Medicine today is delivered by a team of health professionals. Whether it’s a primary care clinic or a large hospital, different professions work side-by-side, sharing responsibility for patient care. Teamwork is essential, and that’s only possible because health professionals share common roots. Whether you’re a physician, a pharmacist, a nurse, a dentist, a registered dietitian, or a physiotherapist, you work from the same core set of rules: scientific principles. Biochemistry, pharmacology, physiology, anatomy – all health professions accept the same basic “facts” of medicine.
Integrative medicine is a tactic of embedding complementary and alternative medical practices and providers into conventional medical care. While this is touted as giving the “best of both worlds” to patients, it’s not difficult to imagine how this can be problematic in practice. Integrative medicine explicitly seeks to “integrate” providers that may not accept the scientific basis of medicine, and who may offer treatments that can be antagonistic to established and accepted medical practices. Many alternative medicine practices have nonscientific roots, grounded in belief systems such as the idea of “vitalism“. While vitalism was discarded by science-based medical practitioners long ago, it lives on in the philosophies of practices like homeopathy, naturopathy, and chiropractic. It is these vitalistic roots that lead many alternative medicine providers to be antivaccine.
Chiropractic is an alternative medicine practice with deep anti-vaccine roots, which persist to this day. As discussed yesterday by Steven Novella, this week the Canadian Broadcasting Corporation (CBC) published a story illustrating concerning statements and advertisements made by chiropractors in the province of Manitoba. These statements are at odds with medical facts, and critics are questioning why chiropractic remains publicly funded in the province. Importantly, the story illustrates that many Manitoba chiropractors are routinely promoting opinions that contradict important public health goals. It also illustrates that considerable change is needed in the profession of chiropractic in order for it become a true allied health profession.
Chiropractic’s antivaccine roots
I won’t repeat the numerous scientific and evidentiary concerns with chiropractic, as they’ve been well documented before. Even in an area where chiropractic manipulations could more plausibly help, low back pain, the evidence for chiropratic manipulations is weak and unconvincing. However, as a physical therapy, there is the potential (and some support by chiroprators) for chiropractic to move towards a more science-based, evidence-based practice, as Steve discussed in yesterday’s post. But this will require a major shift in the basis of chiropractic itself, and a rejection of much of the dogma in the profession. Anti-vaccination is one of the most obvious examples of the vitalistic thinking in chiropractic that persists to this day. Anti-vaccination sentiment in chiropractic goes as far back as the first chiropractor. D.D. Palmer, the “inventor” of chiropractic, described vaccination as a “medical delusion” in 1889. Chirowatch itemizes the evidence, collected over decades, that antivaccination sentiment has been a part of chiropractic since that time. One of the most interesting studies was back in 2002 that found that students at Canadian Memorial Chiropractic College in Toronto appeared to be developing progressively more anti-vaccine sentiment, year-over-year of their education.
While many primarily think of chiropractic for back and neck pain issues, few chiropractors limit their practice to this area. Given there’s no scientific basis to the chiropractic “subluxation”, the business of chiropractic has expanded into treatments for many conditions which have never been shown to benefit from spinal manipulation therapies, and for which there is no credible evidence to support. And it’s clear that evidence is no real barrier to the marketing of chiropractic, as the CBC showed:
A CBC News analysis of company websites and Facebook pages of every registered chiropractor in Manitoba found several dozen examples of statements, claims and social media content at odds with many public health policies or medical research.
- Offers of treatments for autism, Tourette’s syndrome, Alzheimer’s disease, colic, infections and cancer.
- Anti-vaccination literature and recently published letters to the editor from chiropractors that discourage vaccination.
- An article claiming vaccines have caused a 200 to 600 per cent increase in autism rates.
- A statement that claims the education and training of a chiropractor is “virtually identical” to that of a medical doctor.
- Discouraging people from getting diagnostic tests such as CT scans, colonoscopies and mammograms.
- An informational video discouraging the use of sunscreen.
It seems anti-vaccine, vitalism-believing chiropractors aren’t hard to find:
The Manitoba Chiropractors Association (MCA) is responsible for regulating chiropractors in Manitoba. Its website makes no public mention of vaccination. Unlike the Ontario Chiropractic Association the MCA’s website provides no public guidance to chiropractors, nor does it endorse the Canadian Chiropractic Association’s unambiguous statement on public health vaccination:
The Canadian Chiropractic Association recognizes that vaccination and immunization are established public health practices in the prevention of infectious diseases. Vaccination is not within the scope of chiropractic practice. The appropriate sources for patient consultation and education regarding vaccination and immunization are public health authorities and health professionals with a scope of practice that includes vaccination.
While the MCA states that they have addressed vaccination issues with “internal communication“, it is notable that none of this communication appeared to have had any meaningful effects on marketing claims made by Manitoba chiropractors.
This is not only a Manitoba issue. Anti-vaccination sentiment is well-document in chiropractors around the world. The Sydney Morning Herald has described chiropractors’ waiting rooms as “recruiting grounds for the anti-vaccination cause“. No less than (former Doctor) antivaccinationist Andrew Wakefield was the keynote speaker at the recent International Chiropractors Association’s Annual Conference on Chiropractic and Pediatrics, speaking, not surprisingly, on the (nonexistent) relationship between vaccines and autism.
The numerous instances where antivaccine sentiment has been noted among chiropractors was also reviewed by chiropractor Dana J Lawrence in 2012. She noted in her conclusion:
Anti-vaccination attitudes till [sic] abound within the chiropractic profession. Despite a growing body of evidence about the safety and efficacy of vaccination, many chiropractors do not believe in vaccination, will not recommend it to their patients, and place emphasis on risk rather than benefit. This is positioned within a context privileging individual autonomy, which by many is seen as core ethical value. But this puts the chiropractic profession outside the greater healthcare community and may contribute to its continued marginalization and small market impact.
Conclusion: The antivaccine roots run deep
Anti-vaccine views have been a part of chiropractic since inception. The facts of vaccination are untenable to those in the profession that prioritize its vitalistic roots over acceptance of scientific evidence. While not all chiropractors are antivaccine, it’s unclear whether the profession of chiropractic is ready or capable of accepting a scientific worldview and basis for its practice. And without this, chiropractors cannot be considered to be appropriate and capable of working alongside, and in partnership, with health professionals in the delivery of science-based health care. It seems clear that there is a long way for the profession of chiropractic to go.
Photos from flickr users University of Liverpool and Michael Dorausch, used under a CC licence.