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A bit of an editorial today, and a walk down memory lane. A few thoughts on chiropractic, if you’ll indulge me, starting with the origin story of my animus towards the profession and a bit on how my thinking has evolved over time. I’ll finish up with a few of the most egregious examples of how absurd and dangerous members of the profession can be when they attempt to manage pediatric patients.

I recently took care of a young child with constipation severe enough to require admission to the hospital for treatment. I’ve written about constipation in the past here on SBM. This was the kind of constipation that is far too common in children and can result in fecal impaction, severe acute pain that mimics surgical emergencies like appendicitis, chronic pain that can reduce a child’s quality of life, urinary tract infections, bedwetting, stool accidents, and social upheaval. Unfortunately, my patient had been undergoing “treatment” by a local chiropractor. Needless to say, it wasn’t working.

I couldn’t help but recall my first exposure to so-called pediatric chiropractic during my residency training at Vanderbilt Children’s Hospital in Nashville. At the time, I was familiar with chiropractic as a profession but didn’t know much more than that they were back and neck pain specialists in the same way that podiatrists focus on the feet. This erroneous assumption came mostly from commercials that I was exposed to in my youth. I can still remember the commercials for a chiropractor in Baton Rouge that played during the 1980s and promoted something called the “NOOPE Plan” (no out of pocket expense). Now I recognize this as an illegal marketing bait used to reel in more patients.

On that day in 2007, while on a pulmonary medicine rotation as a 2nd year resident, I encountered a child with a severe asthma exacerbation that had been under the care of a local chiropractor. As she developed increasingly severe respiratory distress, gasping for air with lungs already dangerously hyperexpanded and using every available muscle of respiration (retractions), her parents finally sought proper medical attention. The father, a famous musician, explained that he was told repeatedly by the chiropractor not to worry, that he had things under control. Luckily, the child responded to treatment quickly and did not require intensive care.

I remember being so angry back then. Of course, it didn’t help that at about that same time I also took care of a child with a life threatening infection in the deep tissue of the neck that was being treated with acupuncture. These experiences, and a fortuitous viewing of an interview of James Randi, set me on my current path. My initial stance on the subject of chiropractic, once my eyes had been opened to its potential for outright quackery, was firm and unyielding: all chiropractors were charlatans seeking to deceive the public, placing their patients at risk of severe injury or delayed medical care just to get more referrals and the chance to convince them of the benefits of long term contracts.

I have learned a lot since then, and developed a much more nuanced understanding on the subject of chiropractic and medical pseudoscience in general. Now I know that mine was a simplistic view, emotionally satisfying but clumsy and unfair. I’m not arguing that there isn’t an unfortunate amount of blind faith, arrogance of ignorance, and even intentional deception within the profession. Far from it. But as is so often the case, it’s complicated.

Over the past 13 years, I’ve read a great deal about the training and clinical activities of chiropractors. I’ve shadowed a pediatric chiropractor for a day. I’ve silently observed their message boards and have occasionally been unable to resist chiming in only to be banned. I’ve watched hundreds, if not thousands, of online marketing videos demonstrating a wide variety of pure and unadulterated pseudomedical buffoonery. (Just google “ring dinger” or “Y-Strap” to get a small taste.) I’ve read the research on strokes from vertebral artery injuries. I’ve seen several more pediatric patients whose care was inappropriately delayed. The bottom line is that if all anyone was ever exposed to was this, the correct stance would be that the profession deserves our contempt.

I’ve also conversed, both online and in person, with chiropractors who disagree with and even push back against the worst of these practices, publicly disavowing such nonsense as the chiropractic subluxation and the management of all but a short list of musculoskeletal complaints. There are evidence-minded chiropractors who promote quality medical information, work with physicians, and function essentially as physical therapists. There is legitimate chiropractic research. It can help some patients.

Does this absolve the entire profession of guilt? Of course not. Although I’m now much more cognizant of the chiropractors who don’t fit into my initial understanding, it is not clear to me how successful they have been in their efforts to reform chiropractic from within. I’d argue that it hasn’t been very successful at all if you take into account the overall quality of the online outreach from most chiropractic practices. And the bulk of the chiropractic literature isn’t much better, particularly when it involves children.

I have had several chiropractors tell me that the “good ones” far outnumber the practitioners treating asthma or promoting anti-vaccine propaganda, to name just a couple examples. But I’m not convinced by the surveys that I’ve seen. I think that it remains incredibly challenging for the public to weed out the charlatans and to find their way into the offices of a Samuel Homola or a Mark Croucher. So I still find myself wondering, if a science-based chiropractor is equivalent to a good physical therapist, why not just go to a physical therapist instead of rolling the dice in a rigged game?

But the question of just how generous to be when evaluating the chiropractic profession is entirely moot when we double back to the issue of pediatric chiropractic, particularly the nauseating concept of newborn/infant care. Any claim of chiropractic involving the evaluation and management of infants is indefensible nonsense based on magical thinking and pseudomedical garbage. All of it.

It boggles the mind that this is something that is even allowed in this country or any other. It serves as a prime example of how the regulation of quackery fails when the very people who promote and practice it are given oversight authority rather than those who would evaluate safety and effectiveness using rigorous scientific standards. The lack of basic scientific plausibility and the overall poor quality of clinical studies do not support any indication for bringing an infant to a chiropractor. But when the fox is guarding the hen house, I guess it makes sense that they would go for the most vulnerable first: the scared, the sick, and the young.

Here are a few examples of the pediatric chiropractic topics I’ve discussed over the years:

In my very first post for SBM, I discussed the limitations of chiropractic research that heavily relies on case reports, and claims of success in treating Tourette syndrome. I can’t believe it has been 8 years since I joined the team. I did a quick search and yes, nothing has changed in that time.

My 2013 post on the claims by some chiropractors that they can prevent the sudden unexpected death of an infant during sleep is still the one that makes me the most angry. Again, it’s like none of these people even read my posts. Sheesh!

In the past 8 years, I’ve also covered chiropractors managing newborns requiring resuscitation after delivery (yes, you read that right), claiming to prevent abusive head trauma (formerly known as shaken baby syndrome), managing dangerous abnormal heart rhythms, and manipulating infants under anesthesia. As with TS and SIDS, nothing has changed because there is apparently no political will for it to do so. That ship sadly sailed a long time ago and I don’t see a future where there are regulations put into place by the government. I am left hoping that those chiropractors fighting from within will gain a foothold, but I’m not holding my breath.

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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.