In January, Melbourne chiropractor Ian Rossborough uploaded a video to YouTube of himself treating a 4-day-old premature infant. The video, one of many that can be found on his “Chiropractic Excellence” channel, is for educational purposes only, intended to teach the world about the miraculous benefits of chiropractic care for a wide variety of conditions. Although the cynical among us may proclaim that his videos are just more examples of chiropractic practice building shenanigans, Rossborough claims that he simply wants to “enable natural healthy living, without resorting to drugs or surgery.”
Australian physicians respond
Well, there are apparently a lot of angry and cynical Australians, particularly journalists and physicians. In late April, the video, which features Rossborough manipulating the newborn’s thoracic spine hard enough to cause a loud cracking sound and a cry of pain went viral after it was featured in a story on Australian Broadcasting Corporation Radio National. Rossborough, and the treatment of children by chiropractors, has since come under intense scrutiny.
According to the Australian press, “doctors have declared war on chiropractors” in response to the realization that newborns and young infants are undergoing unnecessary spinal manipulation for problems such as colic, acid reflux, and excessive crying as well as for nebulous benefits like boosting the immune system and improved growth and development. The Royal Australian College of General Practitioners, the largest medical college in Australia with a membership of over 30,000 rural and urban primary care physicians, has even requested that members refrain from referring patients to chiropractors. They want the federal government and private insurers to stop paying for nonsense such as infant chiropractic.
Frank Jones MD, president of the RACGP, has made the media rounds, describing infant and toddler adjustments as “seemingly almost cruel” and lacking any supporting evidence. He has also called for the Chiropractic Board of Australia to shape up in order to have any chance of being accepted as a legitimate scientific discipline. Jones thinks that chiropractors like Rossborough and his ilk don’t know what they are doing and are putting patients at risk. He reminds the public that a physician’s job is to advocate for patients and to try to reduce exposure to practices where the risk far exceeds any potential benefit. I like this guy.
History repeats itself
There are two interesting historical tidbits that are worth mentioning. Back in September of 2013, infant chiropractic in Australia was front and center after Melbourne pediatrician Chris Pappas reported a concerning case to the Australian Health Practitioner Regulation Agency (AHPRA), who handed the case over to the Chiropractic Board of Australia. Dr. Pappas had personally cared for a 4-month-old infant whose neck was allegedly broken by a chiropractor attempting to treat torticollis. Steven Novella wrote about the case at the time and, as usual, provided an excellent risk versus benefit analysis.
At the time, the President of the Australian Medical Association spoke out, calling for the chiropractic board to “either produce evidence supporting chiropractic treatments for children or rule out pediatric care.” He stressed, and nothing has changed since, that there is no available evidence to suggest that spinal manipulation helps infants in any way. As Steve discussed in his post, the initial response from chiropractic leadership was an attempt at damage control. They were simply beside themselves that a chiropractor’s good name was being sullied.
The plot thickened after Steve’s post, with reports that the chiropractor had been cleared by an investigation. The president of the Chiropractor’s Association of Australia claimed that the child had been found to have a congenital abnormality that only mimicked a “hangman’s fracture” of the second cervical vertebra. Dr. Pappas stood by his report. I like this guy too.
Soon after, doubts about the claims being made by the CAA were raised when the investigation’s report was leaked. There was evidence of a fracture as well as a congenital abnormality. And although it is true that certainty of a causal relationship is hard to prove, it strains credulity to hand wave the chiropractor’s role in injuring the child. The truly despicable aspect of this is the implication from the chiropractic community that the family must have caused the fracture themselves.
The chiropractic board’s toothless gesture
The second interesting historical tidbit is much more recent, occurring just one month prior to the Rossborough video going viral. In March of this year, the Chiropractic Board of Australia issued a statement on advertising that includes the following guffaw-inducing introduction:
The Board is very concerned about any chiropractors with advertising (including websites) that may not meet the required standards despite repeated guidance being provided by the Board.
In order to provide further clarity to both practitioners and the public, the Board provides the following clear advice on advertising matters.
So in an attempt to reign in blatantly false marketing by chiropractors, the board “strongly encourages practitioners to review their advertising and ensure it complies with the requirements of the National Law or they risk prosecution and/or disciplinary action.” Their response to the chiropractic community’s utter disregard for prior requests to stop lying to patients or their caregivers is to issue another request. As if anyone is listening, they reveal exactly what isn’t allowed:
Claims suggesting that manual therapy for spinal problems can assist with general wellness and/or benefit a variety of pediatric syndromes and organic conditions are not supported by satisfactory evidence. This includes claims relating to developmental and behavioral disorders, ADHD, autistic spectrum disorders, asthma, infantile colic, bedwetting, ear infections and digestive problems.
The National Law mentioned above specifies that advertising of health services that is “false, misleading or deceptive or is likely to be so” is prohibited. Testimonials aren’t allowed. Neither is advertising that “creates an unreasonable expectation of beneficial treatment, and/or encourages the indiscriminate or unnecessary use of health services.” Violations are a criminal offence punishable by fines of thousands of dollars per offence.
Despite rampant false advertising, the Rossborough video being just one of countless examples easily encountered online, nobody at the AHPRA is enforcing this law. Why? As we saw with the 2013 case, concerns are simply passed along to the chiropractic board. They might talk the talk, but their own president recently refused to condemn advertising in a Chiropractic Association of Australia’s newsletter for treating colic, fussiness, and tongue-tie.
More concern from experts and politicians in Australia
Adding to the response from the RACGP are concerns from the AMA Victoria as well as the Victorian Department of Health and Human Services. AMA Victoria’s president, Dr. Tony Bartone, pointed out that no evidence supports spinal manipulation for treating infant colic and that babies might be injured by chiropractic care. The Health Minister herself has written to the chiropractic board and AHPRA “demanding they take tougher action.” She also raised concerns about chiropractors who “pedal anti-vaccination myths outside their scope of practice.”
The disgraced chiropractor at the heart of this issue has not backed down. Soon after the backlash began he uploaded another video to YouTube in an attempt to respond to concerns voiced by the medical community and disgusted public. He also appeared live on Studio 10 in what can only be described as a painfully awkward defense of his methods.
His excuses actually make for excellent examples of the kind of thinking that we encounter from proponents of pseudoscience in medicine. They are full of logical missteps, false assumptions, and blatant rationalizations. I’ll discuss a few examples here but will be going into greater detail in my upcoming talk at NECSS next week.
1. “The reason why we adjust the babies is because the parents bring them to us…They come to us in desperation.”
I’ve been there both as a pediatrician and as a parent with an extremely fussy infant. There were weeks of what seemed like non-stop crying and many sleepless nights for my wife and I with our first child. And I’ve cared for many children whose parents were haggard with exhaustion and stress. I can understand how some parents feel desperate. But desperation is not an excuse to give false promises and charge money for taking advantage of the self-limited nature of infant colic.
2. “The birth process can be very traumatic for many babies so it is logical to check a newborn child to ensure their spine is functioning properly…”
Birth can be a traumatic process. Just today I diagnosed a broken clavicle in a 3-day-old infant. Babies can suffer bruised and swollen heads, broken bones, and even injured spinal nerves during difficult deliveries. This reality in no way supports the benefit of a chiropractic evaluation.
The kind of trauma they are talking about is the chiropractic subluxation, and it does not exist. There is no subtle birth trauma resulting in myriad widespread health concerns that can be detected by palpation of the skull and spine. There is no birth trauma that can be corrected by spinal manipulations.
3. “We do NOT twist, rotate, manipulate or randomly crack the spine.”
Except when you do. The video linked to at the onset of this post, several others by Rossborough, and countless others from other chiropractors reveal twisting, rotating, manipulation AND cracking. And it is random. Just because these practitioners have convinced themselves that they feel specific areas of decreased joint movement, increased heat, paraspinal edema, or unbalanced energy doesn’t mean it exists.
4. “There is a divide between some parts of the medical profession and chiropractic and I think it’s largely based on misunderstanding.”
No, it’s largely based on an understanding of human anatomy and physiology, and of infant behavior, and the many ways that we can fool ourselves into believing that a useless intervention works.
5. “We don’t treat colic as such. It’s not like in medicine where a symptom plus a symptom equals colic and then you get a medication for colic. There is no colic bone or part of the spine associated with colic.”
Rossborough is simply spouting classic “straight” chiropractic rhetoric. They say that they don’t treat specific illness or symptoms, they simply remove interference that prevents the body from healing. In the days of Daniel David Palmer, this vitalistic healing power was known as the Innate. It came down from God and coursed through the body to keep us healthy. With this in mind, it shouldn’t come as a surprise that Palmer and his son B.J. once considered making chiropractic into a religion.
These days there are still believers in the Innate, but most chiropractors simply give credit to the nervous system. The claims they make are equally outrageous however. But if you watch the video that started this whole mess, Rossborough clearly tells the parents that he is treating their child’s acid reflux disease. He knows what he is going to “find” before he examines the baby’s spine. Oh, and the medical treatment for colic is reassurance and counseling on methods to calm a fussy infant and to help deal with the stress associated with frequent crying spells.
What really happened in the Rossborough video?
The funny thing is, the child in the video doesn’t have acid reflux or colic. Neither of those are conditions we diagnose in 4-day-old infant. The kid was hungry.
What the parents describe, and taking into account the mild prematurity of the infant, is consistent with a hungry, cluster-feeding baby whose mother’s milk hadn’t come in yet. The reason the child was less fussy one week later was because by that time it had. She didn’t need chiropractic, she needed a weight check and an evaluation of her obvious jaundice. Her parents needed reassurance and breastfeeding support. They all just needed a good primary care doctor.
Conclusion: It’s bad down-under, is it worse up-over?
The Australian medical community, and even some high ranking government officials, are going on the offensive against blatant quackery thanks to a Melbourne chiropractor’s particularly unsettling marketing video. But it seems a bit like deja vu as similar concerns were raised two years ago when a young infant was likely severely injured by unnecessary manipulation of the neck. And while I’m happy that the Australian medical community is once again focusing on the most egregious example of chiropractic nonsense, the treatment of infants, I have to worry if this will actually result in any increased regulation or enforcement of truth in advertising laws already on the books.
Chiropractic in America is no different than in Australia*. There are also plenty of practitioners here who see newborns and children of all ages for a variety of medical conditions that have absolutely nothing to do with the spine. Where is the outrage of doctors and medical organizations here? The notoriously CAM-friendly American Academy of Pediatrics remains silent as usual.
*With the exception that Australian chiropractors perform spinal adjustments in a clockwise fashion rather than counterclockwise, because of the Coriolis force.