An Australian chiropractor treating a baby kangaroo makes as much sense as treating a human child
Before I begin this brief update to my recent post on Australian baby chiropractor Ian Rossborough’s “crack heard round the world,” I want to give a quick thanks to Jann Bellamy for organizing our day of Science-Based Medicine at NECSS last week. It was an amazing experience sharing the stage with the SBM crew for my first public presentation, and finally getting to meet Scott, John, and Saul. I’ve given hundreds of lectures to residents and students, and even a grand rounds or two, but this was orders of magnitude more exciting and stressful. I may be biased, but I think we nailed it.
With NECSS prep taking up a significant percentage of my time and a rough current work week making up for days off, my post today is a little shorter than usual. My overall average word count still gives Gorski a run for his money however. Well, that’s not actually true. Gorski is in another league.
Rossborough provides an undertaking?
Chiropractor Ian Rossborough, who I recently discussed in a post on the backlash against pediatric chiropractic in Australia, has received the slap on the wrist I sadly expected. According to the Australian Health Practitioner Regulation Agency website, which has jurisdiction over the Chiropractic Board of Australia when it comes to “professional conduct, performance or health of registered health practitioners,” Rossborough has promised to leave them kids alone:
Chiropractor Ian Rossborough shown here mid-rationalization
In January, Melbourne chiropractor Ian Rossborough uploaded a video to YouTube of himself treating a 4-day-old premature infant. The video, one of many that can be found on his “Chiropractic Excellence” channel, is for educational purposes only, intended to teach the world about the miraculous benefits of chiropractic care for a wide variety of conditions. Although the cynical among us may proclaim that his videos are just more examples of chiropractic practice building shenanigans, Rossborough claims that he simply wants to “enable natural healthy living, without resorting to drugs or surgery.”
Australian physicians respond
Well, there are apparently a lot of angry and cynical Australians, particularly journalists and physicians. In late April, the video, which features Rossborough manipulating the newborn’s thoracic spine hard enough to cause a loud cracking sound and a cry of pain went viral after it was featured in a story on Australian Broadcasting Corporation Radio National. Rossborough, and the treatment of children by chiropractors, has since come under intense scrutiny.
According to the Australian press, “doctors have declared war on chiropractors” in response to the realization that newborns and young infants are undergoing unnecessary spinal manipulation for problems such as colic, acid reflux, and excessive crying as well as for nebulous benefits like boosting the immune system and improved growth and development. The Royal Australian College of General Practitioners, the largest medical college in Australia with a membership of over 30,000 rural and urban primary care physicians, has even requested that members refrain from referring patients to chiropractors. They want the federal government and private insurers to stop paying for nonsense such as infant chiropractic.
Frank Jones MD, president of the RACGP, has made the media rounds, describing infant and toddler adjustments as “seemingly almost cruel” and lacking any supporting evidence. He has also called for the Chiropractic Board of Australia to shape up in order to have any chance of being accepted as a legitimate scientific discipline. Jones thinks that chiropractors like Rossborough and his ilk don’t know what they are doing and are putting patients at risk. He reminds the public that a physician’s job is to advocate for patients and to try to reduce exposure to practices where the risk far exceeds any potential benefit. I like this guy.
Thanks to a hot tip from a follower on Twitter, I’ve once again found myself neck deep in chiropractic propaganda involving the care of a pediatric patient. The case as presented involves, among numerous specious assumptions, claims of successfully treating an infant’s paralyzed arm using chiropractic philosophy and spinal adjustment techniques. As I will explain in detail, this “miracle” is just another in a seemingly endless stream of emotional but worthless anecdotes being used for marketing purposes.
I’ll be discussing two videos, uploaded to YouTube by a father who wants to tell the world about the miracle of chiropractic. He uses that word a lot, in fact, assigning the label to no less than four outcomes and clearly setting the bar lower than my own personal threshold. The videos are a few years old, but have over 150,000 views and can still be found linked to on numerous websites and discussed in interviews. If you’re feeling generous, they serve as excellent examples of how the mind of the believer works when facing uncertainty regarding the health of a loved one.
I will provide a general synopsis of the events in question, but I do recommend watching the videos despite the fact that you will never get those 18 minutes back. They contain the details of the case and, particularly in the second video, some great examples of typical chiropractic tactics and buzzwords. (more…)
CAM proponents view National Health Interview Surveys recording the supposed popularity of CAM, an amorphous conflation of anything from conventional medical advice to mythical methods, as an invitation to unleash even more unproven remedies on the public. My interpretation is quite different. I see the same figures as proof that we are doing too little to protect the public from pseudoscience.
In fact, state and federal governments are acting as handmaidens to the CAM industry by legalizing practices and products that have insufficient proof of safety and efficacy and, in some cases, are so scientifically implausible that they can never meet that standard. The federal government keeps “integrative” medicine centers at major academic institutions and private foundations afloat with taxpayer money by funding research that has failed to improve public health or the treatment of disease, despite seemingly endless trials, because “more research is needed”.
As we shall see, Australia has a more effective regulatory system for dealing with CAM. And the advocacy group Friends of Science in Medicine (FSM), an organization with goals similar to our own Society for Science-Based Medicine, is keeping the government on its toes, investigating violations of the law on its own and reporting them. We in the US could learn something from their two recent successful campaigns attacking misleading health claims. (more…)
I had the pleasure of speaking on the topic of chiropractic and the newborn baby earlier this week at a meeting of the Boston Skeptics. There is a video of the talk online for anyone interested in learning more. And if you haven’t yet, please read yesterday’s post on chiropractic and babies by Sam Homola.
My introduction to pediatric chiropractic
Although I was aware of the existence of chiropractic well before beginning my medical training, I was blissfully ignorant of the full scope of what many chiropractors actually do on a daily basis. My belief that they practiced solely as “doctors of the back” was shattered early in my pediatric training at Vanderbilt while on a pulmonary medicine rotation when I was asked to consult on the child of a well-known musician who lived in the area. The patient, perhaps only hours from respiratory failure, had been brought to our emergency department only after chiropractic treatments had failed to manage a severe asthma exacerbation.
That encounter, as well as another around the same time involving a child with a throat abscess being treated with acupuncture, inspired me to dig deeper into the general concept of alternative medicine. I even went so far as to approach a local chiropractor who had set up a table at a Nashville YMCA to promote chiropractic prevention and treatment of the flu. Dr. Fakename happily allowed me to spend a day in his office, and even brought in his own child to demonstrate his approach pediatric care.
Needless to say, Dr. Fakename failed to convince me of the benefits or need for chiropractic involvement in pediatric healthcare. When the discussion turned to routine childhood vaccines, I heard the party line on the subject for the first of many times. Dr. Fakename was not against vaccines, he was in favor of giving families all of the facts. He gave me some reading material, and a book suggestion or two, which provided nothing but potential and unproven risks with no mention of the well-established benefits and proven safety of immunizations. I’ll never forget what his wife, who had brought their child in for the demonstration, whispered to me during a moment of distraction: “Don’t worry, we vaccinate our kids. I make sure.”
By the end of my residency I was a full blown skeptic of a variety of alternative medical modalities in addition to chiropractic, and had built a reputation as someone interested in and knowledgeable on the subject of quackery. I even gave a grand rounds on pediatric CAM with a focus on chiropractic which I’m proud to say drew a standing room only crowd that included folks from the community interested in alternative medicine as well as from the brand new integrative medicine center at Vanderbilt. I had even been asked to serve as a resident representative, however that invitation was quickly rescinded after my skeptical talk. (more…)
The risk of suffering a stroke when undergoing aggressive chiropractic manipulation of the neck is not a new concern. We’ve discussed it several times on the pages of Science-Based Medicine over the years, most recently in November of 2014 when Steven Novella covered the death by chiropractor of 30-year-old Jeremy Youngblood, whose fatal brain injury occurred while seeking treatment for a sore neck. For a nice review of cervical manipulation in general, the evidence against its inappropriate use, and an assessment of the literature on this subject, check out prior posts by Dr. Hall and chiropractor Samuel Homola.
I believe that my take on the issue is in line with my fellow SBM authors. There is no role for high velocity, low amplitude (HVLA) thrust-type maneuvers that cause sudden and intense rotation of the neck in any patient, for any reason. It is not effective for neck pain, headache or any other complaint, and it is a proven risk factor for injury to the vertebral arteries and subsequent stroke. Some patients are at higher risk, such as the elderly or those with atherosclerosis or connective tissue disorders, but this type of injury can occur at any age and even in a perfectly healthy individual. (more…)
The recent uproar about the chiropractor who was accused of breaking an infant’s neck has provoked renewed discussions about the role of chiropractors, not only in the care of children, but in general. We have addressed chiropractic many times on this blog. While spinal manipulation therapy (SMT) is an effective option for treating certain types of low back pain, chiropractors typically do a lot of other things that are not evidence-based, can be dangerous (strokes from neck manipulation), and are often outright quackery like applied kinesiology. Chiropractic treatment of children has been called child abuse, and even some chiropractors have spoken out against it.
Chiropractors have protested in the comment threads that we have an outdated, biased view of chiropractic, and that modern chiropractic practice is very different. They claim that they have rejected the original basis of chiropractic (the subluxation/nerve interference/innate paradigm), that they reject all forms of quackery, that what they do is based on scientific evidence, and that they have an important role to play in modern health care. We think that “reformed” attitude is rare. We would love to know what percentage of chiropractors fall into the “reformed” category, but no studies have been done to answer that question. Now there is a new study from Australia that provides important information about the state of chiropractic practice in that country. While it can’t answer the question about the number of “reformed” chiropractors in the US, it does shed some light on the subject. (more…)
A right sided congenital torticollis
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. (more…)
Pictured: Not helping with SIDS
As a pediatrician caring for hospitalized children, I deal with fear on a daily basis. My day is saturated with it. I encounter fear in a variety of presentations, with parental fear the most obvious but probably least impactful on my management decisions. I do spend a lot of time and mental energy calming the fears of others but more managing my own, both struggling to prevent it from biasing my thought process and harnessing it as a productive motivational force. I devote a significant amount of effort towards teaching residents and students the practice of inpatient pediatric medicine and fear can be a valuable teaching tool when used appropriately.
So I admit that I take advantage of fear to a certain extent in my practice. Most pediatricians do. Maybe we all do. Proper informed consent, for instance, must include potential poor health outcomes related to medical intervention or the refusal of them. I accept that fear is an impetus for seeking medical care. Parents should be afraid of poor health outcomes from vaccine-preventable illnesses, for example. They should be made aware of the repercussions of poor adherence to home asthma management or of not placing their child in a proper car seat every time they put them in a car. Fear can serve the greater good.
But there is a difference between these unavoidable aspects of science-based medical care and the abuse of fear by practitioners of irregular medicine. (more…)