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The chiropractic war with reality rages on…

Regular readers will know that I have had a bit to say in the past about the way the chiropractic profession is run in Australia. I have refrained thus far from posting about the latest controversy, but I feel compelled to comment again now.

The cudgels were taken up again back on 29 September, when Amy Corderoy and Julia Medew published an article in the Fairfax press detailing the story of an infant who had been taken to Monash Medical Centre in Melbourne with an apparent serious injury to the upper spine. The medical slang term for the type of injury is a “hangman’s fracture” as it was commonly seen in those who died at the end of a noose if the job was properly done. It can also occur in situations where the head is forcibly extended (chin up) and a lengthening force is applied along the neck, such as an unrestrained head hitting a car dash, or your chin hitting a table violently if you fell forwards. The Fairfax article also detailed evidence from Reasonable Hank, a blogger who had been observing discussions on a Facebook list for chiropractors and noticed several of them boasting about surreptitiously treating patients in public hospitals, including newborns. The screenshots published on Reasonable Hank’s blog post can be viewed here.

It’s fair to say the Chiropractors' Association of Australia (CAA) went into crisis management mode. They issued a demand for a retraction of the story on the grounds that the report generated by the Chiropractic Board of Australia’s investigation had found that

“In fact no finding was made that any treatment performed by the Chiropractor caused a fracture as alleged.”

“It remains the case that not a single serious adverse event has been recorded in the medical literature (world-wide) involving a qualified Chiropractor treating a child since 1992.”

I’ve heard this line from CAA officials before. I pointed out this case to the CAA Board member who I first heard make this claim. It details a case of suspected child abuse of an infant with fractured ribs. The parents were cleared and the fractures attributed to the use of an Activator instrument (“the stick that clicks”) by a chiropractor who had treated the baby. To avoid the risk of misquoting, I’ll give you his response verbatim:

“Occam’s razor would suggest another, far more common cause of such an injury, no matter how nice the parents may have seemed to the hospital social workers.”

Nice. Since it is clearly impossible for a chiropractor to injure a child, the logical conclusion is child abuse, no matter what the experienced social workers and paediatricians who actually did the investigation thought. Classy.

But back to the CAA’s response to this latest report of a serious injury. In their initial response to the article, CAA President Laurie Tassell told Medical Observer magazine:

“The official report made it quite clear that the chiropractor did not cause the injury but unless AHPRA releases the report we can’t use those findings.”

But it didn’t stop him going on to tell everybody that it showed there was no fracture, hangman’s or otherwise.

The next blow to CAA’s PR effort came on October 3 when, in the wake of Medew and Corderoy’s article, Queensland MP and former GP Dr Alex Douglas announced he would lobby for legislative changes to prevent chiropractors treating children unless adequate evidence of safety and efficacy was found.

Somehow, a copy of the AHPRA report, with names redacted, was obtained by Labour MP Jo-Ann Miller, the Shadow Minister for Health in Queensland. It was tabled in the Queensland parliament with a short speech and thus became a publicly available document. This was accompanied by a co-ordinated damage control effort including a favourable report in the Australian, which gave them the reassuring headline they no doubt wanted and which has been widely quoted on chiropractors' social media. Newscorp journalist Andrew Fraser must have been secretly delighted at the prospect of giving his Fairfax colleagues a bit of a poke in the eye by having such a neat story handed to him. Certainly it emboldened CAA President Laurie Tassell, who trumpeted to Medical Observer that there were:

“no features on any images to confirm there has been a fracture, with no oedema of the bone, cleft or surrounding tissues”.

“The child did not have a fracture as alleged; [the child] had a congenital condition known as congenital spondylosis and the chiropractor could not and did not cause any injury to the child.”

Before I discuss the relevance of this new finding, it might pay to reflect for a second on the extraordinary situation of a professional association’s spin program benefiting from the leaking to a politician of a confidential investigation. The circumstances of the chain of events which occurred are now in the public domain, under parliamentary privilege. Such reports are highly sensitive, and are kept strictly confidential for very good reasons. In this case, both the child involved and the father of the child have a rare congenital spinal condition. This, plus other details in the leaked report could easily identify them. Experts and witnesses must be confident that they can speak freely and give frank opinions to the regulator without fear of leaks. Future investigations will be compromised if there is a legitimate concern on the part of expert witnesses that their opinions will become part of a media circus. A spokesperson for AHPRA told Medical Observer:

“As a regulator, the board is not able to breach the law or confidentiality requirements by releasing information that is not public.”

This leak represents a massive governance failure on the part of the CBA, and for the sake of the integrity of future investigations cannot be without consequences for those involved.

Sadly for the CAA’s efforts, the release of the report has not so much been a bullet in the foot as a landmine which has taken both their legs off.

The report in fact DOES confirm that the imaging showed a fracture. Without getting too heavily into technicalities, the congenital condition the baby had makes it harder to exclude a hangman’s fracture than usual, as the piece of bone which fractures is replaced by cartilage and immature bone which doesn’t image well. Nevertheless, Paragraph 33 of the report notes that “initial radiology opinion was that (redacted) had suffered a bilateral fracture of the posterior arch of the axis vertebra”. These initial reports and even what type of scan it was are never referred to again. A repeat CT done a couple of months down the track, and quoted at length in Paragraph 33 was reported as showing the spondylolysis but no obvious fracture.

Another CT done nearly six months after the child first went to hospital seems damning. The report of the CT concludes:

Evidence of some healing involving the left C2 pedicle defect suggesting a likely previous underlying trauma/fracture superimposed on a developmental spondylolysis

So in fact, the scenario appears to be that the injury was initially diagnosed as a bilateral fracture, which was hard to see on the next scan, but clearly evident as an asymmetrical area of new bone formation with the appearance of a healing fracture. In anticipation of indignant protests in the comments section, I would hasten to add that normal development of a child’s spine is very hard to mistake for a healing fracture if you have an experienced eye. Monash Medical Centre is a major teaching and research hospital with no shortage of highly skilled radiologists. I am intrigued to know what the scan was that the child initially had. It may have been an MRI, or another CT, but it is mentioned once, then not again.

Later paragraphs of the report are puzzling in their logic. Paragraph 61 admits that the “low force techniques” supposedly used by the chiropractor would provide biomechanical forces which may be exceeded by or matched by forces produced by normal handling.

If this is so, why bother doing them? Perhaps we are all paediatric chiropractors, fixing subluxations inadvertently every time we cuddle our kids or change their nappy.

The rest of Paragraph 61 is simply incredible. The expert chiropractor writing the report suggests that:

because of inability to completely rule out any other occurence during the period 25-27 January it is difficult to link without reasonable doubt the examination and treatment provided by (redacted) and (redacted)’s loss of head control. Temporal relationship does not automatically confirm cause and effect.

See what they did there? Just because the child lost the ability to control its head movements after a chiropractic neck treatment, don’t assume that the two are related. It was clearly those parents again, probably chucking the kid around at an Australia Day barbie, seems to be the message. Cases of hangman’s fracture due to child abuse are referred to in several places within the body of the report. More innocent peoples' reputations get pushed under a bus in pursuit of keeping the “no-harm” myth intact.

So on that form I am drawn to the unsavoury conclusion that if your child gets injured having chiropractic treatment, there seems a fair chance you as a parent might get accused of injuring your own child if you complain.

Andrew McNamara, the CEO of CAA, put his point of view as simply as possible on Twitter.

This is what doubling down looks like

CAA has also put out a couple of Member Updates, reassuring their members that “an internationally renowned medical radiologist has examined the material (x-rays, CT Scans, MRIs) and confirms that there are ‘no features on any images to confirm there has been a fracture, with no edema of the bone, cleft or surrounding tissues’”. This radiologist has not been named, and according to a Medical Observer interview with Tassell, this is because of “regrettable fear of retribution”. Now I know that the Big Pharma cabal of which I am regularly accused of being a part is powerful, but are we ruthless and cold-blooded enough to force an overseas radiologist of considerable eminence into witness protection? Just because he read a few x-rays in a way we didn’t like? And anyway, Monash Medical Centre has its own Professor of Radiology, plus a fleet of Associate Professors so why get some anonymous, terrified foreigner when you could just ask any of these equally capable hometown imaging boffins?

As things stand now, we have CAA categorically stating in a Members' Update that:

  1. The child did not have a fracture as alleged
  2. The child had a congenital condition known as Congenital Spondylolysis
  3. The Chiropractor could not and did not cause any injury to the child.

Of these statements, I would say the first seems highly questionable given the AHPRA report and perhaps other facts of the case not contained or mentioned at length in it. The second is uncontroversial, and nobody disagrees with it. If you believe the third statement, you require a better explanation to be found for such a serious injury. The suggestion from the AHPRA expert is that the parents were responsible, either accidentally or deliberately. This is at odds with the conclusions of the treating team at Monash. One wonders what Dr Pappas and his team saw in this case that convinced them to go ahead with a report to the Chiropractic Board. I doubt Pappas or any other time-poor public hospital clinician would start a process like this for laughs, or even because they hate chiropractors. Still less because they are “camp followers” of the AMA as Tassell has remarked. If you believe the President and CEO of CAA, this is an unprovoked malicious attack on the credibility of the chiropractic profession by shadowy powers strong enough to meaningfully retaliate against an eminent overseas radiologist. This is a point of view they seem prepared to seek help from politicians and journalists to defend.

There never was a baby with a broken neck. 2+2=5. Ignorance is strength. And we’ve always been at war with Eastasia, didn’t you know?

Join the conversation

64 Comments sorted by

  1. Mike Brisco

    Scientist at Flinders University of South Australia

    Just trying to remember the five elements of Denialism, mentioned by Diethelm and McKee
    "Denialism: what is it and how should scientists respond?" Eur J Public Health (2009) 19 (1): 2-4. doi: 10.1093/eurpub/ckn139

    1. Allege a conspiracy
    2. Be selective with data (cherry pick)
    3. Use fake experts
    4. Say that you will accept evidence - but put the bar so high, that no evidence will ever achieve it
    5. use misrepresentation and logical fallacies

    Certainly the CAA allege a conspiracy…

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  2. David Arthur

    resistance gnome

    I don't have personal experience of chiropractic, but I know someone who once went to a chiropractor, and has been living with the consequences thereafter.

    Let's just say that if there is even the remotest possibility of the injury being due to spinal disc damage, get an MRI scan before even thinking about seeing a back-cracker.

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  3. Sue Ieraci

    Public hospital clinician

    I have no idea whether the diagnosed injury was caused by the chiropractor's manipulation or not. What concerns me, however, is this:

    What do chiropractors claim to be diagnosing and treating in babies spines (even newborns), what clinical signs do they find', and how valid are these signs.

    If light touch through clothing and nappies allows a practitioner to diagnose a spinal problem in an otherwise well infant, and a light touch can make an ''adjustment'', just how valid are these diagnoses and treatments?

    ''the “low force techniques” supposedly used by the chiropractor would provide biomechanical forces which may be exceeded by or matched by forces produced by normal handling.

    If this is so, why bother doing them? Perhaps we are all paediatric chiropractors, fixing subluxations inadvertently every time we cuddle our kids or change their nappy.''

    Indeed.

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    1. In reply to Sue Ieraci

      Comment removed by moderator.

    2. Sue Ieraci

      Public hospital clinician

      In reply to Miles Ruhl

      Miles Ruhl, I have seen extremely pissed-off babies settled in all manner of ways.

      Despite having looked widely, I have seen no evidence at all that such a thing as ''subluxation'' (in the Chiro sense) exists, let alone that babies have them, or that gentle massage through the clothing or turning babies'necks does anything special.

      Do you believe it is acceptable, in the 21st century, to sell outdated remedies to people? The community doesn't accept that from engineers or doctors, why accept it from chiros.

      Even if some gentle ''adjustment'' does no harm, there is no evidence of validity, or benefit beyond what a parent or friend can do for free.

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    3. Mia Masters

      person

      In reply to Sue Ieraci

      But Ms Ieraci, the medical profession just as well is engaged in selling outdated diagnoses and remedies to people! Just recent reading on the 'magical "floating' kidney that can be ...cured by surgery. The diagnosis seem to have disappeared until! the "minimally invasive keyhole, much safer and less invasive version came along. Now the diagnosis is on the increase. Should I pull out more dubious examples?!
      I most certainly agree with Dr McKeown, that the effectiveness of medicine is overestimated and the harm caused by medical treatment (drug and surgical) is certainly underestimated. (There is no more successful propaganda machine than the medical advertising in it's all forms) And this does not even mention the dubious diagnoses and conditions specialties seem to invent...

      As for this article: there is a lot of yelling, yet nobody knows the facts of the case. But what a great opportunity to flog this horse!

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Mia Masters

      Ms Masters - the medical profession is engaged in activities to minimise the use of outdated or ineffective treatments - as evidenced here: http://www.choosingwisely.org/

      As new evidence has become available, there have been campaigns to improve antibiotic prescribing, minimise inappropriate imaging for back pain, minimise use of arthroscopy - and a whole host of othter things. Clearly medicine - as a human service with an enormous responsibility and scope - is not a perfect service - it depends…

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    5. Mia Masters

      person

      In reply to Sue Ieraci

      The 'magical' was sarcastic Ms Ieraci, as the diagnosis of 'floating kidney' or Nephroptosis or Nephropexy, if you like is especially useful to illustrate dubious diagnoses and then dubious surgical/medical procedures to treat/cure the patient. Surely you have heard the diagnosis before?

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    6. Mia Masters

      person

      In reply to Sue Ieraci

      Also: can you provide the data/statistics on the "minimise(d) use of arthroscopy"? Thanks.

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  4. Wendy Wilkinson

    logged in via Facebook

    As someone who does investigate adverse events, I personally am appalled that an 'expert' investigator can write (let alone have a report accepted by AHPRA) anything that implies BLAME on the patient/carers. Yes, patient factors can be taken into account when looking at the case as a whole, but to overtly imply that the injury may be the result of the parents or someone else 'mishandling' the child is deplorable.
    One can't help but draw parallels with the 'one armed man' or 'bushy haired stranger' defence in both crime fiction and non-fiction.
    But that's where this tactic is wrong. In these type of investigations proof is not beyond reasonable doubt. It's balance of probabilities.
    AHPRA should be questioning the system that the CBA has in place for investigation and report writing for cases involving alleged substandard care or misconduct of practitioners.

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  5. jerry sprom

    logged in via email @gmail.com

    Hi Mick,

    A couple of questions if I may. You say the initial radiology report stated a bilateral fracture of the C2 posterior arch. Given the conclusions of the subsequent CT scans, do you think the initial radiology report was correct?

    The initial CT scan was done prior to the infant having an MRI. Which I presume means that the radiologist would not have ideal imaging to determine if there was any damage to surrounding soft tissues as would be expected in the case of trauma causing a…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to jerry sprom

      SO you agree, jerry sprom, that CT shows evidence of a healing fracture? Why are your colleagues so keen to deny there ever was one.

      The whole episode casts doubt on the diagnostic ability of chiropractors and the necks of babies. There is no other registered health profession that would make a clinical diagnosis of bony misalignment in a newborn without imaging, and attempt to correct it manually - no matter how gently.

      Of course one would not perform imaging involving radiation of a baby's…

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    2. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to jerry sprom

      We only have the leaked report to look at. I don't think it's completely cler what was done when, and only the CT reports are noted in any detail. Like I say, I think more information would make it clearer. I remain of the opinion that there is no justification based on that report to be adamant that there was no hangman's fracture.

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    3. Steve Pratt
      Steve Pratt is a Friend of The Conversation.

      logged in via email @me.com

      In reply to Michael Vagg

      I think the lack of clarity is Jerry's point, Michael. Headlines such as 'chiro breaks baby's neck'
      may seem to be deliberately inflammatory if there is in fact some doubt as to the exact nature of the findings. As you say, there may be no justification being adamant that there was no hangman's fracture but it is perhaps equally unjustified to be adamant that there was.

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    4. jerry sprom

      logged in via email @gmail.com

      In reply to Michael Vagg

      Wow Sue! Feel free to answer the questions now.

      Thanks for the response Mick,
      The questions I posed don't really require information from the AHPRA report. An answer would be appreciated, given that others have so far avoided answering them.

      Also, what further information would be required for you to be satisfied that
      a) there was no hangman's fracture and it was in fact a congenital defect all along?
      b) if there was a fracture, that it was not present at the time of the treatment? and
      c) that the chiropractic procedures were not responsible for it?

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    5. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to jerry sprom

      (a) Initial imaging and clinical notes documenting the extent of the presenting injury, plus progress notes to determine what treatment was given and for how long followup was necessary. I don't imagine the child went home the next day without followup. It appears the infant presented with loss of head control which is a grave sign of ligamentous or bony disruption that cannot be ignored. The presence of a congenital defect cannot by itself be responsible for a child presenting like that for treatment…

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  6. Ken McLeod

    logged in via Facebook

    So the Chiropractors' Association of Australia (CAA) said:

    “It remains the case that not a single serious adverse event has been recorded in the medical literature (world-wide) involving a qualified Chiropractor treating a child since 1992.”

    My understanding is that this is simply not true. However, this claim raises a more important issue, that of the lack of a mandatory adverse events reporting system in chiropractic.

    This just beggars belief: an industry whose prime responsibility…

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    1. Paul Prociv

      ex medical academic; botanical engineer at University of Queensland

      In reply to Ken McLeod

      It's amazing, isn't it, that they can see subluxations everywhere, even when experienced radiologists fail to do so, yet cannot recognise a serious fracture when it's pointed out to their faces. Years ago, as a neurology registrar, I was involved in the management of a young woman who became acutely quadriparetic after chiropractic manipulation of her neck. We did find an underlying problem that could explain her earlier symptoms, and which was exacerbated by the rough handling. She was in rehabilitation for many months, with specific treatment for the underlying problem. We were disappointed that she never accepted that the chiropractor might have made things worse for her; in fact, she was very defensive of him. That he was often on the phone to her, even visiting several times, might have had something to do with this.

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    2. Mia Masters

      person

      In reply to Ken McLeod

      "Reporting of adverse events by healthcare practitioners is not mandated by theTherapeutic Goods Association (TGA), and currently only nine per cent of all problemsreported to the TGA originate from them, meaning that potential safety issues with medications are going unreported." Just one example.

      Is there a mandatory system for reporting adverse events in the medical setting in Australia??? To which state, federal authority?

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  7. Stephen H

    In a contemplative fashion...

    So what was wrong with this child's subluxions, to cause his neck to be broken? Why would parents of an infant even consider taking their child to some quack to have their bones manipulated based on the tenets of a 19th century believer in spiritualism and the wondrous powers of magnets?

    Politicians need to grow spines, and outlaw quackery in all its forms. The fact that my health insurer recognises some of these forms causes me great unease - it suggests that "alternative medicine" (otherwise known as supplements, complementary and alternative medicine or SCAMs) has managed to buy its way into mainstream beliefs.

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  8. John McLennan

    Paediatrician, Senior Lecturer

    The baby in this case received numerous treatments largely for a head tilt and crying defined as colic. These are both benign and self limiting conditions. The chiropractor indentified "dysfunction" in C1,S1, T4-5, temporal and sphenoid and occipital and subocciptal regions. The basic pathology and the precise interventions are not described.

    Chiropractic is primarily an intervention. Does anyone ever receive just information and reassurance. Babies with a head tilt may have an abnormality of the cervical spine such as hemivertebrae. When I assess them it is done gently and with some anxiety. None require manipulation. This baby may not have had a "hangman's fracture" but other injuries may have occured.

    A fundamental tenet of medical practice is primum non nocere (first do no harm). Any intervention that makes a difference will have potential for harm.

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  9. Michael Shand

    Software Tester

    Great Article, psuedo-science will be psuedo-science

    you can't reason with these people

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    1. Mia Masters

      person

      In reply to Michael Shand

      I am just sayin': the commenters, nor the authors KNOW the facts of the case. But at least it works as a good excuse to publish another article about.... what? What is this article about? Because how can there be an article about the case without the facts?

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  10. Miles Ruhl

    Thinker

    Really Michael, Chiro's again? Stick to what you know eh, rather than bagging a whole profession continually. Pretty childish and starting to look more like a personal vendetta than reasoned thought.

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    1. Michael Vagg

      Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist at Barwon Health

      In reply to Miles Ruhl

      It's nothing personal Miles. I'd be interested in your considered opinion about whether anyone has a right to leak a confidential regulator's report which contains sensitive medical details? I'd call that the public interest rather than a personal vendetta, wouldn't you? Like many doctors, I'm very concerned that the chiropractic profession is not up to the sort of self-examination and maturity you need to be trusted with self-regulation. I'd have nothing to say if there wasn't incidents like this happening. So I'm sorry of you think I'm a broken record, but you can at least rest assured that it's in the public interest. Many chiropractors are in fact mortified at the goings-on that their leadership gets involved in.

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    2. Miles Ruhl

      Thinker

      In reply to Michael Vagg

      Oh I know, I hear it first hand all the time. But there are dodgy practitioners in all medical fields, why single out Chiro continually? Are they an easier target than say, the GP who told my wife that she shouldn't have sex if she didn't want to get pregnant (going for a morning after pill) and that she was completely irresponsible for wanting sex in the first place?

      Or another (at the same practice!) who sent my nan home after basically telling her she was being an old fuddy-duddy when complaining…

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    3. Miles Ruhl

      Thinker

      In reply to Michael Vagg

      And no, I think that is highly unprofessional and unethical, to say the least. However, and I'm not saying the end always justifies the means, but sometimes if you're being pilloried continually for whatever reason (say Jayant Patel for example) and you had a report that vindicates you or another person, well, you'd have to weigh it up as to whether it was worth breaching that privacy or not.

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  11. Comment removed by moderator.

  12. Sue Ieraci

    Public hospital clinician

    There is another aspect of this discussion which needs to emerge: the chiropractic profession appears to be divided between those who accept evidence in the clinical sciences and provide effective care for musculo-skeletal injuries and pain (who have lots in common with physios), and those who promote the DD Palmer dogma that ''the nervous system'' controls all healing via ''innate intelligence'', and that ''subluxations'' can interfere with nerve transmission, which in turn affects cellular health…

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    1. Russell Hamilton

      Librarian

      In reply to Sue Ieraci

      "Why wouldn't we want health care modalities that are based on the best current evidence for how the body works?"

      Sue, I think everybody wants that. The problem is for people who have some condition that conventional medicine hasn't yet a cure. Are they to do nothing, or investigate other possible solutions? Maybe evidence will turn up later in some unexpected way. Of course the evidence might be that the treatment was actually causing harm, but

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    2. Russell Hamilton

      Librarian

      In reply to Russell Hamilton

      .. . but I guess that's a risk people are prepared to take.

      I don't mind a bit of chiropractic between consenting adults, but am very uncomfortable with the idea of chiropractors dealing with babies.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Russell Hamilton

      Hi, Russell,

      I don't blame people seeking a cure if they don't think they have been helped by medicine. Sometimes, however, the answer is found by looking more thoroughly within the same knowledge and skills pool, rather than abandoning it to another model.

      What does not appear to be reasonable is for practitioners/purveyors to continue to promote either a model or therapy that are not supported by evidence. The other thing that does not appear to be reasonable is to recruit clients (literally…

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    4. jerry sprom

      logged in via email @gmail.com

      In reply to Sue Ieraci

      Sue,
      You're now on the executive of Friends of Science in Medicine right? All of what you have written sounds nice in theory, but I am finding it hard to accept that you actually believe what you just wrote.

      Friends of Science in Medicine are advocating to have chiropractic removed from university, which will result in decreasing the education standards of chiropractor. How will this result in the improved standards, knowledge and research that you so dearly value in the health system and…

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    5. Russell Hamilton

      Librarian

      In reply to Sue Ieraci

      "The fact is, though, that most scientific evidence builds incrementally. It is highly unlikely that we will now, despite all the investigative methods we have, discover that all we currently know about physiology is wrong"

      Agree, but doesn't the incremental growth suggest it is developing sort of along the same path? May we not discover new explanations for how different things are connected?

      I'm not going to defend what chiropractors say about health - the ones I went to decades ago never mentioned any such stuff - I went with a bad back and they fixed it. From what I hear my experience is very different from most people get today: instead of 45 minutes of heat and massage and manipulation, it's 10 minutes of somewhat violent manipulation accompanied by their theories of disease.

      Still, how do you account for their popularity if patients aren't satisfied with the results?

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    6. Sue Ieraci

      Public hospital clinician

      In reply to jerry sprom

      Jerry,

      I assure you I do believe what I wrote. The congruity of my argument with the position of FoSIM relates to the way in which chiropractic is taught, and what the ''chiropractic philosophy'' seems to do to distort a rational understanding of the clinical sciences. It is the pseudo-science that FoSIM argues has no place in universities.

      Before you call me out on my ignorance on what is taught in chiropractic courses, let me explain two things:
      1. Whatever the clinical science content of courses, Australian chiros are emerging with a distorted understanding of well-defined human physiology. You have surely seen examples of this yourself.
      and
      2. There are many rational chiros who speak from within the profession and describe how the chiropractic ''philosophy'' leads to a distortion of understanding of the clinical sciences.

      As evidence of the second point, I'll leave this link:
      http://www.chirobase.org/03Edu/lattanze.html

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Russell Hamilton

      "Still, how do you account for their popularity if patients aren't satisfied with the results?''

      An interesting phenomenon, Russell. Many people are also satisfied with the results of homeopathy, although it's not plausible for those ''remedies'' to have any effect beyond placebo.

      Here are my thoughts:
      - Firstly, people are happy to spend their own money out-of-pocket on chiros, knowing that the entire medical system is still accessible to them when they need it
      -Second, chiros tend to be…

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    8. Russell Hamilton

      Librarian

      In reply to Sue Ieraci

      All reasonable points, Sue. Would you mind hanging out a shingle as Chiropractor and seeing what people come to you for? You can tell them you're not one, after you get the info - just tell them they are part of an experiment to advance knowledge. Because it would be interesting to know .... why do people go to chiros, and why do they go back. How many of those people's problems would likely resolve in time without doing anything etc.

      Presumably there are studies of GPs which show how many patients don't really need medical attention?

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    9. jerry sprom

      logged in via email @gmail.com

      In reply to Sue Ieraci

      Regarding point 1. evidence?

      Regarding point 2.Your evidence is the personal experience of one chiropractor who graduated nearly 20 years ago from a private chiropractic college in the US? I don't see how that has any relevance to the current day teaching of chiropractic in Australian universities.

      In any event, I don't intend to call you out on your ignorance of chiropractic course content, but I do suggest you don't get on your high horse about wanting to embrace chiro's as allied health practitioners when you are on the executive of Friends of Science in Medicine, which, at this point, clearly has no intention of ever accepting chiropractors as part of the health system, nor working with them to improve a patients health problems.

      Do you have any thoughts on the questions I posed to Mick in an earlier post?

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    10. Mia Masters

      person

      In reply to Sue Ieraci

      Please, what is your point with that statement under 'firstly'? Seriously, how does your statement explain the popularity of the chiros and how is it relevant to this 'discourse'?

      And "forth", is it then the problem that chiros are venturing into the territory of a 'serious' condition which should be left to the 'proper' medical professional, or are you now saying that " chiros are not really treating people with significant illnesses"? Which one is it?

      Also, you are saying: "It's easy to provide wellness care to well people".
      Are the chiros providing 'wellness care?

      I think the important thing would be to have credible, reliable data on harm caused in a medical setting and harm in a chiropractic setting. That would settle this ongoing drama and ...war for what, because surely this has very little to do with patient care.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Russell Hamilton

      Russell - many people seek out medical care when it is not objectively ''necessary'' - they may need reassurance due to anxiety, or have a particular concern because of a family death, or due to a range of social or psychological problems, or merely the fact that they have not learned what symptoms to worry about and what not to.

      Getting a GP's reassurance when you feel it is needed is quite different from being coaxed into regular ''wellness therapy'' , in my view, on the basis of a dubious model of care.

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    12. Sue Ieraci

      Public hospital clinician

      In reply to jerry sprom

      jerry - as I clearly said above, ''here are my thoughts'' - in response to Russell's direct question. I don't think he was requesting a referenced treatise. If he was, I apologise to him.

      I remain committed to the aims of FoSIM - I don't want to see universities teaching medical science to some people and pseudo-science to others.

      My awareness of the pervasiveness of the "chiropractic philosophy'' , including newborns having ''subluxations'' and the alleged interruption of neural flow causing…

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    13. jerry sprom

      logged in via email @gmail.com

      In reply to Sue Ieraci

      Sue, threats to the chiropractic profession have been around since inception. FSM bears striking resemblance to the Committee on Quackery' which was in existence in the states a few decades back.

      I am more concerned about your organisations quite open principle of disrupting the ability of health professionals to communicate and collaborate and seeking to reduce peoples access to these services by making them less affordable. By removing medicare rebates, you are punishing the communities most…

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    14. Sue Ieraci

      Public hospital clinician

      In reply to jerry sprom

      jerry - your comments are somewhat ironic, considering that this article is written by a medical specialist in pain management.

      The open attempts by many chiros to expand their practices, recruit children from the time of birth and life-long for ''wellness therapy'' does not suggest that there is an unmet need for their services.

      Ultimately, however, the question is this: do we need two musculoskeletal professions - both physiotherapy and chiropractic, the former based on the clinical sciences and the latter based on the theories of a nineteenth century ''magnetic healer''?

      I sincerely do acknowledge the abilities and motivations of chiropractors who practise effective musculoskeletal therapy. I would encourage them to step away from the ''subluxation'' and ''innate energy'' movement and towards some sort of an alliance or partnership with physiotherapists.

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    15. Steve Pratt
      Steve Pratt is a Friend of The Conversation.

      logged in via email @me.com

      In reply to Sue Ieraci

      Sue, I'm afraid I agree with Jerry on the contradictory nature of what you say and what Fosim does. And yes your knowledge of chiropractic undergraduate teaching IS inaccurate ( the problem starts after). The more noble intention you state of cooperation and alliance is at odds with the Fosim campaign of conglomeration that lumps all the perceived (and real) failings of chiropractic into one and seeks to deny any professional validity. It's a bit like the clinician saying to the patient: we've found a tumour but we consider it so ugly that the only option is euthanasia....oh and by the way I will be happy to do that job for free.

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    16. Mike Jubow

      forestry nurseryman

      In reply to Sue Ieraci

      Sue, this article and the links provided, reads to me, like a first class horror story. I am having difficulty in trying to imagine why there has not been a full blown enquiry into the whole episode. Isn't there sufficient grounds so far to suspect malpractice? And why isn't there a push for an official enquiry by the police, child welfare and the medical fraternity?

      To date, I have never been anti-chiropractic as such, but after having had a bad experience at the hands of one some 40 years ago, have preferred physiotherapists since. A story like this should frighten off most people from going to chiropractors. One would have thought that bad chiropractic practices would have been eliminated by the 21st century. Seems they haven't!

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    17. Sue Ieraci

      Public hospital clinician

      In reply to Mike Jubow

      '' And yes your knowledge of chiropractic undergraduate teaching IS inaccurate ( the problem starts after).''

      Steve - help us all understand this.

      What is it that chiropractors spend five years studying at university? Since they (you?) specialise and focus only on the anatomy and position of the spine, and limb anatomy, what focus is there on the rest of the body systems - vascular, endocrine, renal etc etc. And how does rational knowledge of the clinical sciences (if indeed that is what is…

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    18. Sue Ieraci

      Public hospital clinician

      In reply to Steve Pratt

      Steve Pratt - perhaps you could also help me understand this:

      The website of Beaconsfield Chiropractic offers this explanation of how chiropractic works:

      ''Practically speaking, chiropractors are primarily concerned with locating and treating vertebral subluxations.

      A vertebral subluxation is a complex of functional and/or structural and/or pathological articular (joint) changes that compromise neural integrity and may influence organ system function and general health.

      Using a number…

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    19. Sue Ieraci

      Public hospital clinician

      In reply to Mike Jubow

      You're right - sorry Mike - I meant to reply to Steve.

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    20. Sue Ieraci

      Public hospital clinician

      In reply to Steve Pratt

      '' And yes your knowledge of chiropractic undergraduate teaching IS inaccurate ( the problem starts after).''

      Steve - help us all understand this.

      What is it that chiropractors spend five years studying at university? Since they (you?) specialise and focus only on the anatomy and position of the spine, and limb anatomy, what focus is there on the rest of the body systems - vascular, endocrine, renal etc etc. And how does rational knowledge of the clinical sciences (if indeed that is what is…

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    21. Steve Pratt
      Steve Pratt is a Friend of The Conversation.

      logged in via email @me.com

      In reply to Sue Ieraci

      Sue, as you have gathered I am just an average joe not an academic but I believe terminology is a problem at many levels.The nature of spinal dysfunction has been long debated and disputed across many fields with attempts to make labels such as joint dysfunction, joint position error, manipulable lesion the standard but there is no common agreement. The term subluxation is not a good one but it would seem slightly better than what some patients are told by other health professionals (including medical…

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    22. Sue Ieraci

      Public hospital clinician

      In reply to Steve Pratt

      Hi, Steve. I acknowledge and respect your sincerity, but I see the issue as going far beyond terminology.

      The problem is this: whether you say that a joint is subluxed or just stiff, there is no evidence of the sensorimotor dysfunction that you describe, or that the mobilisation of the that joint, leads to ''a better functioning organism.''

      I strongly agree that mobility and physical fitness is crucial in the safety and health of the elderly - I collaborate with physiotherapists and OTs a lot…

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  13. Anvil Springstien

    scribbler and talker of sorts at 'Near the Knuckle Productions'

    Well, if it walks like a quack, and quacks like a quack...

    Anvil.

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  14. James Hill

    Industrial Designer

    And, of course, it would be entirely beyond the bounds of probability that a child delivered by forceps, ie dragged out of the birth canal by its head, ever, ever suffered any sort of spinal "complications" as a result.
    No, simply not possible.
    And certainly no need for a chiropractor to come along later to remedy any such iatrogenic injury.
    Any such child should just go on to a lifetime of avoidable suffering because, hey, we couldn't possibly have collaboration between the various "specialists", could we?
    Time for some heads to be banged together.
    Risk of neck injury not withstanding.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to James Hill

      James Hill - why would a health care modality in the 21st centurey need to rely entirely on the ''bounds of probability'' - why not test it?

      We have lots of ways of imaging at both micro and macro levels. What evidence has emerged that ''subluxations'' even exist, let alone are present in most babies just from a vaginal birth, as many chiros allege.

      There is no lack of collaboration between medical practitioners and physiotherapists - whose therapies are based on the clinical sciences.

      It's not a matter of banging heads together - it;s a matter of proponents of "The Subluxation'' either coming up with evidence for it, or moving on.

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    2. James Hill

      Industrial Designer

      In reply to Sue Ieraci

      Irony doesn't translate very well does it, no matter how exaggerated.
      Please allow that that general mass of brainless protoplasm known as the "patients" have an interest in the so-called specialists actually recognising that those patients or potential patients have intelligent contributions to make to these "specialised" debates.
      Banging those heads together was put forward as a way to make that realisation occur.
      Going to take the hint?

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  15. Anna Ross

    Healthcare professional

    Do you have any idea how many people are killed each week by medical malpractice in Hospitals round Australia?" Jayand Patel being one example. How much did the pharmaceutical industry pay you to write this crap?

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  16. Anvil Springstien

    scribbler and talker of sorts at 'Near the Knuckle Productions'

    "Anna Ross
    Healthcare professional
    Do you have any idea how many people are killed each week by medical malpractice in Hospitals round Australia?" Jayand Patel being one example. How much did the pharmaceutical industry pay you to write this crap?"

    Not too sure I understand your point, Anna? Are you suggesting that because malpractice exists within an evidence based profession this somehow abrogates the need for an industry that purports to assist in the well being of its customers to justify…

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    1. Anvil Springstien

      scribbler and talker of sorts at 'Near the Knuckle Productions'

      In reply to Michael Vagg

      Which apologises for the leak of confidential information and assures the community that a full investigation to ascertain the nature and source of said leak is now under way and, further, that steps are being taken and measures implemented to regain public confidence and ensure that this cannot happen again, and... oh, wait...

      Anvil.

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  17. Brooke Berry

    logged in via Facebook

    Sue, if all current medical treatments were clinically validated I wouldn't have a full time job facilitating clinical research within hospitals as there'd be so little to do. I would love to see more evidence on chiropractic and other "alternative" treatments, however a lack of evidence doesn't equal lack efficacy until the studies have been done. I see a GP, a naturopath and a chiropractor. I have waded through some terrible chiropractors, also some terrible doctors including spending my life…

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