increasingly becoming targets of practitioners taking comically short training courses run by the International Chiropractic Pediatric Association:

Attendees will be practicing on baby dolls. “Any type of baby doll, other than Barbie (too small) or Cabbage Patch Kid (no neck) is acceptable,” according to the conference website. Mon Bébé is the preferred choice.

Several experts are quoted in the article, with each helping to further reveal that infant chiropractic has no legitimate evidence to support it as an intervention for any complaint, and that the claimed underlying pathology supposedly being treated is pure fantasy. As I have said many times in the past, it is at best a misguided treatment based on a true belief in chiropractic philosophy and a profound ignorance of infant medicine, and at worst a manipulative and fear-based marketing strategy designed to drum up business. And it does hurt kids, sometimes a lot.

The Canadian Chiropractic Association responds…again

Three days after The National Post article was published, the CCA issued a public statement meant to counter the claims made by Kirkey and the quoted experts. It raises more questions than it answers, and fails to provide any reasonable rationale for parents to bring their children to a chiropractor. It is very misleading and full of weasel words. Here are some highlights:

Millions of Canadians of all ages visit a chiropractor each year and there is a growing body of scientific evidence showing the value of chiropractic in the treatment of conditions and disorders related to the muscular, skeletal and nervous systems. Chiropractic treatments can effectively relieve pain, restore function and mobility and improve health outcomes for all Canadians, including children.

The first claim is undoubtedly true, although the percentage of those visits that involve infants is still, thankfully, fairly small. There is also a growing body of evidence involving chiropractic care, it just isn’t of a very high quality and it doesn’t support treatments that are specific to chiropractic for much more than some forms of mild back and neck pain, and even that is underwhelming. Chiropractic plays no role in treatment of the nervous system, and it is a huge leap to make claims regarding general health outcomes.

All of this is especially problematic when focusing on children, particularly infants. And if there was evidence to back up their claims, they would have cited it. What they do cite is a study on pediatric chiropractic care best practices, which is just a collection practices that they mostly agree on but they are thoroughly untrained for, such as assessing children for red flags concerning for serious illness. It contains no actual evidence that their treatment interventions are effective. In fact, it contains the following:

However, the scientific evidence for the effectiveness and efficacy of chiropractic care and spinal manipulation for treatment of children is not plentiful or definitive.

And if the evidence base for treatment of children is lacking, just imaging what infant chiropractic care might draw upon for guidance. Again, this was the study that the CCA cited in a rebuttal to Kirkey’s article, the primary point of which is to point out that infant chiropractic is not science-based. They’ve got nothing.

The only other citation is a study on reports of adverse events occurring during pediatric chiropractic interventions. They are congratulating themselves for being unable to causally link chiropractic care to any pediatric deaths with certainty. There were deaths and serious injuries, however. And of course, no pseudoscientific intervention is ever risk free. Even a small risk of minor injury outweighs the complete absence of benefit in the case of infant chiropractic care.

While Daniel David Palmer is considered the founder of chiropractic, the profession — like other mainstream healthcare fields — has evolved, growing more reliant on evidence-based, patient-centered care.

Yes, there are chiropractors that have denounced the fictional subluxation and provide what is essentially physical therapy without any of the philosophical nonsense. But any chiropractor who is treating infants has not evolved. There is no evidence to support it, and it is almost exclusively based on the false claim that birth trauma results in subluxations that interfere with the function of the nervous system.

We’ll give Ms. Kirkey the benefit of the doubt and assume she’s unaware of the extent of the curriculum taught at Canada’s two chiropractic colleges.

This is irrelevant to the concerns Kirkey and the quoted experts are expressing. There is no curriculum at any chiropractic college in Canada or throughout the world that prepares them to appropriately care for infant patients.

We’ll also acknowledge that a 12-hour continuing education course does not give one sufficient education or training to make a claim of expertise – in the field of pediatric chiropractic or any other field. As we have no affiliation with the course provider, we cannot comment on course quality or its teachings. And the claim that “most newborns need a spinal adjustment to unblock nervous system interference caused by the trauma of passing through the birth canal”, referenced in the article, is not supported by current scientific evidence.

Then why aren’t they doing something about it, considering that almost all Canadian chiropractors are members of the CCA?

Continuing education courses are common in all health professions. They afford practitioners the opportunity to learn about the latest evidence, guidelines and best practices and are intended to improve patient outcomes and care. However, in the case of chiropractors, continuing education courses aren’t their first introduction to pediatrics.

No chiropractic trainee has access to enough pediatric patients to gain anything remotely approximating expertise, and they have absolutely no exposure to ill children. They may learn about pediatric medicine from books and lectures, but they are not trained to provide competent pediatric care or to recognize true illness.

While there is no recognized pediatric specialization in chiropractic in Canada, pediatrics and pre- and ante-natal care are an integral component of the four-year chiropractic curriculum and include relevant topics such as embryology, genetics, congenital and developmental defects, maturation of the skeletal system, etc. Students also complete over 50 hours of coursework in pediatric diagnosis and management and antenatal care, followed by a mandatory one-year internship during which they care for patients of all ages under the supervision of an experienced chiropractor.

Pediatric residents are capped at an average of 80 hours a week, for three years. Even then it takes almost constant review to maintain diagnostic and management skills. To think that 50 hours is something to brag about reveals just how clueless these people are. I also highly doubt that these year-long internships improve their pediatric fund of knowledge very much. I guarantee that any 3rd year medication student having completed the typical 3-month pediatric rotation would blow any chiropractor out of the water.

Chiropractic is not simply the technique of adjustments or manipulations, although this is a common misconception. Chiropractors use a range of techniques, supplementary procedures and advice in the provision of comprehensive patient care. As allied health professionals, chiropractors also work collaboratively with a range of other healthcare providers using a collaborative care approach to co-manage and provide advice and referrals in the best interests of the patient.

Yes, they often do this despite a complete lack of evidence to support it. And their comprehensive patient care far too often involves promoting anti-vaccine propaganda.

Chiropractors put patient safety first. This is especially true with pediatric patients. When treating infants and children, chiropractors follow best practices. This includes modifying techniques and the application of force to support the needs and comfort of the child.

These are the best practices referenced above. None of them involves a treatment approach supported by actual evidence. If 80% of survey respondents agree on a certain treatment approach, it doesn’t mean that it works. It just means that they were exposed to the same propaganda and have fallen prey to the same biases.

Chiropractic expertise in the musculoskeletal system comes not only from seven years of intensive post-secondary education and practical hours, but also from a growing body of rigorous research. Since 1976, the Canadian Chiropractic Research Foundation (CCRF) has been funding chiropractic research to discover the best, evidence-informed treatments for patients living with pain and disability caused by spinal dysfunction and disease.

None of it in infants.

The body of knowledge that comes from research allows chiropractors to provide safe, scientifically-sound treatments in their practice – bringing the most advanced methods to patient care. Chiropractic research also informs other health professionals who partner with chiropractors to deliver quality MSK treatment to their patients.

None of this applies to infants.

Existing evidence related to pediatric chiropractic treatment draws heavily on inter-professional and international research studies. Available evidence suggests moderately positive or favourable outcomes in pediatric populations.

The study they cited, which I referenced above, says the exact opposite.

While the evidence for pediatric conditions is limited, research in this area is ongoing and growing. Like other healthcare professions the processes and challenges of translating an ever-increasing evidence base into practise is a healthcare wide issue not a chiropractic-specific one, but one that the chiropractic profession and educators take seriously.

So is there evidence or not? Perhaps aggressive marketing aimed at recruiting pediatric patients should stop until they have figured this out. Just a thought.

Same as it ever was: Infant chiropractic is pseudoscience

The article written by Sharon Kirkey is accurate across the board. There is no quality evidence that supports the treatment of infants by chiropractors for any reason. They should not be allowed to do it. The response from the CCA is hollow propaganda. If they had any integrity at all, they would join the call to end this pseudoscientific and risky practice.

Shares

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.