Australasian Science: Australia's authority on science since 1938

Chiro for Kids?

Paediatric patients form a significant part of chiropractic care.

Paediatric patients form a significant proportion of chiropractic patients.

By Loretta Marron

Why is a university running a paediatric chiropractic clinic that targets the vulnerable parents of sick children?

I will never forget my early days at university, feeling both proud that I was clever enough to be there yet humbled to be part of an institution associated with “the pursuit of education, learning and research at the highest international levels of excellence”.

But now that’s all changed. With universities offering chiropractic degrees, my pride has turned to shame.

The 19th century philosophy that forms the basis of chiropractic does not stand up to any kind of scientific scrutiny. It includes the pseudoscientific concept that the “vertebral subluxation complex” (VSC) is the cause of most disease.

The VSC is merely a term made up in the 1890s by chiropractic’s founder, Daniel Palmer. In May 2010 the General Chiropractic Council (UK) stated in a guidance document that VSC “is an historical concept but it remains a theoretical model” that is not supported by clinical research.

Introduced as a result of “market pressure”, these universities are graduating students trained in pseudoscience that masquerades as evidence-based medicine. Chiropractic courses are winding back the clock by actively promoting disproven treatments that affect the health of babies, children and pregnant women.

Paediatric patients form a significant part of chiropractic care. While data are not available in Australia, one USA survey found that children comprised 17% of patients and a second study from Europe, Canada and the USA put that number at 21%. A 2009 Danish study reported that babies made up most of these children, with more than 15% of them being treated for colic, asthma, allergies, hyperactivity and ear problems.

But there is no evidence that chiropractic helps childhood conditions like ADHD, asthma, allergies, bedwetting, colic and ear ache. While this alternative therapy could be brushed aside as a harmless placebo, it crosses the line when its teachings deliberately target the vulnerable parents of sick children.

Until recently the Head of Chiropractic at RMIT University was Phillip Ebrall, whose book Vertebral Assessment of the Spine is an RMIT first-year text. He is a “true believer” of VSC, stating in an email to me: “Chiropractic may well be beneficial in patients suffering subluxation, particularly of the upper neck (cervical spine) that causes altered signals to reach the brain, resulting in mental discomfort, decreased thinking ability, headache and other symptoms”.

RMIT also has a paediatric chiropractic training clinic. When asked for details of conditions treated and the treatments used the university told Australian Doctor: “We look at the biomechanical situation for an individual and make the appropriate gentle adjustments. This can improve the situations in other parts of the patient’s health.”

Concerned that the university was offering potentially harmful techniques, I decided that I would write a report to the Federal Health Minister asking for the clinic to be shut down pending an investigation.

Challenging chiropractic does not come without personal risks. In 2008 UK science writer Simon Singh was sued for libel by the British Chiropractic Association (BCA) after his column in the UK Guardian stated that many chiropractors were making “bogus” claims. The BCA dropped its case in 2010, but during those 2 years all scientific counterarguments in the UK were effectively silenced by inadequate libel laws. As a result of the Singh case, those laws are now being reformed.

I contacted experts in the UK and asked for their help with my report, and they willingly gave it. Prof Edzard Ernst of the University of Exeter stated that “chiropractic is based on outdated assumptions, and the evidence suggesting that it works is very weak indeed. In the case of non-spinal conditions and paediatric illnesses, the evidence is largely negative... The fact that so many chiropractors openly make claims beyond back pain renders them a risk to public health.”

Em/Prof John Dwyer, Chair of the Australian Healthcare Reform Alliance, said that “subluxations of the cervical spine causing pressure on cervical nerves is a medical emergency requiring expert neurological management” rather than spinal manipulation.

Prof Jennifer Couper, Head of Paediatrics at Adelaide’s Women’s and Children’s Hospital, said she is “aware of no evidence for effective treatment provided by chiropractic in this [paediatric] age group,” and noted that many childhood conditions “may improve spontaneously”. She was also concerned that paediatric chiropractic “could delay an important diagnosis and necessary treatment”.

Many chiropractors oppose vaccination because they believe that removing VSCs boosts children’s immune systems. This concerned Prof Ian Frazer, creator of a vaccine against human papilloma virus, who said: “Any suggestion that chiropractic could substitute for vaccination is without evidence, and therefore promoting such an idea, especially by a registered health care professional, should not be permitted”.

Prof Joseph Forgas of the University of NSW added that “it is high time that the claimed chiropractic treatments of pregnancy, babies and young children should be regulated and join the long list of bogus therapies that we no longer tolerate”.

My report was posted to the Federal Health Minister, Nicola Roxon, in March, with copies sent to the Federal Education Minister and the chancellors of the universities offering chiropractic degrees. For the next few weeks articles criticising chiropractic appeared in the media.

I received a number of responses, but they were not what I expected. They came from chiropractors who wanted change. While they asked that their names be kept confidential for fear of reprisal, they gave me an insight into the ongoing conflict in their profession.

Following the media coverage, Phillip Ebrall stood down from his position at RMIT stating that he wanted to refocus on his academic activities. However, he continues to be “responsible for all matters pertaining to chiropractic” at RMIT.

I received letters from the Education Minister, who referred me to the Health Minister, who referred me to several organisations, including RMIT.

The Chancellor of RMIT stated that he was confident that RMIT’s education services were of the “highest quality and met all required standards,” and that its teaching clinics were staffed by registered and experienced chiropractors to “facilitate student learning”. He added that patients “are normally referrals from maternal health nurses and local general medical practitioners”. While RMIT does not train doctors, it does offer a “Nursing and Midwifery” course.

Reputable Australian institutes of higher learning should not tolerate – let alone actively support – unproven, unscientific and potentially dangerous therapies. Our universities have traditionally had a reputation for academic probity and accuracy, and the inclusion of these courses is seen by both students and academics as an endorsement of them.

It is even more outrageous that scarce government funding should be provided to finance useless therapies that are little more than expensive, potentially harmful forms of faith healing.

Universities that introduce disproven or unproven therapies should take their responsibility to the community seriously and remove these courses, particularly when they are applied to small children and other vulnerable patients, from both our public institutions and from our health care system.

But for now market forces are winning out. On 6 May the CAA announced that it had been collaborating with Central Queensland University to introduce a chiropractic program in 2012.

Loretta Marron was named Australia’s Skeptic of the Year in 2007.