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Biased, Unethical, Immoral, Unscientific, Unfair, but, Sadly, Highly Predictable: The Reported findings of the recent review of Chiropractic Care for Children Under 12 by the Victoria Health Ministry in Australia.
Let’s review and discuss a few of the FACTS that were established by the review panel:
• Let’s start with being honest. The review found that the evidence base for chiropractic pediatric care was poor, with no strong evidence for most conditions due to lack of studies. They did not find strong evidence for or against the effectiveness of chiropractic care, they just found little research evidence period. They did find weak evidence for the effectiveness of chiropractic in the form of modestly reduced crying times in infantile colic and reduced wet nights in children with enuresis (bed wetting). This is a very accurate portrayal of the available evidence regarding chiropractic care – there just has been very few studies conducted – most of what goes on in chiropractic clinical practice is based on practitioner experience and patient preference – which, for the record, is EXACTLY in line with evidence-informed care guidelines. • Let’s now also be honest about the available evidence for the medical management of children under 12 with these same health issues. The first thing you will hopefully realise is that the evidence for effectiveness and safety of medical management was not reviewed by this panel. There seems to be an inexplicable lack of interest in evaluating the safety and effectiveness of medical interventions, especially for children. The presupposition is that medical management of these children with these conditions is evidence-based in terms of safety and effectiveness and thus the lack of research evidence of effectiveness regarding chiropractic management should result in the de facto conclusion that medical management is safer, more effective, and thus should be universally recommended. But is it? I invite the reader to do a review of the evidence for the medical management of children under 12 with these same health issues. I invite the reader, and BEGGED the review panel in posts preceding the review, to conduct the IDENTICAL REVIEW for usual medical management for children under 12 with these conditions and then compare it to the findings regarding chiropractic management. PLEASE!! We will get back to this later. What you will find, if you do an HONEST review, is that most of what goes on in medical pediatric clinical practice with respect to these health issues is also based on practitioner experience and patient preference. The ONE GLARING difference is in the area of evidence of potential harm – we will also discuss this later. • There are, based on conservative estimates, 30,000 pediatric chiropractic treatments per week in Australia. • Public consultation for this review resulted in 21,824 responses from people who utilized chiropractic spinal care for children under the age of 12. The most common conditions for which chiropractic spinal care was sought for children under the age of 12 were posture, colic, neck pain, breastfeeding issues, back pain, headache. • 99.7% of respondents reported a positive experience and 98% reported in improvement in symptoms. The most commonly reported benefits of (DRUG FREE) care were decreased pain, improvements in sleep patterns, more relaxed, improved breast feeding and latching, and improved range of movement. • “The review found very little evidence of patient harm for spinal manipulation in the treatment of children under 12 years. No patient complaints were identified and there were no practitioner notifications.” • “Three reports of serious harm were reported relative to spinal manipulation in children under 12 years. None of these events involved chiropractors, nor did they feature techniques used by chiropractors in Australia.” • From 30,000 visits per week in Australia for decades, MILLIONS of pediatric chiropractic treatments overall, there have been ZERO reports of serious harm from chiropractic pediatric care in Australia. With the exception of course of the 2013 newspaper article quoting a medical doctor claiming that a chiropractor had broken a babies neck which, though proven to be complete fabrication, resulted in the absurd, biased, unscientific, unfounded, and most repugnantly, unsanctioned and unretracted public demand by the President of the Australian Medical Association to ban chiropractic pediatric care! If this is not evidence of a biased agenda to try and get rid of chiropractic care for children, I’m not sure what is. There are countless other examples which I have written about in previous posts. • From millions of visits worldwide, there have been ZERO reports of serious harm from chiropractic pediatric care - ZERO. Of the three reports of serious harm from around the world, NONE involved chiropractors, and to be clear, these three reports of harm from manipulation have NEVER been established as evidence of a causal connection between manipulation and harm – they are simply case reports which, as everyone with even the most basic scientific methodological knowledge knows, are useless when it comes to providing evidence of cause and effect. This is why case reports regarding benefit of chiropractic care were dismissed by this panel. Case reports regarding harm, even though none involved a chiropractor, were accepted as evidence of potential harm from chiropractic care and were used to justify the recommendation to restrict chiropractic care for children under 12 years of age in the Report. • This would be too hard to believe if one did not understand that these EXACT TACTICS were used when medical associations were attempting to ban chiropractic care for adults and pretending that this was only to “protect the public” rather than “protect their monopoly” which was proven in the Wilk vs American Medical Association case in the United States in the late 1980’s early 1990’s. This is why chiropractors and chiropractic patients in the United States no longer have to put up with this garbage, they sued the Medical Association and proved beyond a reasonable doubt, both in the original case and in the appeal case, that the members of the AMA, including medical doctors, outright lied to medical students, to medical doctors, to the public, to politicians, and under oath in trial proceedings. They lied about chiropractic being dangerous, they lied about chiropractic being ineffective, they deliberately hid from any scrutiny regarding the safety and effectiveness of usual medical treatments, and the judge ruled conclusively that they did all this not to protect the public but to protect their monopoly. READ the Wilk vs AMA case!! • Medical Associations have been lying about, or hiding the truth about, the effectiveness and safety of their interventions for decades. Just look at the evidence of safety, effectiveness, and cost-effectiveness for usual medical care for back pain and compare this to how they have systematically attacked chiropractic for lacking evidence and for causing harm. THE INDISPUTABLE FACT is that, as medical associations, and dogmatic pseudoscientific organizations like Friends of Science in Medicine in Australia, have been attacking chiropractic they have been providing care that has less evidence of benefit and more evidence of harm. • The strategy of those trying to remove chiropractic as competition has always been the same. Use political lobby, purchased cultural authority, and medical credentials (not education or knowledge) to create the unchallenged presupposition that usual medical care for any given condition or population cohort is already proven safe and effective and then put every other competitive intervention under a level of scrutiny that the medical interventions could NEVER withstand – and don’t withstand in many peer-reviewed scientific journals. This is EXACTLY what they tried to do for chiropractic care for adults and it is EXACTLY what they are trying to do for chiropractic care for children. • The ONLY VALID, ETHICAL REVIEW is one which identifies ALL AVAILABLE care options for any given condition or population, and then does a review of ALL AVAILABLE EVIDENCE regarding effectiveness and safety and cost-effectiveness and then identifies the best available option for patients based on the EVIDENCE of safety, effectiveness, and cost effectiveness. • WHY WASN’T THE EVIDENCE OF SAFETY AND EFFECTIVENESS OF MEDICAL MANAGEMENT OF CHILDREN UNDER 12 OR ANY OF THE NAMED CONDITIONS UNDER REVIEW???????????? • Isn’t the most scientific, evidence-based, moral, ethical, and fair thing to do, that is in the best interest of the patients, a thorough review of the evidence for all available interventions? Of course it is. About this there is no logical or ethical debate. • What has more evidence of harm with respect to treating children under 12 for the conditions listed in the review, usual medical care or usual chiropractic care? Well, there is ZERO evidence of harm from chiropractic care – ZERO. There is ample evidence of harm from medical management, check the peer-reviewed literature or look at my previous posts on the topic. • What has more evidence of benefit with respect to treating children under 12 for the conditions listed in the review, usual medical care or usual chiropractic care? The truth is that the evidence of benefit from properly controlled trials measuring valid outcomes is so sparse that this is virtually impossible to determine. Chiropractic would probably have a slight advantage in terms of benefit but let’s just, for argument sake, call it a tie. • So, usual medical care and usual chiropractic care are about the same with respect to evidence of benefit and chiropractic is FAR BETTER in terms of evidence of safety. • The conclusion of the Report? Restrict chiropractic care while continuing to recommend usual medical care. Do a review of chiropractic care but do not do a review of usual medical care. I will end by quoting myself from an earlier post which preceded the review and findings of this Report which were, sadly, predictable. “What is in the best interest of the public, and what represents the only ethical and scientific approach, is an unbiased comparison of all available interventions. Only demanding unequivocal evidence for chiropractic while blindly accepting the false presupposition that usual medical care for children is proven safe and effective may be an effective strategy to create a false narrative but it is unethical, unscientific, and against public interest.”
“I would welcome a full government inquiry into chiropractic care for neuromusculoskeletal and other pediatric health issues. I would welcome future studies comparing chiropractic care to usual medical care, and to other interventions. If such studies indicate that there is evidence that an alternative intervention is safer, more effective, and more cost-effective then so be it.” “In the meantime, let’s not arbitrarily, without due cause, after over 100 years of care for millions of highly satisfied patients without any documented danger, give in to dogma and fear mongering and restrict access to chiropractic care. Such a policy would NOT represent an evidence-based, logical, or reasonable approach! Let's hope that science prevails over dogma and that evidence prevails over fear mongering and misinformation.”
We must all agree that patients deserve to be informed about which interventions have the highest statistical probability of eliciting benefit and the lowest statistical probability of causing harm. It is the moral obligation of practitioners, practitioner associations, policy makers, and insurers to recommend and reimburse based on this evidence-based model. Anything else is not just unscientific, it is immoral and repugnant.
The FACT is that a trial of gentle, safe chiropractic care for children under the age of 12 who have spinal exam findings indicating chiropractic spinal manipulation therapy/adjustment is as evidence-based in terms of effectiveness and more evidence-based in terms of safety than usual medical pediatric care for many childhood conditions.
It would be unethical to make false promises regarding results from chiropractic care that lacks evidence but it is equally unethical to make false promises about medical care that lacks evidence. It is ethical to inform patients about the available evidence of benefit vs harm for chiropractic care, but it is also ethical to inform patients about the available evidence of benefit vs harm for medical care.
The FACT is chiropractic has a superior ethical record when it comes to informed consent. I hope, for the sake of the children, that cooler, unbiased, scientific, ethical heads will prevail.
Dr. James L. Chestnut MSc., D.C., C.C.W.P.
If you want more information. Please call Health Wise Chiropractic 03 9467 7889 or book online to see one of our Chiropractors in Sunbury or Bundoora Today!
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