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Chiropractor Breaks Baby’s Neck – A Risk vs Benefit Analysis

It is unfortunately that individual dramatic cases are often required to garner public and regulatory attention toward a clear problem. The Australian press is reporting:

Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis – an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery.

Medicine is a game of risk vs benefit – everything we do, or don’t do, should be evaluated on the potential benefit vs the potential risk, using the best available evidence and scientific rationale. This case is important, not because it is a case of harm, which can happen with any intervention, but because it highlights the risk vs benefit question. Are there any indications for chiropractic care of children, for neck manipulation at any age, and what are the risks?

For an overview of chiropractic see my prior summaries here and here. Overall the evidence suggests some benefit for manipulative therapy for acute uncomplicated lower back strain, but probably no better than physical therapy or even minimal intervention. The risks of chiropractic are not sufficiently studied, and other indications have not been established by adequate evidence.

Chiropractic for children

The chiropractic profession generally has been aggressive in expanding its scope of practice, including treating children and infants, despite a lack of evidence or even plausible scientific rationale. The chiropractic treatment of childhood disorders was the focus of the British Chiropractic Association’s libel suit against Simon Singh. During that suit the BCA put out a statement attempting to justify the chiropractic treatment of childhood illness, but the result merely showcased the lack of evidence, and their own poor standards of science.

The BCA was claiming evidence for the chiropractic treatment of asthma, colic, otitis media, and nocturnal enuresis (bedwetting). In each case the evidence actually showed a lack of effectiveness for these indications.

The current case involved the treatment of infantile torticollis, which is a dystonic disorder, an involuntary contraction of a muscle, in the case of torticollis involving the neck. This is generally a benign disorder. A review of 624 cases found that 97% resolved with conservative management, including stretching and active stimulation, most in less than 6 months. The other 3% had an underlying anatomical defect and required surgery.

Another prospective study of 821 patients treated with manual stretching found:

subsequent surgical treatment was required by 8% (thirty-four) of the 452 patients in the sternomastoid tumor group compared with 3% (eight) of the 276 patients in the muscular torticollis group and 0% (none) of the ninety-three patients in the postural torticollis group.

There does not seem to be a role or need for chiropractic neck manipulation for this condition.

I could only find two references in PubMed presenting evidence for chiropractic manipulation of torticollis, both single case reports, one in a 6-year old, and one in a 7-month old infant. That’s it – two cases. In the case of the 7-month old, the intervention included:

chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises.

We already know that stretching works, so there is no reason to conclude that the chiropractic manipulation added anything to the patient’s recovery in this case.

I also found one case report from 1992 of quadraplegia in an infant following spinal manipulation for torticollis. The child had a spinal tumor, and the manipulation caused it to bleed, resulting in the damage. There is also another report of a spinal astrocytoma presenting as torticollis. The authors conclude that such tumors should be ruled out in infantile torticollis.

Risk vs benefit

As with chiropractic care in general, there is insufficient evidence to make firm statements about the risk vs benefit of chiropractic intervention in children for any indication, including torticollis. This is due, in my opinion, to a cultural and historical lack of science-based practice within the profession of chiropractic. This represents a failure of the entire profession that is in dire need of correction.

In the case of infantile torticollis, this is a benign condition in most patients, who quickly recover with conservative and safe management. The single case report discussed above is worthless as scientific evidence because it is anecdotal, and usual care was combined with manipulation, and the patient was overwhelmingly likely to recover from the usual care alone.

Given a benign condition with an established safe and effective treatment, the standard of care dictates that any new intervention should at least demonstrate equivalency to the established therapy. If the new therapy is more expensive or has higher risk than the established therapy, it should demonstrate sufficient superiority to justify the added risk or expense.

Chiropractors have not established equivalency let alone superiority for manipulation in infantile torticollis, and therefore there is no justification for treatment.

In a risk vs benefit analysis, therefore, any incremental risk is not justified. Chiropractors, however, are not in the habit of reporting or systematically studying the risks of their interventions, so we often have to rely upon case reports from non-chiropractors who receive the results of their interventions. With regard to infantile torticollis we have the 1992 report of quadriplegia, and now we have an additional report of a fractured cervical spine.

Chiropractic response

The response of the chiropractic profession to these cases is unsatisfactory, to say the least. Dr. Pappas, the pediatrician who treated the infant with the broken neck, reported the case to the health authorities in Australia. They turned the case over to the chiropractic board.

That is the first problem – chiropractors are in the position of self-regulating. But if the profession itself has a problem with science and evidence, self-regulation will not provide the solution. Predictably, the chiropractic board closed the case with the judgement that the chiropractor can continue practicing if he obtains further education in pediatric chiropractic care.

That is a paltry slap on the wrist. The decision also implies endorsement of pediatric chiropractic, which has never been established as a legitimate practice. Training is irrelevant when you don’t have a science-based practice in the first place.

The response of the Chiropractic Association of Australia was outrage – not that one of their members committed malpractice, but at the suggestion that it was chiropractic manipulation that caused the child’s neck fracture.

The CAA is outraged that rather than clearing the chiropractor’s name, as appropriate, the newspapers have smeared the chiropractor and the profession with such an allegation

It seems clear from their response that they are more concerned with the reputation of chiropractors than the safety of their patients. Perhaps they will try the same gambit as the BCA and put out a statement reviewing the scientific evidence for the chiropractic treatment of infantile torticollis, hoping that no one actually reads the evidence and is simply impressed by the list of references.

Conclusion

The chiropractic profession continues to have a serious problem of being insufficiently based upon science and evidence (to put it mildly). There are a great deal of practices that occur under the banner of “chiropractic” from blatant pseudoscience, such as energy medicine, to somewhat plausible musculoskeletal management. In the latter case chiropractors are little more than physical therapists.

Chiropractors continue to use and promote chiropractic treatment for a long list of indications that are not supported by basic scientific plausibility or clinical evidence. They cannot justify their interventions on an evidence-based risk vs benefit assessment.

Rather, they seem to employ a strategy of not reporting or studying the risks of their interventions, then citing the lack of evidence for risk as evidence that their treatments are safe. Lack of evidence is not sufficient in the practice of medicine, however.

What evidence we do have suggests that there is not a single legitimate indication for chiropractic manipulation of children or infants, which is sufficient to condemn the practice. There is also evidence of potential harm, and even if rare, any harm resulting from a worthless intervention results in an unfavorable risk vs benefit.

Posted in: Chiropractic

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115 thoughts on “Chiropractor Breaks Baby’s Neck – A Risk vs Benefit Analysis

  1. ” In the latter case chiropractors are little more than physical therapists.”

    Except that physical therapists undergo rigorous science-based training in physiology/anatomy and actually understand what they are doing and why.

    1. goodnightirene says:

      Thanks Daniel, I was thinking exactly the same thing. I’ve overcome a couple of tendonitis issues with excellent stretching and strengthening exercises from my PT, who has a masters degree from a legitimate college. I was referred, by my internist who verified the problem to start with, of course.

      Another difference with the PT is that you have to go home and do the work yourself, then you come back and get more reps, etc, then later she measures your actual range of motion to see if you’ve progressed from where you started; whereas the chiro does his magic manipulations (and who knows what else s(he) might be “into?), and “presto!” you are all better–but you will need “maintenance”, of course.

    2. PTJason says:

      Hi all, first post here, so I apologize that it is a rant.

      As a PT with the DPT degree, I can definitely speak to some of the issues with Chiropractors. Although spinal manipulation is part of our standardaized curriculum in PT school, Chiropractors have successfully barred the use of spinal manipulation by PTs in Missouri and Washington. That is no big loss in my opinion since there is such limited evidence on its efficacy, but it is annoying. We were warned generally against doing cervical manipulations unless we take continuing education on it, and then in only very limited cases.

      However I would like to raise a bigger issue about PT. Many PTs are woefully inadequate and uninformed in their practice in the outpatient orthopedic realm. To my colleagues defense, they are much better in acute care, wound care, pediatrics, cardiopulmonary, and neurolgical rehabilitation. This is a recognized issue within the profession and my training hammered home the need for evidence based practice. We were required to take research statistics, as well as research review courses. The problem is generally older therapists let their years of clinical experience guide their treatments (i.e. anecdotes) rather than current best practices. Compounding this is that the high quality research into PT interventions occurred after many of these people recieved their education, so they are practicing with disproven techniques. Since continuing education courses can be taken in whatever you are interested in, you can remain blissfully ignorant of up to date practices.

      In training we were consistently warned against using guru treatments such as McKenzie technique and Astym. Even more pervasive and warned about is the use of passive modalities with little evidence for healing like ultrasound, modalities that are designed without healing even in mind like TENS, or modalities with no plausible method of working like phonophoresis. We call this “shake and bake.” It was really common in the 80s.

      I worked in a clinic where a person was voted one of the top PTs in my town. She would do dry needling (i.e. acupuncture into trigger points), ultrasound/estim combination, and Astym, which is just a variation on massage, on all her patients. Exercise and balance were minimally done, and many patients would be seen for 30 visits or more without any objective improvements. Patients loved that treatment as they always felt good when the left.

      PT is really going through growing pains. Moving to the Masters and then Doctorate was a big step in improving the education and rationale in treatments/diagnosis, but still even recent grad PTs get drawn into poor practice patterns. Please don’t assume that because PT is taught in Medical schools with a science-based curriculum that people actually put this into practice.

      Finally, when I try as hard as I can to practice with only the best evidence-based treatments, I ofte find that I don’t have effective treatment options. Many times we trial exercises that have been disproven on RCT simply because there is nothing left to try. I always let patients know if the treatment we are trying is not proven by evidence. In the words of one of my professors from her speech at our graduation, “And this is when the dog that is evidence-based practice runs across the freeway that is clinical practice.”

      PT is limited in its answers, but it does have many good journals and does apply the scientific method to its treatments. Finding a good PT can be difficult.

      1. mousethatroared says:

        testify PTJason – I was ultimately pretty unhappy with my last PT person. He kept giving me exercises that just really hurt and not in a good strengthening kinda way. When you want your pain to go away really bad, it’s hard to say no to someone when they say something will pay off. Especially when you just don’t know what may work or not.

        I’d never visit a chiropractor (even more so after reading this article, which was so upsetting that I felt sick) but it’s not easy knowing when you can trust a PT (or an orthopedic surgeon for that matter) either.

        Woe is me :)

        1. Dan says:

          Woe is you for not checking their sources.

      2. WilliamLawrenceUtridge says:

        Paul Ingraham made a point on his site (apparently from a fellow named Simons) that muscle is an orphan organ, there is no specialty dedicated to its study. Which is funny since it is the biggest organ, by volume and by weight.

        PT is certainly imperfect. The good thing is that the schooling seems to be changing with the passage of time, and is relying more on scientific evaluation. Until chiropractic makes that leap, it will never improve.

        1. mousethatroared says:

          To true, WLU – even worse, it’s not just muscles, it’s tendons, bursa, joints capsules, all that darn connective tissue, then cartilage (I don’t even know if that’s connective tissue, seems like it should be)…nerves and then the bones which pinch, gets spurs and stuff.

          It’s a pain in the neck, literally.

          Just thinking about it, you start to realize how limited the whole subluxation idea is. It’s like saying, “well, you car doesn’t start? Let’s adjust the timing. What do you mean you think it’s the alternator? No, it must be the timing.”

          1. WilliamLawrenceUtridge says:

            Heh, I would argue it’s more like saying it’s always the suspension. “Car won’t start? Sounds like you need new shocks!”

            I know very little about cars.

          2. mousethatroared says:

            Yeah, I would have gone with suspension, but I couldn’t remember any of the parts and didn’t feel like looking it up. :)

            Apparently the spine doc said that my symptoms indicate C6 nerve compression, probably from a cervical disc that’s lost it’s cushiness*. So maybe that IS like the suspension…and the wiring (?) Perhaps that metaphor has run it’s course…because replacing my wiring is not an option.

            *see, don’t get old.

    3. Marion says:

      Physical therapy is just as much worthless pseudoscience as chiropracty.

      I regret all the money I wasted going to PT after various orthopedic surgeries I had (even after insurance paid the bulk: I feel sorry for the insurance company getting scammed, too!) But, the stupid surgeons “ordered” that I go. (Of course, I had the free choice not to.)

      Surgery & drugs do what they are intended to do. PT doesn’t even have a clear definition of what it intends to accomplish.

      If we could move the atoms around in our bodies to where we want them, as PTs propose, then we could make ourselves look perpetually young and could rearrange cancer cells into normal cells.

      1. PTJason says:

        ?

        Where did you come up with that statement, or are you just trolling? Moving atoms?

        PTs who know the standards of practice, apply research, and understand anatomy and physiology generally can help people out. Sometimes we don’t have good evidence based treatments, but we will then pick something that has a physiologic rationale for its use, weighing whether or not it there is a chance for harm. Good PTs don’t just guess at what they are doing.

        Post surgical rehab is about the most mind numbning treatment you can ever perform. PTs can pretty much sleepwalk through it. If you had a bad outcome, I wouldn’t necessarily blame the PT unless they were truly bad at their job.

    4. silly penguinPT says:

      “little more than physical therapists” … HA, that makes me laugh a little, and cry a little, as they’re considerably less than physical therapists in almost every aspect.

      I can almost sympathize, since there are bad eggs in every profession, and some chiropractors are disappointed by the pseudoscientific approach of some of their colleagues. However, since I am currently about to complete the 3rd year of my B. Physiotherapy, with one year left, I can say that every clinical technique that we are taught is backed by peer reviewed evidence. Why is this NOT the case for Chiropractic? they’re also generally trained at a university, they also have access to the peer reviewed evidence, they also have a duty of care and responsibility for the health of their patients, how can they get away with this blatant negligence??? They really have no excuse.
      And then they have the nerve to put a Dr. before their name *sigh*

      For those people who have commented on the poor outcome after seeing a PT for certain problems I will say this: not every problem can be treated with conservative management, if your PT did not refer your case to a specialist after a reasonable number of sessions failed to produce an improved outcome, they should have! That’s what we are trained to do in a modern physiotherapy degree anyway. Bad eggs in every profession, as I said.

      Finally, the vast majority of treatment techniques used in physiotherapy practice are fully evidence based, so this is an aside, however, with regard to some of the more “alternative” physiotherapy treatments mentioned, TENS, Therapeutic Ultrasound, McKenzie technique etc. These all have a plausible scientific rationale, and some evidence to support their use IN CERTAIN CASES, using them as a blanket therapy is (of course) ridiculous! No self respecting clinician that I know personally would do that. See this article for some boring clarification of the evidence for TENS. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003222/full.

      Let me ask you this though, pretend you are a PT, a patient comes in with chronic pain, they have been through all the usual medical channels, pain clinics, etc. The patient is non-compliant with exercise programs and manual therapy is ineffective, you trial TENS as a last resort and the patient subjectively reports a decrease in pain, an increase in functional capacity and nil side effects, why not use it! Or at the very least, use it as one part of your treatment strategy, its SAFE, cheap and EFFECTIVE for that that particular patient, even if it is (arguably) a placebo.

      Take that, skeptics. ;-)

      1. Harriet Hall says:

        Why not use it? Of course, give it a try. As long as you don’t misrepresent it to the patient as proven to work.

      2. atguy says:

        As a current Chiro student I would like to say that it is true that many chiropractors do not care about evidence based practice and are taught things that arn’t exactly scientific. However this does not mean that all chiropractic schools allow techniques to be taught without peer-reviewed evidence. There are a few good Chiropractic schools out there, sadly they are less common then their counterparts. And there are good Chiropractors out there that really do help people and don’t just sell them a bunch of bs and have them come back 3 times a week. Sadly my future profession is saturated with these unethical or unintelligent people, but please don’t judge the whole profession based on those people.

  2. mickvagg says:

    Another highly unsatisfactory aspect of the CAA response to this case is that they are trying to stand by their claim that “there is no report in the medical literature of harm to an infant from being treated by a qualified chiropractor.”
    http://www.ncbi.nlm.nih.gov/pubmed/23027167
    I sent this case report to one of their officials who responded by accusing the parents of child abuse, despite the paper clearly stating that they had been investigated and cleared by the local authorities. They appear to be doing the same thing in this current case.
    I disputed their claim in the ABC Catalyst TV documentary that aired earlier this year here. The CAA made a formal complaint to the ABC of a factual error. The complaint has been dismissed by an independent investigation, who agree with my view. They continue to repeat this line although it is provably false.

    It would appear that if your child is harmed by a chiropractor in Australia, you can expect to be me with accusations of child abuse by the people who are supposed to be self-regulating their profession. Classy stuff.

    1. WilliamLawrenceUtridge says:

      Sounds like they tried to us a “no true scotsman” fallacy.

      “Oh, sure, THAT guy killed your baby…but he wasn’t a REAL chiropracter because he was a straight/mixer/alien.”

      1. Mary in Austin says:

        Indeed. No true Scotsman.

  3. Tuck says:

    “That is the first problem – chiropractors are in the position of self-regulating.”

    Aren’t most medical disciplines self-regulating? They are in Connecticut, where you practice.

    “…Connecticut’s Medical Examining Board, two-thirds of whom are volunteer doctors and the rest lay citizens, is charged with looking into complaints about physicians….”

    “State Medical Board Is Too Slow”
    http://articles.courant.com/2013-07-23/news/hc-ed-medical-board-must-speed-up-20130723_1_state-medical-board-doctors-medical-errors

    1. Harriet Hall says:

      Medical Boards need to improve. Chiropractic boards need to improve even more.

    2. WilliamLawrenceUtridge says:

      The medical discipline is ultimately self-regulated by the scientific literature. There are evidence-based standards of care that are not based on anecdotes and hoary wisdom. There are guidelines, systematic reviews and continuing medical education, and the standard against which doctors are judged is whether or not you are aware of them and practice accordingly.

      And, as Dr. Hall notes, tu quoque isn’t a response it’s a distraction. Are chiropractors the world over prevented from basing their practices on good research because the state review boards of doctors aren’t perfect? Are chirporactors allowed to break the necks of babies as long as the Connecticut’s MEB is behind on its obligations? What is preventing chiropractors from saying “holy shit, we should stop taking these tiny, helpless infants and jerking their necks so hard the cartilage cracks and they develop quadriplegia”?

  4. yes, all health professions self-regulate. This can work for professions that have an evidence-based standard of care. It does not work for professions that are not science-based, and essentially have no standard of care.

    The problem is not with self-regulation per say, but putting pseudoscientists in charge of their own regulation.

  5. windriven says:

    “Medicine is a game of risk vs benefit – everything we do, or don’t do, should be evaluated on the potential benefit vs the potential risk, using the best available evidence and scientific rationale.”

    This simple statement neatly summarizes one of the major problems we face in trying to rid health care of quack therapies. The ‘best available evidence and scientific rationale’ is simply not calculable for many health care consumers, legislators and jurists. As Dr. Novella notes, chiropractors do not play by the same rules of scientific evidence as do, well, scientists. This leaves the quacks able to define evidence of benefit in their own terms as far as the average consumer is concerned.

    So if we shed Novella’s critical clause the statement becomes, “medicine is a game of risk versus benefit – everything we do or don’t do should be evaluated on the potential benefit versus the potential risk.” Quacks always have have a raft of testimonials attesting to the benefits of their particular quackology. The Seattle and Portland media markets are flooded with chiropractic advertisements and most of them include breathless testimony of miraculous results.

    That leaves us with the risk part of the equation and, despite the occasional chiropractic misadventure, most quackologies rarely do overt and obvious harm. The harm more often comes from delaying medical care. And so the consumer is left hearing people just like them singing the praises of quack therapies versus rare and rarely reported cases of immediate and obvious harm.

    Is there a website that maintains an inventory of quack misadventures? That would be a useful tool for journalists and consumers evaluating quack therapies. People generally identify with compelling narratives far more easily than with arcane statistical studies.

    1. TwistBarbie says:

      http://whatstheharm.net is exactly what you’re looking for.

      1. windriven says:

        Thank you SO much! That is, indeed, just what I’m looking for.

  6. Chris Hickie says:

    My practice is getting more and more of these “consult notes” from chiropractors on our patients. The most concerning so far was one about how manipulation of C6 was used to treat an infant who spit up a lot. I swear these chiropractic morons must look at one of those anatomy of the nervous system charts you can buy online and go “oooh, looks like there’s a line that goes from the spinal cord there to this part of the body here, so I’ll go pound on that part of the spine”.

    Thank you for this update. I will keep copies of this article ready to hand out to parents. I haven’t had an infant with torticollis fall into the hands of a chiropractor yet, but their “field’s” increasing aggressiveness into pediatrics is worrisome (for both spinal injury and their shameful antivaccine stupidity).

  7. Harriet Hall says:

    At least one of the news reports says what the child had was a hangman’s fracture, which is known to result from “forcible hyperextension of the head, usually with distraction of the neck.” The chiropractors are claiming that it was not the chiropractor who caused the injury. I have 3 problems with this:
    1. The mechanism of a hangman’s fracture sounds like something that would happen with maneuvers chiropractors typically use, not with something otherwise likely to happen to an infant of that age.
    2. If the child already had the fracture, the chiropractor was negligent in failing to recognize it and he had no business manipulating the child’s neck.
    3. They ordered the chiropractor to get further education; this indicates they knew that he had done something wrong.

    Many chiropractors recommend treating a newborn in the delivery room to treat the subluxations allegedly caused by the birth process. One even assured me that a baby’s neck was stretched 2 1/2 times its normal length during the birth process, whether vaginal or Cesarean. I told him that was anatomically impossible and if you succeeded in stretching a baby’s neck that far, it would kill the baby. His answer: yes, the birth process is very dangerous. He was very confident of his facts, although he couldn’t cite a single reference. He refused to take the claim off his website, which fortunately no longer exists because he has joined a group focusing on prevention and health maintenance for adults.

  8. Ray Bellamy says:

    The first post by Daniel Clements is spot on. Physical therapists are light years ahead of chiropractors. PTs rarely injure their patients and when they do so, it is generally within the parameters of risk vs. benefit outlined by Novalla. And when that occurs, they immediately seek corrective action rather than attempting to hide the truth. One case comes to mind in which a severely contracted nonambulatory child was being stretched passively by a caring PT and the osteoporotic femur fractured. The PT immediately took corrective action and was quite upset personally. Chiropractors cannot teach transfers, gait, therapy for arthritis or rehabilitation from surgery and strokes and fractures. And their belief systems of vitalism and energy fields and “hole in one” etc. are imaginary and totally without merit.

  9. davidrlogan says:

    My (at the time) girlfriend’s daughter had her ribs broken by a chiropractor due to some of the underlying ignorance (or so it would seem to me from reading SBM.)

    As far as their (the chiro community’s) response, how does that old saying go? “Don’t ask the barber if you need a haircut”…I think that is sage advice here.

    Thanks for the article Dr. Novella.

  10. Price Weston says:

    According to an article in JAMA, FDA approved drugs prescribed by licensed doctors in hospital settings using approved standards and dosing limits kill in excess of 100,000 patients a year. That is considered science based medicine. How many die outside a hospital? Orthodox medical ?science? is more concerned about cartels and maintaining conditions as chronic than real health.

    1. Chris says:

      So if there is a study, why did you not list at a minimum its title and date? How can we be sure you are not just making it up, or that it really says something quite different? Does it explain how many people who would have died if they did not get medication? Should those with type 1 diebetes stop taking insulin?

      How does pointing out that sometimes medications can cause problems make chiropractic okay?

      Just some questions to ponder while you read Dr. Hall’s article <a href="http://www.sciencebasedmedicine.org/death-by-medicine/"Death by Medicine.

      1. Chris says:

        Sorry, I mucked up the link. Here it is: http://www.sciencebasedmedicine.org/death-by-medicine/

    2. WilliamLawrenceUtridge says:

      Actually, that’s considered malpractice. Science-based medicine is what is used to determine those dosing limits, medical practice is still trying to work in controls over bad handwriting, excessive dosing and related medical errors. Giving pharmacists more involvement and big pharmacy chains implementing their own medication tracking systems has probably helped.

      Oh, and note where that criticism was published, the Journal of the American Medical Association. Medicine is self-critical and tries to improve over time.

      But at least you didn’t try to present chiropractic as a solution, so it’s only half a fallacy.

    3. David Weinberg says:

      I think I found the article to which Price Weston was referring:

      http://jama.jamanetwork.com/article.aspx?articleid=187436

      The article was a meta analysis of articles published between 1966 and 1996. Using those data the authors estimated the number of fatalities due to adverse drug reactions among inpatients in U.S. hospitals in 1994. The estimated number was 106, 000. Price Weston had one piece of information wrong. About 40% of those fatalities were due to drugs administered prior to hospital admission. Fatalities due to drugs administered to inpatients occurred in .19% of hospitalizations, and accounted for an estimated 63,000 1996 fatalities.

      The estimation of fatalities was based on all the articles in the meta analysis. The fatality rate improved over the 30 years of the study by nearly an order of magnitude. If one looks only at the articles between 1986 and 1996, fatalities due to drugs administered before or during admission occurred in .04% of admissions, and would account for about 1300 fatalities in 1994. http://jama.jamanetwork.com/article.aspx?articleid=1152408

      Bottom line: adverse drug reactions are a real phenomenon, and a genuine concern. But they have to be viewed in context with the benefits. They are not a secret. This article was published in a very visible, highly regarded journal. Steps are being taken to minimize the risks, but they will never be zero.

      Show me any similar, rigorous analysis of adverse effects of alternative medicine.

      1. dethe says:

        Thanks for tracking down that article, David.

  11. Paul Spence says:

    “Perhaps they will try the same gambit as the BCA and put out a statement reviewing the scientific evidence for the chiropractic treatment of infantile torticollis, hoping that no one actually reads the evidence and is simply impressed by the list of references”

    I think you meant to type “impressed by the single anecdotal reference”.

  12. Kris says:

    For all the individuals reading this I wanted to clear a few things up about chiropractors. There are good and bad in every profession not just chiropractors. I’ve been a chiropractor for 10 years and I have never treated a infant. This is not because I don’t believe in it, it is because I have not had the proper training or practice. It seams like this makes a great headline “Chiropractor almost kills an baby!!!” I wonder how many infants die each year due to medical error? Why isn’t that reported?

    1. First and foremost there are many published journals showing the benefit and safety of chiropractic care. Chiropractic care has been proven to be the best and most cost effect care for acute low back pain.

    2. Chiropractors are physicians. They have a rigorous curriculum with more hours than medical school.

    Chiropractic College vs Medical School
    456 Anatomy/Embryology 215
    243 Physiology 174
    296 Pathology 507
    161 Chemistry/Biochemistry 100
    145 Microbiology 145
    408 Diagnosis 113
    149 Neurology 171
    56 Psychology/Psychiatry 323
    66 Obstetrics & Gynecology 284
    271 X-ray 13
    168 Orthopedics 2
    2,419 Total Hours for Degree 2,047

    3. The Institute of Medicine’s (IOM) seminal study of preventable medical errors estimated as many as 98,000 people die every year from preventable medical errors as making it the sixth leading cause of death in America.

    4. Chiropractor work together in the medical field with MD’s, PT’s, OD’s, etc. none are which are better than the other. Patients benefit from an interdisciplinary approach to care. All of my patients come from referrals from Neurologists, Medical Doctors, and Orthopedic physicians.

    5. In the United States, people make around 280 million visits each year to chiropractors. How many people die from this? Any? Why is that not reported on the article?

    To bash a profession on the bad judgement of a person is ridiculous. Chiropractic is not only safe for infants and adults it also can help prevent addiction to pain medication, invasive surgery, and unnecessary pain and suffering. Millions of people get relief from chiropractors each year if it didn’t work why would chiropractic be the 3rd biggest population of health care providers after medical doctors and dentists?

    1. Anna says:

      I’d argue your figures for hours done in med school – my brother is a doctor and twelve years after he started, he’s still studying (he’s on the home stretch now, close to being a fully qualified paediatric oncologist). I reckon he’s done a lot more than 2000 hours.

    2. Nashira says:

      @Kris: There is no world in which a chiropractor is justified in calling themself a doctor. You are not even remotely qualified to do so, and the idea that you had more hours of education than an MD or DO is, to be honest, pretty funny. As a chiropractor, you are – at best – an inadequately trained physical therapist.

      You’ve also indulged in multiple logical fallacies: Tu quoque, No True Scotsman, appeal to popularity… Not to mention providing no sources whatsoever for your claim that chiropractic is “the best” treatment for low back pain.

      You sound like the usual parachuting quack, to be honest.

    3. John Milligan says:

      Besides the dubious conjecture about the number of hours that chiropractic requires versus medical school, it’s the quality of the instruction. In medical school, less so now thanks to the infiltration of CAM, the instruction is primarily science based. In chiropractic school it’s primarily based on a fantasy that a 19th century guy had about spinal bones being able to move relative to one another.

    4. Jann Bellamy says:

      @Kris

      “First and foremost there are many published journals showing the benefit and safety of chiropractic care. Chiropractic care has been proven to be the best and most cost effect care for acute low back pain.”

      “They have a rigorous curriculum with more hours than medical school. ”

      My research indicates otherwise: http://www.scienceinmedicine.org/policy/papers/Chiropractic.pdf
      Perhaps I have overlooked something. Could you please provide me with the citations for these assertions?

    5. WilliamLawrenceUtridge says:

      Did you read the article Kris? You seem to have missed the point – you’re either a PT with a different title, or you’re a danger to your patients because you think you can treat non-musculoskeletal conditions. If all those hours are dedicated towards anything but “stay away from this, because joint manipulation won’t help”, it’s not just a waste of time, it’s an active danger.

      Do you think you can treat anything but back, muscle or joint pain? I used to see a chiropractor, he was pretty good at giving me stretches and exercises for when I had joint pain, but he started selling vitamins and insisted on adjusting my cervical spine. After more than a decade, after reading the risks of cervical spine manipulation (unrecognized, still, by chiropractic bodies) I switched to a physiotherapist. Nice guy, he’s pretty funny too.

    6. Calli Arcale says:

      Your numbers for how many house chiros versus MDs have to get in various courses is so far divorced from reality that the word “lying” becomes appropriate.

      First off, you can become a chiropractor with an associates degree. MD is a post-graduate degree; you must first complete a bachelor’s degree in a relevant discipline (biology and chemistry are typical pre-med paths) before you can even *begin* an MD.

      Second, an associates degree (which is adequate for a DC and is what most DC academic programs produce, though a few chiropractic schools have started to offer optional bachelor’s degrees, at the end of which you are qualified to practice) requires generally two years of college, if you are studying fulltime. (Longer otherwise, of course.) A bachelor’s degree generally takes four years. And that is all before starting medical school. Medical school will take another four years, at least. And that’s *before* the residency.

      Third, did you even pause to *look* at the numbers you were claiming? 2 hours for orthopedics? That’s so obviously absurd that it should clue anybody in that it’s nonsense. Or did you go with it because it was so appealingly derogatory to the medical profession?

    7. Harriet Hall says:

      Some comments about the curriculum:
      1. The number of hours is less important than whether those hours are put to good use.
      2. Why is it that after such a “rigorous curriculum” half of all chiropractors discourage immunizations and 37% of them use applied kinesiology? It’s obvious that they haven’t learned much science.
      3. I don’t see pharmacology on the list. How can someone understand medicine without that? Especially since some chiropractors are aspiring to become family physicians and get prescribing privileges?
      4. I don’t see pediatrics on the list. In one study, chiropractors were asked what they would do about a 2 week old baby with a fever, and not one of them recognized that a fever at that age is a medical emergency requiring immediate hospitalization?
      5. And I don’t see epidemiology; surely that’s critical to understanding medicine.
      6. What about critical care? Immunology? Hospital rotations?
      7. Chiropractic students get no experience in hospitals or with seriously ill patients, so they are poorly equipped to recognize serious problems requiring referral.
      8. There is no internship/residency comparable to that in medicine. Medicine is not learned in medical school, but afterwards. School lays the foundation, residency teaches them to put their knowledge to practical use as they take full responsibility for complicated cases.

      If you think your education was comparable to that of an MD, it is only because you don’t realize how much you don’t know.

      As for the chiropractic journals, here’s an example of what gets published in chiropractic’s premier journal, JMPT http://www.sciencebasedmedicine.org/blind-spot-mapping-cortical-function-and-chiropractic-manipulation/

      And they frequently base reports of effectiveness on flawed case reports.
      This systematic review of systematic reviews concluded “Overall, the demonstrable benefit of SM seems to be minimal in the case of acute or chronic back pain; controversial in the case of headache; or absent for all other indications… we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition.”

      And a Cochrane review found that found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham therapy and therapies already known to be unhelpful. It was no more or less effective than medication for pain, physical therapy, exercises, back school, or the care given by a general practitioner.

      The rest of your points are logical fallacies that have been pointed out to you by others, like the appeal to popularity.

    8. Chris Hickie says:

      I’m sorry, but chiropractic is not needed for infants and as we see from above–not safe. Please don’t tell me you’re “just like me”, because you are not.

      I used to tolerate this “can’t we all just get along?” theme espoused by chiropractors, but I’m done with that. That you can get up and say that infants somehow need adjustments fresh out of the womb is just plain and simple pushing a bunch of pseudoscientific garbage onto parents (usually using fear tactics) for the purpose of making money. And that you are antivaccine is just plain and simply a lesson for all to see of the gross ignorance of chiropracty.

  13. TBruce says:

    Kris:

    I ran your numbers for curriculum hours past my experience in medical school. It works out to less than 12.5 hours per week over the four years. That’s less than the usual hours of instruction for any undergraduate degree. Where are your numbers from? Slack-Ass Medical School (down the street from Evil Medical School)?
    It also doesn’t reflect so well on Chiro College, since your numbers indicate less than 15 hours per week over the same time period.

    My med school experience involved 8 or 9 hour days, five days a week, filled with instruction and labs for the first 2 years, and 8 to 24 hour days, with one in three weekends on duty for the last 2 years. When that was done and you got your MD, that was just the start. Postgrad studies took anywhere from 2 to 7 years, with very tough exams (50% pass rate) at the end.

    Yeah I know, we also walked ten miles uphill in the snow etc., but I hope you see one reason (of many) why I do not consider chiropractors to be appropriate primary care professionals.

    1. Harriet Hall says:

      When I was a senior in college, one quarter I wanted to take 20 credits, and I had to get a special dispensation from the dean to exceed the limits (I think 16 was the max). In the first year of medical school, our REQUIRED classes added up to 23 credits!

  14. Alex Webb says:

    What type of insurance does a chiropractor have to get to deal with back and neck injuries for children? I am sure that it raises their rates once they add children to their program.

    1. William says:

      Their malpractice insurance is ten times higher than than Novella’s, Gorski and Hall’s because of the high rate of causing death.

      1. TheRogueChiropractor says:

        Here in Australia PI/PL (professional indemnity/public liability) is AROUND the $1500 a year mark.

  15. Eclair says:

    When my MD suggested I see a chiropractor for a long term neck problem, I was flabbergasted. I told her I’d rather see a PT, someone who can fix the problem, not just mess it up more!

    In agreement with most above, there is no reason for an infant or child to see a chiropractor. I won’t let one touch me above my coccyx.

  16. kidsdoc says:

    I get to fight the same battles here in flyover country. In the last 12 – 18 months I have had 2 kids have very bad outcomes from chiro neck manipulation. One was a few weeks old child with torticollis who wound up paritally dissecting his vertebral artery and now has a nice calcified mass lying amongst his cervical vertebrae. Mercifiully the dissection didn’t progress and he had no neurological symptoms. With all the consult notes expressing their dismay for any chiro manipulation on kids that age I think that perhaps at least that family will now be nicely entrenched on the side of science based medicine. The child himself is now about 18 months and is doing extremely well without any permanent sequelae aside from perhaps a less mobile neck.
    The second was a 17 yr old boy who was at his chiro for “maintainence”, about 4 hours after the neck manipulation he became light headed and started slurring his speech. Eventually he was diagnosed with the same diseccting artery and a mild stroke. Luckily his age and relative neuroplasticity is on his side. He is getting back most of his function and hopefully in a few years no one will be the wiser.
    When I asked both families what the chiro’s had to say…shockingly neither felt they had any culpability. Neither could see how the manipulation could have affected the arteries and both felt there must have been some abnomality there already that would have progressed without their help.
    With those 2 stories my whole practice of 24 pediatricians and 8 PNPs knows to strongly discourage in no uncertain terms chiro neck manipulations to any parent who asks.

  17. austin says:

    do chiropractor give us the insurity of the children’s injuries benefit…..

  18. TER says:

    Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular pilar, the cervical equivalent of the pars interarticularis in the lumbar spine. Associated dysplastic changes and spina bifida suggest that the lesion is congenital. It is a rare condition; only 70 cases have been previously reported in the world literature. Read More: http://www.ajronline.org/doi/abs/10.2214/ajr.154.4.2107670

    Also see http://www.medicalobserver.com.au/news/outrage-at-claim-that-chiropractor-broke-babys-neck

    The jury is out. Did the baby really have an exceedingly rare malformation found only in 1 in a billion people ? If there was no injury, why was the chiropractor told to commit to further education? How did the newspaper obtain such confidential information that nobody else has and how did the journalists manage to interpret complex radiology reports. Its a mystery.

    In any case it doesn’t matter to the average person. Chiropractic is the new black. Its a trend that relies on placebo effect and bedside manner. people believe in it with a religious fervour. I usually just smile nicely when someone else tells me about how they go to their great chiro every week for a tuneup. Fine but I will save my money.

  19. it said they are rare but his dad has the same. And it might be rare but perhaps 1 in 1000 rare (lumbar spondylolysis in about 1 in 20). It isn’t a reportable condition so the fact that there are 70 published cases doesn’t mean anything. I know you probably weren’t serious with the 1 in a billion comment, but in case you were, you might want to consider the fact that they just found 2 and they weren’t even looking.

    Some people were talking about medics/chiros self-regulating higher up in the thread. No registered health practitioners self-regulate, there is an independent body (Australian Health Practitioner Regulation Agency) that investigates each case and is then passed on to the appropriate medic/dentist/chiro association for discipline if they deem it minor enough.

    And about the training, when I did mine about 10 yrs ago we did our anatomy, embryology and some of our neuro training at Sydney uni sharing the same units and exams as medical science students, and I don’t mean they were in another room, it was lectures and labs where some of us were chiro students and some were medical students.
    And yes you have to do a science degree first then masters. Yes you have to do pharmacology.
    As for the Doctor title, Physiotherapists also have the doctor title in most countries but it is a minimum 5 years study, whereas it’s 4 here. It doesn’t mean much, you’re either a MEDICAL doctor or you aren’t, and most people know the difference.

  20. Richard says:

    Evidence based reporting should have all the facts instead of the one sided hype rubbish story that got churned out. Not that it would change the minds of the blinkered but here are the facts with this particular case.

    A CHIROPRACTOR has been cleared over claims a baby’s neck was broken during a treatment.

    An expert report undertaken by the Australian Health Practitioner Regulation Agency, a federal body set up to replace state-based health regulators, quoted a radiologist who examined the four-month-old baby and found that there was “no evidence of fracture”.

    Fairfax newspapers reported claims by a Melbourne doctor who had cared for the baby last year that one of her vertebrae had been fractured during a chiropractic treatment for torticollis, which involves an abnormal head position because of a weakness in the spine.

    The AHPRA report found that the child had congenital spondylolysis, a malformation of the spine, and the child’s father had a similar condition. It concluded that “the treatment reported as provided would not be expected to produce sufficient force to cause a fracture to C1 or C2 vertabra in an infant”.

    “The loss of head control apparent after treatment could have been the result of unrelated factors,” it said.
    - See more at: http://www.theaustralian.com.au/news/nation/chiropractor-cleared-over-break/story-e6frg6nf-1226740575036?sv=81db7a8ae0da0eb23e572bf83dec8693#sthash.PiHWoDSw.dpuf

    Isn’t it nice to know that a chiropractor did NOT break a babies neck?

    1. WilliamLawrenceUtridge says:

      This case is an exemplar. Your argument seems to be “because this one chiropractor didn’t break the baby’s neck, all chiropractors should be free to adjust the necks of all babies”.

      See, doctors would look at this and say “what is the risk-benefit of cervical vertebrae adjustments in infants, based on the peer-reviewed literature”. If they didn’t find any, they wouldn’t adjust the cervical vertebrae. Since the “scientific” literature to support this chiropractic intervention is so astonishingly minimal, just case reports, there is no rational reason to adjust the cervical vertebrae of infants.

      My concern is that people (read: chiropractors) will treat this as a vindication, as if this one case being not the fault of the chiropractor, means that all chiropractic care us safe. It’s not.

    2. Harriet Hall says:

      I don’t think we have sufficient facts on either side at this point. We have two news reports with opposite assertions. I would like to know more. Who were the radiologists who made different diagnoses? Were they pediatric radiologists familiar with the different appearance of the infant spine? Were they chiropractic radiologists? (Yes, there is such a thing: https://www.accr.org/) Did the two radiologists get together and resolve their differences of interpretation? Did an unbiased, independent review establish the true facts in the case? What kind of manipulation did the chiropractor perform? Did he use excessive force? If the chiropractor did nothing wrong, why was he ordered to get more training? If the baby lost head control after treatment, how can we be sure it wasn’t related to the chiropractic manipulation? Was a neurologist consulted? Did a pediatric neurologist with special training review the case? What did he think caused the loss of head control? Can anyone get access to the actual documents in this case, so we don’t have to rely on what the reporters said?

      I hope to see a future report that will reconcile these two opposite reports and explain exactly what happened and why the errors were made, if they were errors. But to me, the most important issue here is why chiropractic manipulation was used at all. It is not indicated for children, much less for infants. See http://www.csicop.org/si/show/should_chiropractors_treat_children/ (written by a chiropractor, by the way!) There is no evidence of benefit to children of any age for any condition. If there is no evidence of benefit for a treatment, why do it? Torticollis usually resolves with physical therapy and simple stretching. Do we know anything about the potential risk of manipulation in spondylolysis? Is it possible that manipulation could result in spondylolisthesis? (Spondylolysis is a bone defect; the defect can allow spondylolisthesis to occur, where one vertebra is displaced in relation to the next.)

      1. nobs says:

        Harriet Hall says:

        October 16, 2013 at 1:03 pm
        “….If the chiropractor did nothing wrong, why was he ordered to get more training?….”

        I submit that Pappas, a pediatriction no less,…… DID do something wrong……Mis-diagnosed a fracture. Given his specialty here, one can only wonder why HE hasn’t been ordered to get even MORE training?

        1. Harriet Hall says:

          That’s why I asked who read the x-rays. If the second x-ray reading was correct, whoever diagnosed a fracture on the first x-ray does need more training. Pediatricians depend on radiologists to read x-rays, and I don’t think it would be fair to fault the pediatrician for accepting a radiologist’s report.

            1. Harriet Hall says:

              Finally, a primary source! Thank you. It clarifies some things but leaves some of my questions unanswered. I would like to know the credentials of the person writing that report. Chiropractor or MD? It clarifies that the chiropractor was criticized for deficiencies in record-keeping rather than for his treatments. I don’t understand the technical language about some of the chiropractic treatments, but I do recognize “craniosacral” which is a bogus technique based on fantasy. It doesn’t offer any explanation for the infant’s loss of head control. It doesn’t have an explanation for the new bone formation except to say that it doesn’t appear to be characteristic of a healing fracture. It doesn’t say that the presence of spondylolysis should be a contraindication for chiropractic manipulations (I suspect it should). It doesn’t cite any studies justifying chiropractic treatment of infants for any condition. I would still like to see this report and the actual x-rays reviewed by a panel of experts and see what their consensus is. Bottom line IMHO: probably no fracture, but chiropractic treatment was not justified.

          1. theroguechiropractor says:

            Are you more interested in the X rays or the CTs?

            I’m also intrigued as to the reason for there being a large gulf between CT examinations included in the report – surely there would have been more than 3 CT examinations done for a potentially serious condition such as this?

            Your recommendation on Cervical Congenital Spondylolysis being a contraindication for cervical manipulation is a good one, but the snag is – how to we check for this without routine exposure to ionising radiation? That then leads into – is there any BENEFIT to exposing the child to radiation? Particularly if the treatment proposed is of any efficacy?

            Could the child have suffered these injuries from any normal head/neck movement? Why is there an apparent temporal relationship?!!?

            Questions, questions questions. More questions than answers still.

            1. Harriet Hall says:

              “Are you more interested in the X rays or the CTs?”

              Umm, CT’s are x-rays too.

            2. Harriet Hall says:

              “is there any BENEFIT to exposing the child to radiation? Particularly if the treatment proposed is of any efficacy?”

              But there isn’t any evidence that chiropractic care is of any efficacy in torticollis. And there certainly isn’t any evidence that craniosacral is effective for anything. In fact, there isn’t any evidence that chiropractic care benefits any condition in young children.

              “Could the child have suffered these injuries from any normal head/neck movement?”

              What “injuries” are you talking about? Neither fracture nor spondylolysis nor torticollis are injuries from normal head/neck movement. Neither is the “loss of head control” that developed after the chiropractor treated the baby.

  21. mousethatroared says:

    here’s another report on the update. “http://www.theage.com.au/victoria/doctor-stands-by-claim-on-baby-injury-despite-chiropractic-bodys-denial-20131016-2vn03.html”

    “On Wednesday, national president of the Chiropractors’ Association of Australia Dr Laurie Tassell said an expert report on the case commissioned by the Australian Health Practitioner Regulation Agency (AHPRA) and cited in The Australian showed the baby’s neck had not been broken.

    In a written statement, Dr Tassell said the baby had a condition known as congenital spondylolysis, a malformation of the spine that ”can be confused with a ‘hangman’s fracture’.”

    Dr Tassell declined to be interviewed or to comment on whether he had a copy of the report, but said the chiropractor who treated the infant had not applied sufficient force to cause a fracture.

    “The chiropractor could not and did not cause an injury to the child,” his statement said.

    But Dr Pappas said he was certain the four-month-old baby girl had sustained a fracture, which was confirmed by a radiologist, and he said further investigations revealed the baby had a congenital condition, which the chiropractor had overlooked. He said this condition put the infant at higher risk of injury and complicated the baby’s treatment after she was taken to hospital with a broken neck.

    The chiropractor declined to comment on Wednesday. A spokeswoman for AHPRA said she could not release any reports on its investigation of the case.”

  22. tatum says:

    @Kris and whatever chiro is reading: A response from a family medicine physician to this dangerous chiropractic PCP non-sense.

    comparing the extensive premed college training, medial school, and residency training us real primary care physicians obtain to the nonsense training a chiropractic person “gets” is so delusional it is hard to know how to respond. So here it goes:

    I am a family medicine physician who graduated residency in 2008 with intensive training. My residency was 4 years. My training gave me the confident knowledge and extensive experience to practice obsetrics (including high risk pregnancies), I do my own c-sections, gynecology including colposcopies, inpatient medicine including ICU ventilator management, central lines, chest tubes, intubations, nursing home care, and of course clinical medicine from birth to death.

    To be a real physician is to be a MEDICAL DOCTOR (that MD we put after our names) and requires a whole hell of a lot more training than whatever you think got in whatever chiro academy you and the lot of you went fell out of – the comparison is just ignorant. to even think of calling yourself a primary care provider is just ignorant.

    So 4 years of pre-med preparation in college – unlike chiropractors we go to college – 4 years of medical school – 4 years of intense training residency in the hospital, ER, clinic, nursing home, etc (working >90-120 hours a week -studying after hospital and clinic work was finished for the day – with difficult tests, practicals and Board Exams), I also did a 1 year teaching fellowship focusing on evidence based medicine. So that is a total of 14 years of study, testing, teaching, and hands on experience – and you are going to compare it to your chiropractic training??

    You have been a chiropractor for 10 years? guess what – it took 14 years of training to be a family medicine physician – a real primary care physician or if you will PCP – just being the first a someone happens to lay their eyes on when they are looking for medical help/advice DOES NOT MAKE YOU A PRIMARY CARE ANYTHING – it makes you a chiropractor a danger to society! You/chiropractors are dangerous because you don’t know what you don’t know and the little that you do know is total nonsense.

    2 quick Examples from last month: a woman with metastatic cancer in her inguinal lymph node delayed MD evaluation because one of your chiro colleges told her “don’t worry its a hernia” (anatomically impossible at location in inguinal area) and proceeded to stick acupuncture needles in the 4 cm hard ball of cancer for months! (currently pt on hospice). another – a man had such severe BPH his bladder became so enlarged to about the size of a 6-7 month pregnancy and was in severe acute renal failure (requiring dialysis) when i finally saw him. this dangerous chiro saw him 3 week prior and started him on a $2,000 herbal pill cleanse for 3 weeks (40 pills of who knows what per day and 6 herbal cleansing shakes a day) because according to this chiro his symptoms were caused by “mold in his blood”- the chiro saw “mold” on one of those “live blood analysis” gimmics. (ends up you chiro guys dont clean the microscope slide nor cover slip nor microscope EVER and use unwashed bare hands to get obtain blood samples and prep a slide with blood on it) . you guys don’t know anything about state/federal lab laws/requirements and evidently haven’t heard about CLIA. but that is besides the point – a chiro should not be doing in the first place! these are only a few examples of the danger of chiros- you don’t know that you don’t know anything.

    now moving on to your comparison of chiro school to medical training:

    you think chiros get more hours in “diagnosis.” what? diagnosis training starts DAY 1 and is everyday – every minute in medical school and continues throughout residency. so add up all the hours in 4 year medical school and 3-4 year residency and that is the #hours that we get in “diagnosis.” The fact that you have to call it “diagnosis” shows that chiros have no idea what your are talking about or what you are doing.

    physiology: please – that was at least 10 hours a week for the entire first year of medical school and part of EVERY class. step one of the medical boards taken after first year is all physiology. I would love for you to take a look at that test and try out your physiology training. Go ahead!

    also you seem to think that medical students get 13 hours of “x-ray.” again this starts day one medical school and occurs in every single rotation, every single class, every single day in med school and in residency. we also get bonus training in ultrasound, ct, mri, pet scans, etc etc! additionally orthopedics is a 2 month class, a dedicated > 1 month rotation in medical school, and 2-3 months rotation in residency. we also did this really cool thing called trauma surgery call for 2 months at level one trauma ER – guess what – that was a lot orthopedics and “xray.”

    anatomy/embryology: try again. We start with a whole human body and dissect the cadaver down to bone both male and female adult and pediatric. including brain, eyes, reproductive organs, bones, muscles tendons, – everything in Netters anatomy book. Everything on the human body. we had 4 -5 hour anatomy lab daily for 5 months, with 2 hour anatomy/embryology lectures afterwards, then the lab was open all night for us to study – so add on about 10 hours a week studying in the lab and add about 2-3 hours of book studying after class and lab a day. feel free to do the math x 5 months. and again – we study anatomy in all of our rotations and classes. it starts day one year 1 – last day of residency – 8 years. sorry.

    66 hours for ob/gyn???? lets compare: 100 hours a week on my 2 month OB rotation in medical school, the 1 medical school month class room course in ob/gyn 7-8 hours a day, then the 6 months of pure hands on OB in the hospital during residency (again working >100 hour weeks), and for the entire 4 years of residency doing prenatal care, delivering my own OB patients, doing deliveries on call every 4th night for 4 years. This is not including my 3 months of GYN training in residency + med school gyn classes +1 month gyn rotation, and 4 years of hands on experience in residency. You can do the math – its a hell of a lot more training than the 284 hours or whatever you think we get.

    Another thing we physicians are required to do to is to go through and extensive admissions process to ensure we have the intelligence, reasoning skills, critical thinking skills, clinical knowledge, scientific knowledge, and dedication to even be considered for admissions to med school. (lets not forget the organic chem class and labs, biochem + lab, physics +lab, biology +lab, anatomy, micorbiology, etc etc etc physicians get in college premed classes.)

    we have constant and continued testing both clinical, simulated, and written tests. Starting with the MCAT before you can even apply to med school. it has a failure rate of about 60%. The average college GPA score for medical school admission was a 3.68. Admission rates to medical schools can be as low as 1.5% of applicants admitted. To say the least the admission process to medical school is extremely difficult. Lets look at chiro school – seems pretty darn easy! – only one chiro school requires a bachelors degree, there is no entrance exam, and you have to have at least a 2.5 GPA.!! Wow a 2.5? source: wikipedia

    so lets test your extensive chiro training: (no looking up answers now!)
    so you know pharmacology and ob and “diagnosis” you say? what are the clinical signs of and how do you diagnose severe pre-eclampsia? then what do you do? what meds to you give and at what dosage and how quickly? what are the contraindications to those medications? you shouldn’t have to look it up if you are a primary care provider who had sufficient training in ob, physiology, and pharm! if you see pregnant women you need know how to recognize ALL the problems that can occur with pregnancy!

    what dose of allopurinol should you start someone on it they have stage 3 CRF? what is stage 3 CRF – how do you diagnose – what are the main causes – how do you treat it? what is your alternative to allopurinol? this is a basic physiology, diagnosis, pharmacology, chemistry, and pathology question that any 3rd-4th year med student can answer.

    if you want to be a physician – go to medical school. if you want to be a primary care physician go to residency after medical school. chiros will never be physicians, can never be physicians, are not PCP’s. This whole chiro movement to try to get states to call them PCP’s is an insult to the entire medical community and a true danger to everyone.

    1. WilliamLawrenceUtridge says:

      so lets test your extensive chiro training: (no looking up answers now!)
      so you know pharmacology and ob and “diagnosis” you say?

      Tatum, I’m going to have to call you out on your knowledge of chiropractic. Clearly you don’t understand how chiropractic works.

      what are the clinical signs of and how do you diagnose severe pre-eclampsia? then what do you do? what meds to you give and at what dosage and how quickly?

      Well, first off, no meds. All disease is caused by subluxation. The first test is a wallet biopsy, followed by a $2,000 bill for six months of services in advance. Then you eyeball the patient, and if it looks like they might have pre-eclampsia, you adjust their lumbar, thoracic and cervical spine. Again, get the money up front because sometimes they stop coming in for adjustments (in rare cases because of cervical artery dissection that killed them). Then you repeat, until the patient gets better, runs out of money or dies.

      what are the contraindications to those medications?

      Immediately cease all medications, it might interfere with the adjustments (i.e. if medications help, patients might stop coming).

      if you see pregnant women you need know how to recognize ALL the problems that can occur with pregnancy!

      Well duh! Of course you have to recognize both problems that might come with pregnancy – a pregnant woman is not getting adjusted, and her baby isn’t getting adjusted. Geez, let’s evaluate the person holistically and make sure their w”hol”e family is getting charged for weekly maintenance treatments!

      what dose of allopurinol should you start someone on it they have stage 3 CRF? what is stage 3 CRF – how do you diagnose – what are the main causes – how do you treat it? what is your alternative to allopurinol? this is a basic physiology, diagnosis, pharmacology, chemistry, and pathology question that any 3rd-4th year med student can answer.

      Well, first off, no meds. All disease is caused by subluxation. The first test is a wallet biopsy, followed by a $2,000 bill for six months of services in advance. Then you eyeball the patient, and if it looks like they might have pre-eclampsia, you adjust their lumbar, thoracic and cervical spine. Again, get the money up front because sometimes they stop coming in for adjustments (in rare cases because of cervical artery dissection that killed them). Then you repeat, until the patient gets better, runs out of money or dies.

      This whole chiro movement to try to get states to call them PCP’s is an insult to the entire medical community and a true danger to everyone.

      I’ll take my tongue out of my cheek now, and just agree.

      1. WilliamLawrenceUtridge says:

        Heh, my copy-paste neglected to correct for the condition (stage 3 CRF versus pre-eclampsia) but I doubt it would make any difference anyway since the treatment is the same. When all you have is a hammer…

    2. william says:

      @Tatum,
      Since you’ve decided all chiropractors are the same here’s a no spin question for you:
      How many people have died under your careful watch?

      1. WilliamLawrenceUtridge says:

        What does that have to do with the safety and efficacy of chiropractic care? It sounds like you are attempting to justify chiropractic care through the lack of perfect safety in medical care. This is a false dilemma; the reality is, the safety and efficacy of chiropractic care is totally unrelated to the safety and efficacy of real medicine. The solution to improving chiropractic care isn’t to wait until medicine is perfect to start researching whether chiropractors are a danger to their patients. The solution is to evaluate whether individual treatments are effective at alleviating neck or back pain, and whether they are worth the risks (such as cervical artery dissection for neck manipulation).

        Chiropractors aren’t all the same, straights are lunatics and mixers are much closer to simple physiotherapists, but only one of their interventions is justified through scientific research – spinal manipulation for the relief of lower back pain (a modality being adopted by physiotherapists). None of which justifies any other type of spinal manipulation, in particular cervical manipulation which can cause strokes, clots and death. And there’s absolutely no justification for claims that chiropractors can cure cancer, allergies, asthma, colic or should be primary care physicians.

        1. William says:

          @WLU
          Your posts are nothing but your layman opinions. And you must like to read your opinion online because generally you have to say something about everything even if someone else said it before.
          You say
          Again, missing the point – this one example was used as a lead-in to the overall issue: chiropractors shouldn’t be adjusting the necks of babies with softened bones. The risk of adjusting infants are not commensurate with the benefits of this practice – mainly because NONE OF THEM HAVE BEEN PROVEN THROUGH WELL-MANAGED RESEARCH.

          How do you know ” this one example was used as a lead-in to the overall issue”?
          The article was another slam against chiropractors which is what this blog likes to do.

          You say

          Well, first off, no meds. All disease is caused by subluxation. The first test is a wallet biopsy, followed by a $2,000 bill for six months of services in advance. Then you eyeball the patient, and if it looks like they might have pre-eclampsia, you adjust their lumbar, thoracic and cervical spine. Again, get the money up front because sometimes they stop coming in for adjustments (in rare cases because of cervical artery dissection that killed them). Then you repeat, until the patient gets better, runs out of money or dies.

          Is this supposed to be funny?

          Real honest science, I’m sure you’ll keep it coming.

          1. WilliamLawrenceUtridge says:

            Your posts are nothing but your layman opinions.

            Yes. Does that invalidate them? Why? How does that address the fact that there doesn’t seem to be any good science backing the benefits performing spinal manipulations of babies? Why are you attempting to distract me from the issues by pretending my qualifications would matter? It’s like a bloodletter claiming I can’t say bloodletting is useless because I’ve never cut someone open.

            And you must like to read your opinion online because generally you have to say something about everything even if someone else said it before.

            I really do like to both read and write my own opinion. I have, on many occasions, revisited old posts solely to read my own comments. But what does this have to do with the lack of support for chiropractic care for infants?

            How do you know ” this one example was used as a lead-in to the overall issue”?

            I read the article. Did you?

            The article was another slam against chiropractors which is what this blog likes to do.

            Yep, because the rise of complementary medicine has not been accompanied by a rise in quality science demonstrating it has strong benefits and few harms. Chiropractors have had over a century to research their treatments and demonstrate safety and efficacy – this hasn’t happened. Any particular reason why, aside from “it would interfere with our ability to make money”?

            Is this supposed to be funny?

            Yes. In case I was too subtle, I’m making fun of chiropractors for pretending that all disease is caused by spinal subluxations, when really that’s just their made-up nondisease they use to keep charging asymptomatic patients for spinal manipulations.

            Real honest science, I’m sure you’ll keep it coming.

            I notice your comment is long on complaints and completely absent any actual science, so that kinda makes you a hypocrite – doesn’t it?

  23. william says:

    BTW@ Steven Novella,
    Great Journalistic reporting before the all the facts were in ! On a science-blog no less!

    1. WilliamLawrenceUtridge says:

      Again, missing the point – this one example was used as a lead-in to the overall issue: chiropractors shouldn’t be adjusting the necks of babies with softened bones. The risk of adjusting infants are not commensurate with the benefits of this practice – mainly because NONE OF THEM HAVE BEEN PROVEN THROUGH WELL-MANAGED RESEARCH.

      Got anything to say about the real substance of the post, or are you just going to keep picking at the substantially irrelevant part?

  24. travis says:

    When will this post be retracted? The comments in this section don’t warrant saving and the story has been proven to be untrue.

    1. Chris says:

      Because you say so? Did you read Dr. Hall’s comment that some questions are still not answered?

      Actually the discussion brings more of the nuances, and emphasizes that chiropractors should not treat babies. Especially if they cannot determine if the child has a congenital condition that they could make worse.

    2. WilliamLawrenceUtridge says:

      The individual example might not be true (perhaps), but the larger question of “should chiropractors adjust babies” is still quite relevant. That question still hasn’t been answered, for torticollis specifically, or for any indication whatsoever. Where are the clinical trials demonstrating improved outcomes for babies undergoing chiropractic care? I’ve made this point several time in the comments, but nobody has responded. Care to be the first?

  25. William says:

    @travis
    this is anti-chiropractic site. Don’t expect them to say they jumped the gun.

    1. Helg says:

      The “sceptical” movement is a propganda organisation for lobbyists. Steve Novella is conected to ACSH (See Sourcewatch about ACSH). Chris and other followers of that
      movement are unable to critises their leaders. They are trained to not admitt they are wrong.

      1. Chris says:

        Aw, you poor guys. You have no response that is based on science and evidence, so you must rely on some kind of random accusations of “lobbying.” Here is some reading:

        Crosby next goes on to the fact that I have been an adviser to the American Counsel on Science and Health (ACSH). The implication, again, is that I am somehow getting my marching orders from them. This is dangerously close to libel, and Crosby has absolutely no evidence (because none exists) of any conflict of interest between me and ACSH.

        I used the hand dandy search box at the top of the page for “ACSH”. I found about three articles where they were mentioned. Go up and do it yourself, tell us which of the articles were pushing ASCH’s agenda.

        In the future, folks, if you want to discuss things on a blog about science based medicine, try to actually do something novel and unique: provide scientific evidence for your claims instead of random accusations. Like perhaps actual scientific studies that show chiropractic methods are as good or better than medical care. Please do a better job at gathering the evidence than the British Chiropractic Association.

        1. William says:

          In the future, folks, if you want to discuss things on a blog about science based medicine, try to actually do something novel and unique: provide scientific evidence for your claims instead of random accusations. Like perhaps actual scientific studies that show chiropractic methods are as good or better than medical care.

          Hey Chrissy,
          That’s all been done before for how many posts? The same old topics about chiropractic: PCPs, strokes,bad guys,quacks,Blah,blah,insults. This isn’t about “science” it’s about how many idiotic comments from lay people like WLU,TGOBBI and perhaps you can we let go by till we get drawn in. It’s bad enough that the medical sleuths on this site write their
          predjuced articles based on internet research but when you and your buddies start in …….

          1. WilliamLawrenceUtridge says:

            The burden is on the claimant though – if you think chiropractic care is safe and effective, particularly for infants, surely you can provide evidence to support this point? I mean, I can claim chiropractors are all vampires, but that doesn’t make it true and evidence is required. Why is it different for chiropractors? Why do their claims that their treatments are safe and effective get a free pass? Why should we believe them when chiropractors charge for their services, and have a direct financial incentive in pretending chiropractic care is safe and effective?

          2. Chris says:

            william:

            his isn’t about “science” it’s about how many idiotic comments from lay people like WLU,TGOBBI and perhaps you can we let go by till we get drawn in

            So why are still relying on random insults, like using a diminutive of my name, instead of presenting the actual science? If you think our comments are idiotic, then present actual evidence. Why is that so difficult?

    2. WilliamLawrenceUtridge says:

      Damn right it is anti-chiropractic; as a site based on science-based medicine, the near-complete lack of good evidence for chiropractic treatments, particularly for infants and children, pointing out why this is a bad thing is kinda the raison d’etre.

      The exception is acute low back pain, chiropractors are supported in that. Then again, so are physiotherapists, who are now adopting spinal manipulation as a type of therapy. Which makes chiropractors redundant in my opinion, and underscores two points:

      1) For over a century chiropractors resisted or neglected research on their preferred form of treatment.

      2) Now that the evidence is there, we witness the strength of science-based medicine; changing practice in the face of proven treatments.

  26. Helge says:

    In the article above Novella does Novella say,that a chiropractor has broke a babys neck.
    Was it true?

    Isnt it true that S. Novella has been a “scientific advisor” for ACSH , and so has S. Barett and Shermer. Novella said it was because ACSH was against smoking!

    But the subject here is was the babys neck broken or not?

    If the neck NOT is broken. WHY the slander?

    Has it anything to do with the fact that S. NOVELLA was “scientific advisor” to ACSH for five years. Why not comparing Novellas and ACSHs views on “chiropractic”!?

    why did you not check what “Sourcewatch”says about how ACSH work.

    Why this false accusation against a chiropractor?

    1. weing says:

      “Why this false accusation against a chiropractor?”

      “The Australian press is reporting:

      Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis – an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery.”

      “This case is important, not because it is a case of harm, which can happen with any intervention, but because it highlights the risk vs benefit question. Are there any indications for chiropractic care of children, for neck manipulation at any age, and what are the risks?”

      Why this false accusation against Dr. Novella?

      1. David R says:

        An x-ray was taken and confirmed there was no fracture, somebody just claimed it with no evidence at all.

        1. WilliamLawrenceUtridge says:

          And as usual, chiropractors are defending this case as if it justified all infant neck manipulations. It doesn’t matter if the chiropractor didn’t break this baby’s neck – he had no reason to manipulate the neck of any baby for a condition that either self-repairs, or can be treated much more safely with gentle stretching.

          That’s the point consistently forgotten or ignored by every single chiropractor who pops into these comments with the same stupid point.

    2. WilliamLawrenceUtridge says:

      Why don’t people address the real and larger point? Why do chiropractors use spinal adjustments of the cervical vertebrae for torticollis when the intervention hasn’t been proven in clinical trials? Why not test it rather than arrogantly assuming it is effective and has an adequate adverse effects profile compared to its benefits?

  27. Helge says:

    WilliamLawrenceUtridge

    You are spreading lies about chiropractors. You said that an australian chiropractor had broken a babies neck!

    That is a lie. The real question YOU have to answer is : WHY DO YOU SPREAD LIES ABOUT CHIROPRACTORS????

    Start studying facts about chiropractic,, and about the Sceptical movements lies on the subject. Why didn´t you comment on the facts in the link above?

    From 27.: http://buggesblogg.blogspot.se/

    WilliamLawrenceUtridge YOU are not a serious debater. It is NO idea to discuss with you until you stop spread untruths about chiropractors. You seem to be one of the sorcerer’s (“James Randis”)apprentices. Why not start to study the subject chiropractic
    instead of spreading lies and propaganda.

    Then we can discuss.

    1. WilliamLawrenceUtridge says:

      You don’t seem to grasp the core of my objection.

      I don’t care if a chiropractor broke this baby’s neck.

      My ultimate point is – what evidence support treating any baby’s neck for torticollis through a spinal adjustment? Where is the evidence supporting superior outcomes compared to no treatment or conventional treatment? Where is the evidence the procedure is as safe or safer than no treatment or conventional treatment. You keep bringing up this case as if it mattered. It doesn’t, really, any more than a thousand other anecdotes, positive or negative, matters.

      So Helge, rather than showing up and posting links to a blog that I am not interested in (even if I could read it as it appears to be mostly in…Swedish?), why not show me the peer-reviewed evidence, the randomized, controlled trials, showing that chiropractic care is superior to no treatment or standard treatment for any condition – and particularly for torticollis.

  28. Amy says:

    The baby’s neck was not even broken.

    http://www.theaustralian.com.au/news/nation/chiropractor-cleared-over-break/story-e6frg6nf-1226740575036

    Do your research on Chiropractic before bashing it. There are case studies. The 1st adjustment, done by DD Palmer, was on a man who went deaf from a blow to his head many years before. After being treated by Palmer, his hearing was restored.

    Our nervous system is the beginning of our life in-utero, even before the heart forms.

    1. WilliamLawrenceUtridge says:

      Do your reasearch, and realize that “case studies” are not research, they are carefully-documented anecdotes. At best they generate ideas for real research.

      Don’t you think treatment should be based on the best and most recent evidence available? And that research only applies to the conditions it studies? Doesn’t that reasonable approach rather suggest that Palmer’s possible treatment of a deaf man at best suggests chiropractic care might have a role in treating deafness? And that it’s totally irrelevant to the treatment of torticollis?

      If Pfizer produced a drug that was only proven in case studies, would you buy it? Do you think it should be sold? If not, why the double-standard?

  29. Harriet Hall says:

    The doctor who reported the fracture continues to believe there was a fracture and insists all other causes have been ruled out.

    http://www.theage.com.au/victoria/doctor-stands-by-claim-on-baby-injury-despite-chiropractic-bodys-denial-20131016-2vn03.html

  30. David R says:

    Why don’t they even say how they verified it? Somebody’s “opinion” that it happened with out a scan is meaningless. An x-ray is also worthless with a child, you can’t see children’s vertebrae on an x-ray.
    I’m guessing nearly this entire story is a lie, cooked up to discredit a profession that helps millions of children and infants a year that Medicine miserably fails to help.

  31. sam says:

    I went to a PT for 1 yr found no results and then after fear I had no choice to try something different and went to chiro and it changed my life. I hate when PT’s or MD’s speak negatively about something they have no knowledge of.
    Furthermore if you actually do some investigating of your own the report shows the doctor didn’t break baby’s neck that she some kind of thind she was born with which on x rays looks like a break. Job well done Dr. Sappas you idiot !!!

    http://chiropractors.asn.au/index.php?option=com_k2&view=item&id=371:outrage-at-claim-that-chiropractor-broke-babys-neck

    1. WilliamLawrenceUtridge says:

      How does this justify adjusting an infant’s neck, with no evidence to support the practice, despite the condition being treated easily via gentle stretching? How does this justify chiropractors being able to treat cancer?

  32. Dan says:

    Well, 100 plus comments, amazing. Has anyone actually read the report of this case from the “Australian Health Practitioner Regulation Agency”? Apparently the author of the article on this website doesn’t want to tell you that the chiropractors demanded a retraction because there was no injury in the first place. To quote the retraction from ‘The Australian’ newspaper, regarding their prior article claiming that the chiropractor broke this childs neck: “An expert report undertaken by the Australian Health Practitioner Regulation Agency (NOT chiropractors) , a federal body set up to replace state-based health regulators, quoted a radiologist who examined the four-month-old baby and found that there was “no evidence of fracture”", In fact, the child was born with a CONGENITAL condition called spondylolysis, which, for you PT’s out there, means that the odontoid is not attached in the first place, therefore no fracture. It is hereditary, and in fact the childs father suffers from the same condition. The paediatrician was WRONG, and ASSUMED the chiropractor caused the separation of the odontoid. What should be called into question here is how a paediatrician can miss this in the first place and start throwing blame around, eventually ending up in every newspaper in the country. Good thing we don’t hear about all the medical mistakes that occur out there, the papers would be full. I doubt this will end up in the comments section but its worth a try.

    1. Harriet Hall says:

      The most recent update I could find was http://www.medicalobserver.com.au/news/no-doubt-babys-neck-was-fractured-doctors-say It says the baby’s neck was indeed fractured, and the chiropractors suppressed the second, confirmatory CT scan that clearly indicated new bone formation and healing of a concurrent fracture in addition to the congenital spondylolysis.

      “No doubt baby’s neck was fractured doctors say
      “The furore surrounding a chiropractor accused of fracturing a baby’s neck gathered momentum today with claims the investigation was flawed…Spinal surgeon Mr John Cunningham said he and his colleagues had no doubt the child suffered a fracture…”I strongly suspect that the injury was through the congenital defect, the weak point, which would have contained cartilaginous tissue. This would not be visible on the initial CT as cartilage is simply not seen. A second CT, performed some weeks later [see paragraph 34 of the report], clearly indicates new bone formation and healing of a concurrent fracture.” Mr Cunningham said the CAA [Chiropractors' Association of Australia] must have appreciated the significance of the second CT scan. “What I find disingenuous is the manner in which they only released to the press the first CT report,” he added.” Medical Observer (18th October 2013)”

      It also says “The CAA countered the claims today releasing the findings of an “internationally renowned medical radiologist” from North America, who declined to be named for “regrettable fear of retribution”.” Yeah, sure!

      Sounds suspiciously like a chiropractic cover-up to me.

  33. Helge says:

    Here is a link there you can find a link to the report. :

    http://buggesblogg.blogspot.se/2013/11/i-denna-lank-kan-du-lasa-om-hur-den.html

    Do also read the link about AHPRA how they work.

  34. Helge says:

    The problem with the claim that a chiropractor has broken a baby’s neck is that it is not true.

    The child had a congenital abnormality, also the baby’s father has the same.
    The pediatrician was unable to read the x-rays.

    You’ll have to reconsider your claim, and come up with a correction! See AHPRAs report(It was made public in the local parliament):

    http://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2013/5413T3781.pdf

    Dr Papas hasn´t said anything, as far as i know since the report become public.

    You’ll have to reconsider your claim, and come up with a correction!

    Harriet Hall says:
    “It also says “The CAA countered the claims today releasing the findings of an “internationally renowned medical radiologist” from North America, who declined to be named for “regrettable fear of retribution”. Yeah, sure!”

    Sounds suspiciously like a chiropractic cover-up to me.”

    You are spreading lies about a chiropractor, and say that the chiropractor has broken a
    babys neck.The skeptics sect acting like they usually do.
    Now you want the medical radiologist name, so you can spread lies about the
    radiologist too!

    It is AHPRA who hired the radiologist not CAA.

    You’ll have to reconsider your claim, and come up with a correction!

    1. Harriet Hall says:

      Dr. Pappas HAS responded to the report, saying that he stands by his initial diagnosis, and “said a thorough investigation excluded any other possible causes.” Followup imaging was interpreted as showing signs of healing of a fracture, and the final conclusion was that the child DID have a fracture in addition to the congenital anomaly.
      http://www.theage.com.au/victoria/doctor-stands-by-claim-on-baby-injury-despite-chiropractic-bodys-denial-20131016-2vn03.html

      A reputable radiologist ought to be happy to have his findings reviewed by other radiologists, and should not fear “retribution.” There were several other troubling things in the report and in the attempts to defend the chiropractor. Someone said he was “sure” the chiropractor didn’t apply excessive force – how could he possibly be sure of that when he wasn’t even there?

      Unless the x-rays, MRI, and full case history are released to the public, we can’t be sure what happened. But the real point here is that there is no evidence-based reason for a chiropractor to adjust an infant’s neck.

  35. Helge says:

    Harriet Hall says:
    “Unless the x-rays, MRI, and full case history are released to the public, we can’t be sure what happened.”

    You are only in propaganda against chiropractic. You do not bother about FACTS.

    Harriet Hall says:
    “Unless the x-rays, MRI, and full case history are released to the public, we can’t be sure what happened.”

    Obviously you do not know, or bother about what is released to the public.

    You propagate against AHPRA. Why ? Is it because of your friend Stephen Barrett and
    his work for ACSH( http://www.sourcewatch.org/index.php?title=American_Council_on_Science_and_Health ) ?

    1. Harriet Hall says:

      “You do not bother about FACTS”
      I do. The “facts” in this case are not clear.

      “you do not know, or bother about what is released to the public.”
      I do; I have read everything that has been released to the public about this case, including of course the full AHPRA report. In fact, I knew about Dr. Pappas’ response to the report, something that you apparently did not know.

      “You propagate against AHPRA. Why ? Is it because of your friend Stephen Barrett”
      I propagated when I had two daughters. I don’t propagate or propagandize against AHPRA. I don’t know anything about them except for reading their report of this case. I don’t know if you could exactly call Stephen Barrett my friend, since I only met him once in my life, over a decade ago, and talked with him for about 5 minutes. I formed my opinion of chiropractic the same way Stephen Barrett did and the same way the other writers on this blog formed their opinions: by looking at the evidence. I read everything I could find on chiropractic, both by critics and advocates, before forming an opinion.

        1. Harriet Hall says:

          A small pilot study. Showed no significant difference between massage and manipulation. Unless it can be replicated in a larger study, I think its recommendation to combine the two modalities is premature, especially considering the possibility of stroke with neck manipulation.

      1. Harriet Hall says:

        I just saw this followup story in Australia’s “Medical Observer” http://www.medicalobserver.com.au/news/outrage-at-claim-that-chiropractor-broke-babys-neck
        “The CAA [Chiropractor's Association of Australia], however, wants AHPRA to release full details of the investigation.
        CAA president Dr Laurie Tassell (Chiro) said there was no doubt the baby had a hangman’s fracture.”

        If he said that, it muddies the waters even more. I have read the leaked AHPRA report and it doesn’t say there was a hangman’s fracture, but there was apparently another MRI scan that the report doesn’t mention that confirmed signs of a healing fracture.

    2. WilliamLawrenceUtridge says:

      Helge, what you are missing, what all chiropractic apologists always miss, is that there is no evidence to support the adjustment in the first place. High-amplitude manipulation of the spine to treat torticollis is unproven. As such, it is unethical to support, defend or practice this until such studies have adequately demonstrated there is a favorable risk to benefit ratio that is superior to even simply waiting, let alone the passive, gentle mobilizations that are used by real doctors.

      Defending torticollis adjustments because this chiropractor didn’t break this baby’s neck (if it’s even true) completely misses the point. It’s like saying it’s OK to leave a loaded gun lying around because the last time your toddler got their hands on it, they only shot the dog.

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