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Chiropractic “pediatrics” firmly in the anti-vaccination camp

chiropractice-baby

Chiropractor “adjusting” an infant.

Who would you invite to speak at your conference if you wanted to show the world you are firmly in the anti-vaccination camp? Barbara Loe Fisher, head of the National Vaccine (Mis) Information Center (NVIC)? How about Andrew Wakefield, the thoroughly disgraced British physician who, having been stripped of his medical license, continues his despicable anti-vaccination campaign? How about both?

The International Chiropractic Pediatric Association sprang for both. Fisher and Wakefield will be keynote speakers at the ICPA’s upcoming conference, “Celebrating the Shift to Conscious Choice.” The conference offers the mutually exclusive opportunities of participating “in the discussion of the latest evidence-based holistic research” while at the same time exploring “the vitalistic perspectives of conception, pregnancy and birth through family wellness.” I hate to be the bearer of bad news, but you can embrace evidence-based research or you can embrace vitalism, but not both at the same time. There will also be an opportunity for the requisite bashing of “conventional” medicine.

It’s hard to decide who’s slumming whom here. On the one hand, the ICPA is a small group (3,000 members). They are straight, subluxation-based chiropractors and they don’t need convincing that vaccination is “bad.” Fisher and Wakefield will be preaching to the choir. Wakefield, with his medical education and training, is most certainly aware that their subluxation-based “theory” is nonsense and they are incompetent to diagnose and treat pediatric patients. And this is a far cry from Fisher’s former gigs as an advisor to the government.

On the other hand, Wakefield and Fisher are not exactly in-demand conference speakers. I can imagine it’s not too hard to get on their calendars.

In the heyday of the media’s penchant for reporting “both sides” of the vaccination manufactroversy, Fisher was the go-to gal for reliable fear-mongering about vaccines. She was, after all, a founder of the NVIC, a source of vaccine “information” that claims to be neither for nor against vaccination, only for “safe” vaccinations and informed consent. By continuously moving the goalposts, the NVIC ensures that vaccination is never safe and that there is always a fresh supply of misinformation with which to scare parents away from vaccinating their children. The NVIC is a sponsor of the ICPA conference.

However, since being excoriated by investigative journalist Seth Mnookin in his excellent book The Panic Virus (2011), the media, suitably chastised, seems to have learned its lesson and appears less likely to ring up Fisher, Jenny McCarthy or other science-deficient sources for their views on vaccination.

In addition to taking the media to task, Mnookin took on Fisher herself. (Wakefield and the NVIC don’t fare too well in the book either.) Here’s how he described Fisher’s talk at a 2009 Autism One conference:

Barbara Loe Fisher, the grande dame of the American anti-vaccine movement, explained how vaccines are a “de facto selection of the genetically vulnerable for sacrifice” and said that doctors who administer vaccines are the moral equivalent of “the doctors at Nuremberg.” (That parallel, she said, had been pointed out to her by Andrew Wakefield . . .)

While Fisher normally seems more than happy to talk to reporters, she clammed up when Mnookin wanted to interview her. Mnookin says he tried several times, but she refused, ostensibly because of an article about vaccines and the anti-vaccine movement that appeared in Wired in 2009. It was in this article that Paul Offit, M.D., famously said Fisher lies and she famously sued Offit. The case was tossed out by the court. Her refusal was based on the fact that Mnookin was a contributing editor at Vanity Fair, which has the same corporate parent as Wired. Sounds a bit thin to me.

The double punch of shaming the media for its credulous reporting and exposing Fisher’s off-the-rails positions seems to have had some effect. Fisher briefly surfaced in a couple of years ago with a few publicity stunts (her background is in PR), such as a “public service” announcement from the NVIC shown on Delta Airlines in which she conveniently excludes vaccination as a means of flu prevention. A few news outlets continue, irresponsibly, to give voice to her views from time to time, even while at the same time reporting (finally) that vaccines are safe and effective. A couple of sources picked up Fisher’s and the NVIC’s attempt to milk the non-event of the CDC non-whistleblower non-exposé, simply parroting their press release calling for removal of vaccine oversight from HHS.

Andrew Wakefield, who is described as an “academic gastroenterologist” in the conference materials, has been discussed a number of times on this blog, most recently in David Gorski’s series of posts in which we find Wakefield attempting to become relevant again with the CDC “whistleblower” kerfuffle. (Last post and references to others here.) Briefly, he is the British physician whose fraudulent “study” suggested a link between the MMR vaccine and autism, thereby igniting an unnecessary fear and consequent increase in vaccine-preventable disease. He was later stripped of his medical license and his article reporting the study withdrawn. He now lives in the U.S., unfortunately.

Diplomates in pediatric chiropractic

The ICPA has its own certification and “diplomate” programs in chiropractic pediatrics. Cleveland Chiropractic College, Northwestern Health Sciences University, Parker College of Chiropractic and Life University all co-sponsor the ICPA’s curriculum and classes. The certification consists of 200 hours of classroom instruction, apparently with no actual patient care involved. An additional 200 hours will make you a diplomate, again with no real clinical component. Its website is chock full of terrible “wellness research,” mainly case reports in which a few patients allegedly benefit from chiropractic treatment for such conditions as ADHD, eczema, stuttering, scoliosis – you name it. They are big on something called “birth trauma,” which is the idea that babies need adjustments after the stress of birth to correct immediate problems caused by this “trauma” and to improve long term health. It appears the chiropractor who’s incompetence in diagnosing and treating a newborn was examined in Clay Jones’s chilling post last Friday subscribes to this notion. If you ever needed evidence that chiropractic education is not up to snuff and that chiropractors are deficient in research skills, this is the place.

Of course, no one would be surprised to learn the ICPA is anti-vaccination. Many chiropractors are anti-vaccination, an attitude that becomes more prevalent as they move through chiropractic school. (Although some do recommend removal of the non-existent subluxation as a means of flu prevention.) But considering the fact that the vast majority of patients see chiropractors for back pain, those visits seem less likely to pose the threat of a chiropractor misinforming his patients about childhood immunizations. Why would someone going to a chiropractor for back pain ask the chiropractor about vaccination of their children? Now, however, by re-defining “primary care physician” to suit their needs, chiropractors are taking up the position that they can serve as PCPs, a subject both Harriet Hall and I have addressed before.

And while chiropractors have always maintained that they can treat children, the movement toward a “specialty” in pediatrics appears to be a fairly recent one. It is hard to find dates but, for one, the ICPA’s Journal of Clinical Chiropractic Pediatrics started publication only in 2009. The ICPA was started by Larry Webster, D.C., in 1986. Webster was the inventor of the Webster Technique, a system of spinal adjustments chiropractors claim are effective in turning breech babies. (And, I might add, yet another example of how poor their education and training must be.) Apparently, it was something of a one-man operation until his death in 1997, when a board of directors took over. The American Chiropractic Association’s Pediatrics Council, which we’ll get to in a minute, was established on 2005.

If chiropractors are anti-vaccination, and are actively seeking to attract pediatric patients via their presumed expertise in pediatric chiropractic care, it is worth looking deeper into what the chiropractic “pediatrician’s” position is given their ability in that role to spread anti-vaccination ideology even further.

ICA and ACA

The International Chiropractors Association has its own “Council on Chiropractic Pediatrics” and its own “Board Certified Diplomate in Chiropractic Pediatrics,” although you need only 360 hours of classroom instruction to become an ICA dipolmate. It too is having a conference this fall, although apparently without the added attraction of virulently anti-vaccination speakers.

A search of the ICA CCP website soon turns up some smoking guns, in the form of recommended books and articles. One is a book by Viera Scheibner, whose dive off the deep end is documented on Wikipedia. Scheibner claims, for example, there is a connection between SIDS and vaccines, that shaken-baby syndrome is misdiagnosed and is actually caused by vaccination, and that polio, measles, whooping cough and rubella pose no danger. Another book on vaccination on the list is praised by Richard Blalock, M.D., an “all-purpose medical crank,” and conspiracy minded anti-vaccinationist, who, among other things, recommends cold showers and a multitude of dietary supplements to counteract the effects of vaccinations.

And there is this chiropractic journal article, from Robin Hyman, D.C., “The Vaccination Myth: An Exercise in Logic:”

The author suggests that the Outside-In, Below-Up approach of the vaccination theory is in direct philosophical contradiction to chiropractic’s Above-Down, Inside-Out healing veracity. [Whatever a “healing veracity” might be.] He provides logical arguments aimed at disproving five basic vaccination myths regarding their safety and effectiveness.

But how about the more mainstream American Chiropractic Association? It too has a pediatric component, the ACA Pediatrics Council. And it too is having a fall conference. (Is there some sort of competition going on here?) In this video, we see the Council’s President, Elise Hewitt, DC, DICCP (from the ICA’s pediatric diplomate program), selling a new mother on the ridiculous “birth trauma” idea, although you will note she is awfully vague as to exactly what it is she is doing, why she is doing it or how it might help this infant.

Oddly, the only article on vaccination I could find on this website was one from the Archives of Pediatrics and Adolescent Medicine (2000), which, based on a survey, found, among other things:

For pediatric care, 30% [of chiropractors] reported actively recommending childhood immunizations; presented with a hypothetical 2-week-old neonate with a fever, 17% would treat the patient themselves rather than immediately refer the patient to a doctor of medicine, doctor of osteopathy, or an emergency facility.

Thus concluding,

Pediatric chiropractic care is often inconsistent with recommended medical guidelines.

Maybe they are bragging?

The ACA itself believes immunization is a topic (scroll down to “Wellness Model”) chiropractors are competent to address as an element of primary prevention. The ACA also believes chiropractors should treat both neuromusculoskeltal and non-neuromusculoskeletal conditions in pediatric patients. (See “Pediatric Chiropractic Care”) The ACA’s official policy on vaccination seems to have taken a page from the NVIC’s playbook:

Since the scientific community acknowledges that the use of vaccines is not without risk, the American Chiropractic Association supports each individual’s right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination. The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual’s right to freedom of choice in health care matters and providing an alternative elective course of action regarding vaccination. (Ratified by the House of Delegates, July 1993, Revised and Ratified June 1998).

(Apparently, this attitude toward the individual’s right to “informed awareness” does not extend to neck manipulation.)

American Public Health Association Chiropractic Section

Finally, although it’s not related specifically to pediatric patients, we’ll close with a look at one organization within chiropractic that one would certainly hope supports childhood immunization: the Chiropractic Section of the American Public Health Association. That’s right, there is one, established after great resistance from the APHA. Of course, chiropractors don’t seem to be all that fond of the APHA either. Here’s what Cheryl Hawk. D.C., VP of Research at Cleveland Chiropractic College has to say on the matter in a Q &A session, when asked “what are some issues that prevent chiropractors from becoming involved in public health issues?”

Public health is too “medical,” especially because of its emphasis on immunizations. Although public health does emphasize immunizations, it also emphasizes other types of prevention, such as treating tobacco dependence and encouraging mothers to breast-feed. Why don’t we focus on the areas where our interests overlap rather than on where they differ?

In other words, chiropractors can cherry-pick the public health measures they like and leave off the rest.

The Section is part of the APHA, but the ACA also has a “APHA/Wellness & Health Promotion Committee,” thereby giving their committee the supposed imprimatur of the APHA.

The American Chiropractic Association’s APHA/Wellness & Health Promotion Committee has assembled the following links and information to help doctors of chiropractic educate their patients about health promotion and injury prevention strategies.

Curiously (actually not) although there is a link to the CDC’s information on smoking cessation, there is none to the extensive information on vaccination available on the CDC’s website. Likewise, in the links for patients, there is no link to the CDC’s vaccination information. This from a group that refers to chiropractors as “primary care physicians” and sees providing information on immunization as part of the chiropractor’s preventive health care role.

The official APHA Chiropractic Section maintains an “Immunization Information Resource Website,” which receives no funding from chiropractic institutions and is run by volunteers. It has not been updated since 2011. The website is a curious mixture of accurate information about immunizations and cherry-picking the studies. While it does link to the CDC and other reputable vaccination information sources, it also contains an odd list of journal articles which do not accurately represent the status of vaccination research, even in 2011. The HPV vaccine is not mentioned at all. Links to abstracts are given but it is doubtful that many chiropractors have access to the full journal articles. There is no mention of the APHA’s own Policy Statement concerning immunizations, which “reaffirms its support for immunization as one of the most cost-effective means of preventing infectious diseases.”

For example, under “Rotavirus,” we find only one link: “Intussusception among recipients of rotovirus vaccine–United States, 1998-1999,” when there have been a number of studies since 1999 on the safety and effectiveness of rotavirus vaccines. Why wasn’t this article from 2009 cited? “Comm. on Infectious Diseases, AAP, Prevention of Rotavirus Disease: Updated Guidelines for Use of Rotavirus Vaccine.”

With more than 14 million doses of RV5 distributed in the United States since 2006, the Centers for Disease Control and Prevention (CDC) Immunization Safety Office summary of postlicensure safety monitoring of RV5 does not indicate that immunization with RV5 is associated with intussusception. Further monitoring is ongoing. Rigorous postlicensure monitoring for safety end points has also been initiated for RV1.

The citations for varicella suffer from the same incompleteness. For example, the list includes “Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention” from 1996 but not 2007 (which has itself been updated).

And, unfortunately, the lack of updates means these two excellent resources are not available on the website, although one wonders if they would have been cited even then: “Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review” and the Institute of Medicine’s “The Childhood Immunization Schedule and Safety,” which concluded,

This report is the most comprehensive examination of the immunization schedule to date. The IOM committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.

All in all, while the Chiropractic Section should be commended for providing links to the CDC and other reliable sources, a fair review of the entire site evidences a “pull the punches” approach to immunization that mixes in outdated and incomplete advice over-emphasizing risks with good information.

The chiropractic position on pediatric immunizations appears to range from virulently anti-vaccination to, at best, tepid support from a small group. Yet many within chiropractic view themselves as capable of acting as primary care physicians in general and pediatricians in particular. Their lack of education and training belies those beliefs, as does a look at their actual practices. And their lack of support for childhood immunization makes the proposition downright scary.
 
 

Posted in: Chiropractic, Obstetrics & gynecology, Science and the Media, Vaccines

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