A few Thursdays ago, chiros in Australia copped a bollocking on Catalyst as Dr Maryanne Demasi turned a spotlight on their profession.

And it wasn’t pretty. What resulted was examples of quackery, infighting between professional bodies and the revelation that chiro does not have an adverse events (AE) reporting system.

You can watch the full report and read the transcript here

I want to emphasise the lack of an AE reporting system, because you often hear the cry from chiros that their profession is overwhelmingly safe, which is usually followed by some strawman about the numbers of iatrogenic deaths in science based medicine. But how do they know their profession is safe if they don’t record adverse events?

Well, to be blunt they don’t.

Even before the programme aired on Thursday night, many chiros had hit the Catalyst FB page,  in a pre-programme show of support (perhaps as result of an email that had been sent by the Chiropractic Association of Australia (CAA) to all chiros warning them about the impending criticism).

I decided to jump in too because I had a burning question that had been bugging me for weeks. It concerns the vaccination status of paediatric chiros and occurred to me when I saw some pictures of chiropractors leaning over very young children to adjust them or whatever they do.

This worries me for several reasons, 1) Australia has been in the grips of a pertussis epidemic and kids have died 2) it’s thought that it is adults who are passing on the bacteria because their vaccination has worn off (pertussis vaccination only lasts between 4 and 8 years) and 3) kids under the age of 12 months are most likely to suffer and die from infection with pertussis given that they are not fully vaccinated thus they’re not protected.

Also by way of background, there are two professional associations for chiros in Australia, the CAA who previously had no policy in vaccination but published one (of sorts) in May 2013.

It’s pretty wishy washy in my opinion,

“Chiropractors do not provide vaccination services; Chiropractors should encourage their patients to make informed health care decisions and to consult their GP in relation to the risks and benefits of vaccination.”

The other being the The Chiropractic and Osteopathic College of Australasia (COCA) who are quite clear about their stance on vaccination,

“(COCA) endorses the Government of Australia’s policy and position on immunisation as a simple, safe and effective way of protecting people against harmful diseases.”

The full policy can be found here (PDF)

So I had a burning question for paediatric chiros, concerning duty of care for babies and what steps they take to ensure they’re protected during manipulations. I ask this because my guess is if the chiros themselves are anti-vaccination then it seems unlikely they will be diligent about getting boosters, but I could be wrong and I hope I am.

Well known to readers of this blog is anti-vaccine paediatric chiropractor, recently the secretary of the CAANSW, Nimrod Weiner, and who has published several pictures of himself leaning over babies whilst adjusting them on his Facebook page.

Nimrod Weiner declined to comment on the Catalyst episode, (even though a complaint made about his anti-vaccine material was mentioned) so I started off by commenting on a post made by Dr Tony Croke, who says on his website that he “..is skilled in cranial adjusting techniques, which are often very helpful for babies and children”.

He has also previously been a professional member of the anti-vaccination lobby group the AVN (details – well, sort of – here). He is also on the National Board of the CAA, who approved a continuing professional development course by notorious anti-vaccine chiro Tim O’Shea (see coverage here).

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Note the time stamp, 22:45, 12th July, 2013.

I had no luck sadly, so I posted a new thread on July 13th at 00:05

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When still no chiropractors commented, my friend Annette had a go

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Eventually a chiropractor by the name of Steele Butcher jumped in with this

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Let me repeat that,
“As with many professions politics get in the way.”

Politics gets in the way of duty of care to babies. Babies who cannot fend for themselves and are susceptible to vaccine preventable disease which could so easily be prevented if the CAA had the balls to tell their paediatric chiros to get boosted (if they are not, once again I hope I am wrong).

This was my response to Steele.

Screen Shot 2013-07-21 at 4.00.39 PM

Let me make this as clear as possible.

I am not accusing anyone of infecting kids with pertussis. I am seeking an answer to the question, “if you’re working with kids are you considering their welfare by having a booster?”.

On the surface this seems like a simple question but over a week later it remains unanswered by any chiros – at least the ones that flooded the Catalyst FB page anyway.

Screen Shot 2013-07-21 at 4.04.53 PM

You can read the entire thread here if you’re interested. Not that it offers any answers.

So we remain none the wiser about the duty of care of paediatric chiros to vulnerable kids who are at risk of contracting any number of infections from adults who have not been boosted for VPDs. On another thread I asked the chiros what their code of conduct had to say about this and once again this.

I have been to seminars given by paediatric chiros before, in fact ones on the topic of vaccination where I’ve listened to chiros tell parents to get their kids to a chiro as soon as possible after leaving hospital. Within hours if possible.

But at what risk? In medicine, decisions about interventions are determined based on a risk versus benefit ratio. For example, there is a risk in undergoing surgery but if the benefit of removing a tumour or whatever the problem may be, outweighs the risks, then people decide to do it.

But what about the risk ratio for paediatric chiro? Well, when the benefits are a a bit better than placebo, but the risks include sustaining an injury or a vaccine preventable disease, then it’s clear. Avoid it like the plague.

UPDATE: I’ve just asked the question of Tony Croke again.

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  • I know a late reply but hope I can still answer Gold. Chiro subluxations are a historical concept that have no place in modern MSK healthcare apart from a history lesson.

    I gather you are refering to joint manipulation in your second point. Joint manip is one modality that Chiro’s can employ as is the various soft tissue modalities, exercise rehab, ergonomic advice, movement assessment etc etc. Joint manip is not required for every patient it is condition dependent

  • ianna

    Sue, I’m not sure what you mean by combine all the science? Is there a
    big chiropractic research institute somewhere doing science (I must have
    missed it) or hundreds of chiropractic PhD students
    and post-docs out there generating evidence for the profession. If you don’t do research you don’t get evidence…..and you are left with anecdotes and belief.

  • Andy

    The whole “turf war” defence is silly. Is there a GP in Australia who has the time to see any more patients than they do now? With waiting times at some suburban clinics measured in weeks, it seems to me that even if half the patients went to chiros instead, GP clinics would still be full.

    I’ll have some faith in the chiro profession when I begin to see blogs like this one, naming and shaming and publicly demanding change from the top down, but written by chiros instead of doctors, scientists and sceptics.

  • So you don’t support the idea of subluxations?

    Earlier you said “But, there are those among us that would argue chiropractors don’t
    diagnose anything, we merely remove nervous system interference by
    removing subluxations.” Does this mean you were quoting “them”?

    If you don’t support the idea of subluxations, how do you explain the mechanism behind your chosen practice?

  • theroguechiropractor

    Explain them into the dustbin as a historical relic? Glad to. Hope my colleagues eventually do the same.

  • While the “rational troops” are behind you on the pro-vax position I think you’ll have to explain away subluxations before anyone takes you too seriously.

  • theroguechiropractor

    Sue wrote: “would they look at ”sins of omission” (missed diagnoses etc) as well as ”sins of commission” (injuries caused by manipulation?”

    We would have to look at the lot. But, there are those among us that would argue chiropractors don’t diagnose anything, we merely remove nervous system interference by removing subluxations. If that were the case, I would move us more into the field of entertainment, and not healthcare.

    Currently, we are trained to recognise when an apparent musculoskeletal pain is of organic origin and make the appropriate referral. We *can* be very good clinical diagnosticians for real problems. The hard part for us is the cognitive separation of “I’ve just found a non-musculoskeletal problem” and “but they’re expecting me to treat/manipulate them”. The patient shouldn’t always expect a treatment and/or manipulation – if that is the case, the patient has every right to expect to be told a chiropractic/manipulative treatment is not appropriate and referred to the correct provider.

  • theroguechiropractor

    It’s a not-so-delicious irony isn’t it. I am hoping to mobilise the rational troops to use their voice and engage with the issues. These issues are a threat to our existence as a profession. Not conspiracy theories, turf wars or belief systems.

  • Sue

    Well put, rogue chiro. But why is it that your rational approach is considered ”rogue”, and yet those who preach magic are in the majority, and in charge of the organisations?

  • Sue

    I agree Mike – what could they possibly spend five years studying that results in them being able to help with back pain and headaches? And why would we need two entire professions for physical therapy?

    Combine all the science, let people sub-specialise (as physios do now) in sports physio, or rehab, or whatever, and hold them all to the same standards.

  • Sue

    Even if they had a reporting system for adverse events, would they look at ”sins of omission” (missed diagnoses etc) as well as ”sins of commission” (injuries caused by manipulation? That’s one of the main problems with applying chiro to an undiagnosed problem – missing the real diagnosis and therefore the ability to apply real therapy.

    Most people don’t have much problem with a diagnosed musculo-skeletal problem being treated with manipulative therapy by a non-woo chiro. The problem occurs when they see themselves as diagnosticians, or they apply non-scienced-based thinking to organic disease. (Which seems to be much more frequent than their organisations will admit – but is all over their websites).

  • Mike

    One of the most remarkable thing about this debate following Catalyst (asides from the telling silence on important issues you highlight here) is that it was pointed out that Chiros do a 5 year university program to get their ‘badge’.

    MEDICINE at the university level is only a year longer (before internship). Physio is shorter (both are better than chiro for all sorts of reasons). In other words, Chiros spend nearly as long at uni as doctors, and longer than physios! Which begs the question, why don’t the ‘good chiros’ just agitate to have the musculo-skeletal portions of their training brought in under physio and be done with it? An enhanced physio qualification would upset noone I’m sure, and then we could be sure that they were being educated solely under the banners of science rather than the creeping woo that exists in chiropractic.

  • DrRachie

    Yup, you’re right. We’re not just talking babies here. There needs to be some serious change of policy.

  • theroguechiropractor

    Regardless of personal beliefs, as a HCW it is encumbent on chiropractors, regardless of whether they treat babies or not, are immunised against VPDs.

    We could be treating babies, but not only that, we are often dealing with people who have multiple conditions, chronic diseases and sometimes people who are immune compromised. Personally, I’m pro-vaccination anyway, so you’re essentially preaching to the converted. Aside from the baby aspect – think of it in this scenario:

    You are experiencing back pain. 12 months ago you successfully completed treatment for leukaemia. Your immune system has not fully recovered. On your friend’s advice, you attend your local chiropractor. Your local chiropractor does not immunise and has pamphlets advising the evils of vaccination in their clinic. You contract VZV, either from droplets in the waiting room, or because the chiropractor has not wiped down the headpiece of their table. Because of your compromised immune system from your leukaemia treatment, you develop malignant chicken pox with purpura and die.

    This would be a rare event but it could happen.

    Or I can prevent a more realistic scenario. A patient has been referred to you by an existing patient for their back pain. On history taking, you find that the back pain is due to psoriatic arthritis. They are trialling treatment of methotrexate but it has not had the desired effect yet. Due to the methotrexate, their immune system is supressed.

    It’s simple. Suspend your beliefs and do what is best for the patient. Otherwise you’re in the wrong field.