Medicandus

Medicandus

Chiropractic care in pregnancy and childhood – a castle built on a swamp

I built this kingdom up from nothing. When I started, all I had was swamp! Other kings said I was daft to build a castle on a swamp, but I built it all the same, just to show ‘em! It sank into the swamp, so I built a second one. That sank into the swamp. I built a third one. It burned down, fell over, and then it sank into the swamp. But the fourth one stayed up! And that’s what you’re going to get, lad – the strongest castle on these islands!

– The Swamp King, Monty Python and the Holy Grail

The chiropractic profession under AHPRA has been forced into taking a more rigorous approach to such niceties as Continuing Professional Development (CPD) and defining their scope of practice. One of the most controversial areas of the claimed scope of practice of chiros is their treatment of pregnant women and children. Regrettably, despite the responsible attempts by institutions such as Murdoch University and the Chiropractic and Osteopathic College of Australia (COCA) to set limits on this basically evidence-free enterprise, there are many others who have doubled down in favour of it.

I’d like to lay before you, the reader, some of the activities going on within the profession and invite you to make your own judgement. Here is a conference put on by the NSW Branch of the Chiropractors Association of Australia (CAANSW). The lead speaker invited from overseas is Jeanne Ohm, who is coming to teach participants about something called the Webster Technique. A major selling point for this seminar is that is can lead to CAA (and therefore AHPRA) approved Continuing Professional Development points as well as “the opportunity to become certified in the Webster technique by the ICPA.”

Sounds all very legit. But a closer look reveals that ICPA is the International Chiropractic Pediatric Association, which is dedicated to the propagation of chiropractic doctrines relating to children. Despite claiming to have a Research Institute, the output of which you can find listed here, the ICPA has had an absolutely negligible impact on Pubmed, which holds abstracts of a lazy 24 million or so articles and forms the basis of biomedical science. The catch is, you have to meet certain very basic and fundamental quality parameters to be listed in Pubmed. A journal must be scholarly and peer-reviewed, as well as meeting standards of open disclosure and credibility. The most common journal ICPA “research” is published in is the Journal of Pediatric, Maternal & Family Health – Chiropractic which hasn’t made it into Pubmed. Not to fret, the Chiropractic Journal of Australia, never made it after decades of trying before recently retiring hurt to await a makeover. There are several chiropractic journals that are listed on Pubmed, so it speaks very poorly of the quality of the research of this self-proclaimed peak body to be almost exclusively published in a journal that either hasn’t meet the basic scholarship requirements of Pubmed or hasn’t bothered to apply for listing.

As for the Webster technique, that unique intellectual property of the ICPA, it has exactly four entries in Pubmed. Not exactly a sturdy edifice of evidence upon which to be certifying professionals to go out with AHPRA’s imprimatur to make claims about the health and care of pregnant women and their babies. It claims to be “a specific chiropractic adjustment to eliminate sacral subluxation and improve nerve system function in the pelvis”. Exactly how is never specified, let alone supported by any type of convincing scientific rationale. Various claims are made of what it can achieve. It seems Larry Webster, the founder of ICPA, had a reckon and made it all up on his own.

Having decided it worked (for whatever it is supposed to do), he then cast about and convinced a few others to agree with him. One of these was Jeanne Ohm, who worked with Dr Webster’s widow after his death to formalise the certification of other practitioners in the Webster technique, according to the ICPA website. And now she is coming to NSW at the specific invitation of CAA NSW to teach this completely unproven technique which will see chiropractors who don’t know any better across the state believing they will be able to reposition babies in breech position and give advice to pregnant women about their their birth process. You can get a flavour of where she is coming from philosophically and professionally in this promotional video on Youtube. She describes at one point how “awesome” it would be to work with deregistered UK medico Andrew Wakefield to spread vaccine misinformation to parents. It makes a complete laughing stock of the CAA’s publicly stated core value commitment to

evidence-based practice – the integration of best available research evidence, clinical expertise and patient values and choices.

Neither does it seem to be in accord with their other Core Value regarding

The highest standards of ethics and professionalism in the areas of research, education and practice.

(It should be noted I am criticising their lack of commitment to research and education standards, not their ethical standards here.)

ICPA is also the purveyor of a magazine for distribution to parents within chiropractic practices called Pathways to Family Wellness which encourages anti-vaccination attitudes, autism conspiracy mongering, germ theory denial (an article authored by….Jeanne Ohm) and a witch’s brew of other fringe practices. If you take a look at ICPA’s Facebook page you get the vibe. Once again, it would appear that CAA has thumbed its nose at AHPRA’s warning to keep anti-vaxers out of its CPD programs.

This also occurs at a time when the Chiropractors Board of Australia (CBA) is trying to unite CAA and COCA into a single CPD approval body. Perhaps the CBA hopes by doing so it will dilute the influence of CAA who appear wholly unable to resist the temptation to continue making unsupported claims about the usefulness of chiropractic care for pregnant women and children.

As well as their infatuation with ICPA, CAA also encourages chiropractors to sign up for the Masters degree in Paediatric Chiropractic run from the UK by the McTimoney Chiropractic College, which was promoted in a half-page advertisement in their members’ news publication in July this year. McTimoney was in deep trouble a few years ago after the University of Wales was forced to stop providing university accreditation for many highly questionable courses. It was taken over by BPP University, a for-profit business university which has been the subject of controversy due to its perceived lack of academic credibility in the health sciences. Maybe because as well as offering a Masters in Paediatric Chiro, they also offer one in Animal Chiro. I thought WC Fields said you should never work with children or animals.

The McTimoney degree is the brainchild of Neil J Davies who has written a textbook to support his program. Needless to say, he has a proprietary method called the Neuroimpulse Protocol and a franchise of child-targeted chiropractic clinics. NIP is referenced in exactly a single Pubmed article that I can find. As seems to be the pattern with the Webster technique and dozens of other sectarian chiropractic belief systems, the Neuroimpulse Protocol idea has been cloaked in a mantle of undeserved credibility when one looks for the carefully researched rationale and due process of establishing efficacy one expects to find in a new treatment, let alone a whole subspecialty qualification.

As you can see from these examples (there are more I could have used), claims by CAA promoting evidence-based treatments for pregnant women and children cannot be reasonably justified. Since the BMJ editor Fiona Godlee pronounced the “complete demolition” of the available scientific evidence for paediatric chiropractic in 2009 nothing substantial has changed. Anecdotes, mangled science and feelpinions are simply not good enough for a profession that aspires to be taken seriously, let alone trusted. It’s enough to enrage reform-minded chiropractors and I must say I feel for them when their professional leaders let them down like this. Like the Swamp King, they keep building their castle where it will fall down.