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Healthy Children

with Steven Parker, MD

This blog is now retired. Dr. P passed away on Monday, April 13, 2009. The WebMD Community will dearly miss his kind, caring, and often humorous manner.

Friday, May 9, 2008

Chiropractic Care for Kids?

“Dr. P,” my exasperated patient said at the end of a visit that revealed her 3-year-old’s fourth ear infection. “I have a friend who took her child to a chiropractor. He manipulated her neck and poof! no more ear infections. Do you think I should go to one?”

I was horrified at the thought. Let me explain why.

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On September 18, 1895, D.D. Palmer was a 50 year old “magnetic” healer, who used the body’s “magnetism” to rid itself of disease. He was visited by Harvey Lillard, the janitor in his building, who was looking for relief from 17 years of hearing loss which, he related, began after he heard something pop in his back.

In the course of his examination, D.D. Palmer noted a lump in the middle of Mr. Lillard’s back. What if the deafness and the lump were related? Indeed they seemed to be as, after a number of gentle thrusts to the lump, Mr. Lillard’s deafness was purported to have been cured.

D.D. Palmer theorized that misplaced spinal vertebrae (“subluxations“) caused pressure on the nerves, which then diminished nerve flow to the body, which then caused disease and dysfunction. Eureka! He was certain he had cracked the disease code and wrote: “A subluxated vertebrae . . . is the cause of 95 percent of all diseases. . . . The other five percent is caused by displaced joints other than those of the vertebral column.” If only the spinal column were correctly positioned, the body would be healthy.

In 1897, he founded what would later be called the Palmer School of Chiropractic in Davenport, Iowa. A new way of healing was born.

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Fast forward to the present. A survey of Consumer Reports readers, published in May 2000, found that 35% of 46,860 respondents had used alternative therapies for a variety of problems, of whom 40% had chiropractic treatment for back pain. By all accounts, most were very happy with their chiropractic care (reporting higher satisfaction ratings than I’ll ever get as a pediatrician!).

Chiropractors (aka “doctors of chiropractic” or “chiropractic physicians”) classically treat neuro-musculo-skeletal complaints, including back pain, neck pain, pain in the joints of the arms or legs, and headaches. Most chiropractic treatments address these issues via manipulation of the spine. Chiropractors also tend to embrace a holistic health perspective, emphasizing natural, drug-free, non-surgical treatments, and healthy lifestyle changes.

Many chiropractors treat children, but not just for backaches. Here are some of the pediatric conditions which some chiropractors claim they can help: ADD/ADHD, asthma, autism, bed wetting, “birth trauma,” hypertension, cerebral palsy, Crohn’s disease, colitis, colic, the common cold, constipation, ear infections, epilepsy, headaches, low immunity, sinus and respiratory infections, eczema, psoriasis, sleep disturbances, stuttering, tonsillitis, Tourette’s Syndrome. Impressive list! These guys must be on to something.

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Let’s take stock: chiropractic is safe, effective, natural, holistic. So why did I react with horror to that mom in my office? Is there a problem here? In a word: yes. Or two words: big problems. Let me list my top 10 most serious gripes about chiropractic care:

  1. Despite all that has been learned about disease and the human body in the past 110 years, there has been no refinement or advancement or proof of D.D. Palmer’s original hypothesis. Given what we know today, it just makes no sense to believe that reduced nerve flow due to subluxations is the root of all evil (or even any evil). Rather, it’s an article of faith, more of a religion than a science, since chiropractors have never bothered to try to prove it with scientific studies.
  2. Even if one buys the subluxation hypothesis (which you shouldn’t), gentle chiropractic manipulations would not change a dislocated spine.
  3. I have never had a patient who went to a chiropractor and was given a clean bill of health. There is always some spinal misalignment. Pretty fishy to me.
  4. When chiropractic care has been put to the test of scientifically valid studies (i.e., prospective, randomized controlled trials with objective observers who are ‘blind’ to the treatment), its benefits are minimal (for back pain, similar to that of physical therapy) or non-existent (similar to a placebo effect – which I will discuss in my next post).
  5. It exposes people (and, of course kids) to needless x-ray exposure.
  6. Because of their “natural” bent and indifference to scientific evidence, many chiropractors do not support childhood immunizations. (You can imagine how I feel about that.)
  7. Some chiropractors dishonestly use the normal “popping” noise (akin to cracking a knuckle) of the manipulated spine to demonstrate spinal realignment. Not even chiropractors believe the popping sound to be of any significance, but you couldn’t prove that by what they have said to my patients.
  8. Eschewing science, some chiropractors veer headlong into the ozone of quackery, endorsing such dubious diagnostic tests as biological terrain assessment, computerized nutrient deficiency testing, computerized range-of-motion analysis, contour analysis, cytotoxic testing, electrodermal testing, functional intracellular analysis, hair analysis, herbal crystallization analysis, inclinometry, iridology, live blood cell analysis, nutrabalance, pendulum divination, reflexology, saliva testing, thermography, a Toftness device. You can guess how much scientific evidence there is for the validity of any of these.
  9. Ditto to other treatment techniques beyond their usual spinal manipulations: activator methods, applied kinesiology, bioenergetic synchronization, chelation therapy, colonic irrigation, cranial or craniosacral therapy, laser acupuncture, magn
    etic or biomagnetic therapy, neuro-emotional technique.
  10. To be fair, there are many chiropractors who limit their care to musculo-skeletal aches and pains, for which at least an argument can be made (although not by me) for some efficacy. But many do not. Once you go down the road of faith rather than science when it comes to healing, this is what you get. It’s a sorry state of affairs.
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This has turned into a rant and has gotten kind of long. I guess what I view as quackery – even if it is relatively safe – bugs me more than I thought, especially when it is being inflicted on kids. So I’ll end here and next week address the important question: if chiropractic is as ineffective as I say, why do so many love it so much?

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Articles cited:

“A Comparison of Active and Simulated Chiropractic Manipulation
as Adjunctive Treatment for Childhood Asthma”
Balon, J, et al. New England Journal of Medicine. 10/8/98
http://content.nejm.org/cgi/content/full/339/15/1013
“A Comparison of Physical Therapy, Chiropractic Manipulation,
and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain.”
Cherkins D, et al. New England Journal of Medicine. 10/8/98
http://content.nejm.org/cgi/content/full/339/15/1021

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Posted by: Steven Parker MD at 1:53 pm

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