Lies, damn lies, statistics… and then there are chiropractors…

The recent media frenzy regarding chiropractors partaking of their CPD (continuing professional development) by attending lectures given by known anti-vaccination campaigners has sparked renewed interest in their particular brand of fraud… quackery… “complementary health” services, from those with meaningful qualifications who actually understand what “science”, “evidence-based” and “honest” mean, and by whom professional ethics and responsibility are considered important and necessary.

In response to the flurry of popular media reporting, individual chiropractors and representatives of their professional associations and governing bodies have come forth to clarify (or in some cases to seemingly actively avoid clarifying) their positions and it was in this context that I stumbled across some nuggets of wisdom from a gentleman by the name of Tony Croke, who is a board member of the Chiropractor’s Association of Australia (CAA). Perusing Mr Croke’s blog, I came across an article which I thought was probably worth mentioning, given its abject failure to co-incide with reality.

The blog article, entitled “it’s not just babies who need safety pins”, concerns the safety and efficacy of chiropractic treatment for children, and can be found here:

http://www.libertychiropractic.com.au/blog/its-not-just-babies-that-need-safety-pins/

Let’s start with Mr Croke’s statement about safety:

“Yes, chiropractic care is super-safe for kids.  In fact, there hasn’t been a serious negative outcome reported anywhere in the world since 1992”

Without worrying about the fact that chiropractors have nothing like the level of internal and external auditing, quality control and adverse incident reporting infrastructure that medicine has (making adverse reactions to chiropractic intervention less likely to be reported in the literature in the first place), or that they treat far fewer patients than doctors do, or that the adverse effect rate for medicine is balanced by the fact that real medicine offers proven tangible benefits in exchange for the risk of those adverse effects, let’s just take that statement at face value. Nothing since 1992, eh? Hmmm…

• Posterior rib fractures in an infant given chiropractic treatment (2012): http://www.ncbi.nlm.nih.gov/pubmed/23027167

• A group of 956 surveyed European chiropractors reported 557 adverse events in paediatric patients in a 12 month period, 23 of them moderately severe (2012): http://www.ncbi.nlm.nih.gov/pubmed/22627100

• A systematic review (2007) of adverse events in paediatric patients treated with spinal manipulation found 14 specifically reported cases of significant adverse events directly caused by chiropractic treatment, 9 of them disastrous (e.g. subarachnoid haemorrhage, paraplegia) and 20 further cases where provision of chiropractic caused delay to real medical care and subsequent adverse outcomes: http://www.ncbi.nlm.nih.gov/pubmed/17178922

If you’re going to assert absolute crap in a public forum, at least take five minutes on Google or PubMed and confirm that it’s not blatantly obvious crap.

Mr Croke then goes on to discuss why performing chiropractic techniques on kids is a good thing:

“A chiropractic textbook published in 1927 used the famous analogy of the safety pin to explain how a brain and body can become partially disconnected by subluxation.  This disconnection opens up the possibility of reduced effectiveness of nerve system function and “dis-ease”, a state of abnormal physiology.

Chiropractic restores the connection between brain and body, helping the body to control and coordinate all its functions in the best way possible.  And that’s a good thing for any body to have at any age.”

Ignoring the fact that the purported pathophysiologic basis of chiropractic (subluxation theory) has absolutely zero evidence for its existence anywhere except in the imagination of chiropractors, let’s ponder whether there is any real world evidence of efficacy for chiropractic in treating children for… well… anything:

• This systematic review, published in one of their own journals in 2008, concludes there is no good quality evidence for the efficacy of chiropractic in children, for any indication: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553791/

• An earlier systematic review of the same topic, with the same findings, is here: http://www.ncbi.nlm.nih.gov/pubmed/19675828

• A Cochrane meta-analysis found that chiropractic is not effective in treating infantile colic: http://summaries.cochrane.org/CD004796/manipulative-therapies-for-infantile-colic

• It’s also no good for asthma: http://www.ncbi.nlm.nih.gov/pubmed/7728627 and http://www.ncbi.nlm.nih.gov/pubmed/9761802

• And you’re out of luck if you want chiropractic to help with your otitis media as well: http://www.ncbi.nlm.nih.gov/pubmed/23449823 and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2573879/

Chiropractors in Australia are now a regulated group, and fall under the auspices of the AHPRA.  Any real doctor spouting incorrect or misleading facts or advice in a public forum where they are asserting their position of knowledge and authority as healthcare professionals would (and should) be taken to task by AHPRA. Why is it that non-evidence based peddlers of misinformation that is to the detriment of public health can get away with it without a second glance? It presumably represents tacit admission by the authorities that they know chiropractic is unsupported bullshit, and that they assume the public must know this as well and therefore don’t need to be protected from it, but if that is the case, why pretend to be “regulating” their industry at all? And if AHPRA truly thinks chiropractors are bona fide healthcare providers, what excuse is there for not holding them to the same standards as other practitioners who practice real medicine?