Articles by JCS

Baby Under Steam Roller

                                                                                                   

 

Word count: 2770

August 1, 2016

TO:   Julianna LeMieux, PhD.

RE: “Pediatric Chiropractics: Why Not Just Throw Babies Under Steam Rollers?”

Dear Dr. LeMieux:

I read with puzzlement your angry article about pediatric chiropractic care and the anti-vax movement posted online at the website of the American Council of Science and Health.

Just to clear the air about your group, let me add that ACSH is not without its own skeletons in the closet as Mother Jones published on October 28, 2013: “Leaked Documents Reveal the Secret Finances of a Pro-Industry Science Group: The American Council on Science and Health defends fracking, BPA, and pesticides. Guess who their funders are.”

According to Mother Jones, ACSH was expected to receive $338,200 from tobacco companies between July 2012 and June 2013. Reynolds American and Phillip Morris International were expected to give $100,000. A complete listing of its many corporate funders is posted including Chevron ($18,500), Coca-Cola ($50,000), the Bristol Myers Squibb Foundation ($15,000), Dr. Pepper/Snapple ($5,000), Bayer Cropscience ($30,000), Procter and Gamble ($6,000), agribusiness giant Syngenta ($22,500), 3M ($30,000), McDonald's ($30,000), among others.[1]

In regards to your torment in your recent ACSH article, “Pediatric Chiropractics: Why Not Just Throw Babies Under Steam Rollers?, let me discuss your many biased comments:

A perfect storm of ignorance and misinformation will be taking place in Maui this December at the International Chiropractors Association (ICA) Council on Chiropractic Pediatrics annual conference.

Amidst the backdrop of talks on the questionable practice of the manipulation of children’s spines, will be a session on “vaccines and autism.”

It is bad enough to perform spinal manipulation therapy (SMT) on children and babies (pediatric chiropractors now recommend starting spinal manipulations a few days after birth – “Chiropractic care can never start too early” appears on the Council on Chiropractic Pediatrics website.) By including the session on vaccines and autism at the conference, they are offering children a one – two punch. As if the inappropriate treatment that you may get from your chiropractor is not bad enough, now their customers will have whooping cough, too.

From the fear-mongering tone of your essay, it is clear you are angry and hell-bent on discrediting both chiropractic care and vaccine awareness, certainly not the “fair and balanced” reporting I might expect from a PhD like you; plus, I find your concern is terribly misplaced.

Nonetheless, keep in mind there are always two-sides to any story, even in medicine despite its historically medical chauvinist attitude against any type of alternative to allopathic medicine.

Rather than citing credible research concerning pediatric chiropractic care, you chose to the unsupported opinion by Sam Homola:

“I do not know of any credible evidence to support chiropractic subluxation theory [altering a misalignment of the vertebrae.] Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary.”[2]

Other than his skewed opinion, where are the other data to support Dr. Homola? Where are the damaged children? Indeed, where is the proof of your anguish or is your article simply a smear campaign?

Text Box: A disturbing view of pediatric chiropractics Image courtesy of www.abc.net.au Does the picture of a pediatric adjustment in your article really look “dangerous” or “disturbing view” to any objective person of science? In fact, this picture was of a successful case where gentle fingertip chiropractic care helped a colicky baby recover.

If your goal is to warn readers of dangerous pediatric treatments, perhaps you should also present a picture of forceps delivery to give a truly “disturbing view” of pediatric medical care as shown in a YouTube instruction video, FORCEPS DELIVERIES - PIPER FORCEPS | Medical Training Film. Another YouTube video reported a baby allegedly died after its head was crushed in a forceps delivery.

If the gentle spinal adjustment on an infant cradled in the lap of a caring chiropractor upsets you so much, Dr. LeMieux, these two videos should make you ill in disgust. However, your intent was not a fair and balanced discussion; your goal was to bash chiropractic with spurious examples and unfounded allegations by medical curmudgeons.

Witch Hunt Down Under

The picture in your article is of a pediatric chiropractor, Dr. Ian Rossborough, who was accused to what amounted to a victim-less non-crime by biased medical reporters in Australia. Keep in mind there was no injured infant, no complaints by parents, and he was well within his scope of practice. He was singled out because his video “didn’t look good.”

The original article, “Doctors speak out against chiropractors treating children,” (April 22, 2016), was simply fear-mongering by a reporter, Ann Arnold, who never interviewed Dr. Rossborough, but she did find medical curmudgeons to defame him. Indeed, this attack on an innocent chiropractor was a modern day Witch Hunt Down Under in the court of public opinion.

Even at his board hearing, Dr. Rossborough presented numerous scientific articles that were ignored by this kangaroo court whose members did not even ask him one question. Indeed, their prejudicial minds were made up well in advance after the onslaught of yellow journalism calling for his head on a stick.

A simple search on PubMed.gov would have discovered articles in support of chiropractic care for colicky babies, such as:

Vaccine Issues

In regards to the hotly debated vaccine issue, let me direct you to a very recent survey of MDs published online at Medscape on Medscape Vaccine Acceptance Report 2016. This survey reveals issues all practitioners face from parents with very sound objections to childhood vaccines.

The avoidance of mandatory vaccinations is due to credible reasons. Slides #9, #12, and #21 give very interesting feedback from parents why they prefer not using vaccines in order to protect their children from the side effects of the vaccines that are often worse than the disease itself.

Your poor choice of words about the growing numbers of children utilizing chiropractic care also illustrates your medical chauvinism:

Although it seems too good to be true, somehow their sales pitch is working. In 2005, the National Board of Chiropractic Examiners reported that children (under age 17) accounted for 18.2% of a chiropractor’s practice. According to a 2007 National Health Interview Survey (NHIS) survey, more than 2 million children have received some kind of manipulation within the year. Even worse, for the youngest children ages 0-4, the predominant reason (~ 40%) was prevention or ‘wellness care.’”

Once again your medical bias comes through loudly. Rather than any attempt to understand, you mock the idea that people seek alternatives to the “pill for every ill” model the AMA and Big Pharma offers them.

CAM Grows

The trend to CAM practitioners must be difficult for medical traditionalists to understand why the public is moving to nondrug and nonsurgical treatments.

According to “The Use of Complementary and Alternative Medicine in the United States” published by the NIH National Center for Complementary and Alternative Medicine, more people use CAM practitioners than the media reveals to the general public:

How Many People Use CAM

In the United States, approximately 38 percent of adults (about 4 in 10) and approximately 12 percent of children (about 1 in 9) are using some form of CAM.

Who Uses CAM Most

People of all backgrounds use CAM. However, CAM use among adults is greater among women and those with higher levels of education and higher incomes.


          Dr. LeMieux, don’t you find intriguing why millions of women just like you, “those with higher levels of education and higher incomes,” are using CAM services at the greatest rate?

What does that tell you, Dr. LeMieux? Perhaps when people are given all options, they choose to use nondrug treatments instead of drugs, shots and surgery?

Instead of intellectual parity, your skepticism comes through clearly when you wrote, “Although it seems too good to be true, somehow their sales pitch is working.” This trend should not come as a surprise to you considering Dr. David Eisenberg, MD, from Harvard’s Osher Institute, revealed the first of his two studies on CAM, “Trends in CAM and Integrative Therapies.” [3]  

These studies shocked medical curmudgeons who cannot understand why Americans would choose alternative “quacks” over “modern medicine.” Apparently the threat to the monolithic medical profession was bigger than anyone had imagined once the researchers took a closer look to find Americans were making more visits to non-MDs than to MDs.

In 1993, Dr. Eisenberg et al. published in the NEJM,Unconventional Medicine in the United States. Prevalence, Costs, and Patterns of Use:”

Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.

CONCLUSIONS:

The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.

At a follow-up seminar on the topic, “Practicing within Mainstream Healthcare,” held at the Massachusetts Medical Society headquarters in Boston on November 18, 2006, Dr. Eisenberg remarked about the growing trend to CAM and chiropractic care. Dr. Eisenberg noted how his own view of chiropractic has changed from his early days to the present.

He was taught in medical school that chiropractic was “irrelevant, worthless, a waste of money, and dangerous.” In the 1980s, it was “unproven, unorthodox, and unconventional.” After his study showing the huge usage of CAM, he noted that the terminology has changed from “complementary and alternative” in the 1990s, to “integrative” in 2000-05, and “comprehensive” in present-day.[4]

Upon seeing the huge number of Americans using CAM practitioners, Dr. Eisenberg wisely concluded, “Maybe ‘alternative’ isn’t so alternative anymore.”

Maybe his opinion is a forewarning to you, Dr. LeMieux, just as it is for the CDC that also reported on May 5, 2016, the increasing use of CAM for chronic conditions in a report,Multiple Chronic Conditions and Use of Complementary and Alternative Medicine Among US Adults: Results From the 2012 National Health Interview Survey.[5]

Results

Chronic conditions were common. US adults reported one (22.3%) or 2 or more (33.8%) conditions. Many used at least one form of CAM. Multivitamins, multiminerals, or both (52.7%); vitamins (34.8%); and minerals (28.4%) were the most common. Compared with adults with no conditions, adults with 2 or more conditions were more likely to use multivitamins or multiminerals or both, vitamins, minerals, nonvitamins or herbs, mind–body therapies, chiropractic or osteopathic manipulation, massage, movement therapies, special diets, acupuncture, naturopathy, or some combination of these therapies (P <.003).

Conclusion

People with multiple chronic conditions have a high prevalence of CAM use. Longitudinal studies are needed to understand the association between CAM use and chronic disease prevention and treatment.

As Dr. Eisenberg said, this CDC study also shows “Maybe ‘alternative’ isn’t so alternative anymore.”

Day at the Beach

You also seem very upset with the upcoming pediatric conference in Maui that will discuss the relationship between vaccines and autism. As you may have noted in the Medscape survey, this issue is paramount among parents, too. I daresay a frank, fair and balanced discussion would be enormously helpful to determine fact from bunk.

In particular, you were miffed by the presence of Andrew Wakefield at this conference:

“Not surprisingly, Andrew Wakefield (the originator and poster child of the modern anti-vaccine movement) is scheduled to speak at the ‘vaccines and autism’ session of the conference.”

I am not here to defend him, but may I suggest if you are so adamantly opposed to Mr. Wakefield, perhaps you should attend the conference to confront his views. What a perfect setting to air your objections about both vaccines and pediatric chiropractic care to an audience devoted to helping children.

You should bring your scientific references and let the chips fall where they may. As you noted in your article, the 2007 National Health Interview Survey (NHIS) survey revealed “more than 2 million children have received some kind of manipulation within the year.”

Obviously there are many infants to be saved by your advice, Dr. LeMieux, by convincing the hundreds of chiropractors in attendance their pediatric care is “dangerous” and “unnecessary.” With your grasp of the issues, it would be enlightening to see how you paint the morbid picture of these dedicated DCs “throwing babies under steam rollers.”

However, after reading the sarcastic ending to your article, I doubt your intent is a fair and balanced discussion about the pros and cons of anything in medical care:

“OK. Now I get it.

“They should just call it the “We Hurt Kids Council” and go spend the day at the beach.”

          Dear Dr. LeMieux, is that really the attitude a learned woman of science should have? Obviously you are swimming against the tide considering the popularity of CAM for both adults and kids. Rather than fighting this tide, perhaps you should embrace it, put it to rigorous study (rather than unsupported criticism), and discover why nondrug, nonsurgical CAM care is so popular.

British Attack

Considering your torment about the possibility of “dangerous” and “unnecessary” treatments, perhaps you can also discuss a recent article in the British Medical Journal concerning the overall danger of medical care in its editorial, “Medical error—the third leading cause of death in the U.S.[6]

While we’re on the topic of clinical iatrogenesis, are you aware of another article about the effectiveness of medical treatments published in the British Medical Journal, “What conclusions has Clinical Evidence drawn about what works, what doesn't based on randomised controlled trial evidence?

The British Medical Journal posted on their website, Clinical Evidence, the results of an analysis of randomized controlled trials focusing on harms and benefits of 3,000 medical treatments.

The results were shocking. Only about a third of the treatments were shown to be beneficial (11%) or likely to be beneficial (23%). Another 7% were rated as trade-offs between benefits and harms, with 6% rated unlikely to be beneficial and another 3% rated likely to be ineffective or harmful. The authors at Clinical Evidence rated the remaining 50% of medical treatments as being of unknown effectiveness.

According to the BMJ, 2,000 of 3,000 medical treatments were found to be ineffective, unproven or too dangerous to use. What do you have to say about this medical mess, Dr. LeMieux?

The editors admitted the “challenge evidence ratings like these pose for clinicians is not new.” In fact, such warnings are just ignored as we see in medicine today evident by the current tsunami of addictions and deaths caused by opioid painkillers brought to Americans by their local MD and pharmacist.

Many stunning revelations also show why medical spine care has been dubbed the “poster child of inefficient spine care” by Mark Schoene, the editor of TheBACKLETTER, a leading international spine research journal who commented on the tsunami of ineffective spine surgeries:[7]

"The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate…Despite a steady stream of technological innovations over the past 15 years—from pedical screws to fusion cages to artificial discs—there is little evidence that patient outcomes have improved.”[8]

Obviously, Dr. LeMieux, your tunnel vision cannot see the forest through the trees. Your argument against pediatric chiropractic care and the concerns of millions of parents about the dangers of vaccines are pale in comparison to the damage from medical care.

While your alarm may have been well-meaning, may I suggest you focus on the misgivings of medical care that present more problems and avoidable deaths by MDs than anything a pediatric chiropractor or any CAM practitioner may cause?

 



[1] Leaked Documents Reveal the Secret Finances of a Pro-Industry Science Group, Mother Jones, Oct. 28, 2013

[2] Homola, S Pediatric Chiropractic Care: The Subluxation Question and Referral Risk Bioethics. 2016; 30(2)

[3] DM Eisenberg, RC Kessler, C Foster, FE Norlock, DR Calkins, TL Delbanco, “Unconventional  Medicine In The United States--Prevalence, Costs, And Patterns Of Use,” N Engl J Med 328 (1993):246-252.

[4] DM Eisenberg, “Practicing within Mainstream Healthcare,” seminar held at the Massachusetts Medical Society headquarters, Boston, Nov. 18, 2006.

[5] Falci L, Shi Z, Greenlee H. Multiple Chronic Conditions and Use of Complementary and Alternative Medicine Among US Adults: Results From the 2012 National Health Interview Survey. Prev Chronic Dis 2016;13:150501. DOI: http://dx.doi.org/10.5888/pcd13.150501.

[6] BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2139 (Published 03 May 2016) Cite this as: BMJ 2016;353:i2139

[7] US Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1

[8] The BackLetter, vol.12, no. 7, pp.79 July, 2004. The BackPage editorial, The BackLetter, pp. 84, vol. 20, No. 7, 2005.



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