Pediatricians address Alberta Standing Committee on Health about Chiropractic spending and tactics

Positions of Endorsement

ONE: The Pediatric Section of the Alberta Medial Association fully endorses the 1994 position of the Canadian Chiefs of Pediatrics in regard to their deep professional concern about chiropractic claims to treat infants and children. (Canadian Journal of Pediatrics; Jan. 1995, vol. 2 no. 1, pages 5-6)

A copy of that position is enclosed. We would draw your particular attention to their concern about x-rays.

"Chiropractic use of x-rays of infants and children to diagnose so-called vertebral subluxations is unscientific and of no value whatsoever. Without any benefit to the child, these x-rays can contribute to the risk of cancers and genetic damage. Parents should never allow their children's spines to be x-rayed by a chiropractor."

Furthermore, in regard to the chiropractic diagnosis of "subluxations" and their treatment by "adjustment", we draw your attention to:

"Chiropractic spinal adjustment is NOT required as preventive therapy to maintain a child's health."

"There is no scientific evidence whatsoever that the so-called chiropractic spinal adjustments result in any correction of the child's spine. These adjustments are ineffective and useless."

TWO: The Pediatric Section of the Alberta Medial Association fully endorses the position of the Canadian Pediatric Society (November 17, 1998) in support of the Chiefs of Pediatrics.

THREE: The Pediatric Section of the Alberta Medial Association wishes to express its sincere appreciation for the actions of the Alberta Society of Radiologists in refusing to take x-ray studies in the pediatric age group on the requisition of a chiropractor.

RECOMMEDATIONS OF THE PEDIATRIC SECTION OF THE

ALBERTA MEDICAL ASSOCIATION

The Pediatric Section of the Alberta Medial Association therefore most strongly recommends the following:

1. We ask that a government regulation be passed forbidding the taking of x-rays by chiropractors in their own offices in the pediatric age group, birth to 18 years. Any requirement for x-rays in the pediatric age group should be on the requisition of a certified Doctor of Medicine.

2. We ask that the Alberta government immeiately de-list all payments to chiropractors in the pediatric age group, birth to 18 years, including x-rays. Such payments can be put to better use for valid scientific medical care. Such payments also delude the public into believing that there is merit to such treatments.

3. We recommend to the Government of Alberta that they adopt scientific standards for the provision of manual therapy to all adult citizens of Alberta. In this regard, the Chiefs of Pediatrics, the Canadian Pediatric Society, the Canadian Orthopractic Manual Therapy Association, the Alberta Society of Radiologists, the Manitoba College of Physicians and Surgeons and the respected publication, Consumer Reports magazine have all recommended the orthopractic guidelines.

4. We recommend that there be no public expenditure to any practitioner of manual therapy who does not adhere to the orthopractic guidelines.

FUTURE PLANS

We recognize that a number of Alberta chiropractors wish to adhere to the orthopractic guidelines. We extend a welcome to them.

The Pediatric Section of the Alberta Medial Association has passed a resolution entrusting upon the Department of Pediatrics of the University of Calgary the responsibility to organize a day long seminar on the subject of the chiropractic pediatrics.

This seminar will be open by personal individual invitation to any Alberta chiropractor. The Agenda will be made in co-operation with any chiropractor or chiropractic organization that may wish to contribute. We hope that the morning will be devoted to chiropractors explaining to the pediatricians their procedures and treatments. The afternoon will be devoted to the reverse.

We hope to have this seminar sometime during the month of May 1999.

BACKGROUND TO THE RECOMMENDATIONS

RECOMMENATATION ONE: PROHIBIT ALL CHIROPRACTIC X-RAYS IN THE PEDIATRIC AGE GROUP

As pediatric age children should not be in a chiropractor's office to begin with, there is no need for any chiropractic diagnosis to be made by x-ray.

It is clear that almost all, if not all pediatric age group x-rays taken by chiropractors in their own office are for the purpose of telling the parents that their infants and children have so-called "vertebral subluxations".

We do not accept the contention of the College of Chiropractorss of Alberta that pediatric age group x-rays are primarily taken to rule out the possibility of pathology.

On behalf of the College of Chiropractors of Alberta, the President, Mr. Allan Halowski, has submitted a synopsis entitled "Chiropractic Care and Children" dated November 1998. In it he praises the textbook, "Pediatric Chiropractic". This text clearly teaches the diagnosis of vertebral subluxations for every pediatric condition imaginable including otitis media, sinusitis, enureses, and even learning disorders.

There are no known scientific indications for vertebral manipulation therapy for infants and children. Whatever other therapies for musculo-skeletal care that mey be required are available from existing scientific sources.

Resources are quickly available for any chiropractor to refer to for a complete differential diagnosis.

As the Chiefs of Pediatrics have stated:

"Without any benefit to the child, these x-rays can contribute to the risks of cancers and genetic damage. Parents should never allow their children's spines to be x-rayed by a chiropractor."

RECOMMENDATION TWO: DELIST MEDICARE PAYMENTS FOR CHIROPRACTIC PEDIATRICS

By endorsing the diagnosis of vertebral subluxations, as defined by the chiropractors, the government is paying for a condition that does not exist. In paying for the supposed treatment of non-existant vertebral subluxations by so called "adjustments", the government is paying for a treatment that does absolutely nothing and may in fact in the long run do more harm than good.

The Alberta government should make it clear that it was never their intention to allow public funds for spinal manipulation services to be claimed for anything other than the treatment of low back pain in adults.

Chiropractors, by expanding beyond the limits of science, with their use of public funds, have broken the trust of the public and the government.

The extent of this broken trust is massive and covers the great majority of practicing chiropractors.

Over $3.5 million have been spent by government to treat infants and children. If we add in the private expenditures from Alberta citizens, the total is close to $8 million.

RECOMMENDATION THREE: THE NEED FOR SCIENTIFIC STANDARDS

The College of Chiropractors of Alberta has failed to maintain scientific standards for the provision of manual therapy. The essential point of the orthopractic guidelines is that manual therapy be limited to musculo-skeletal conditions. It is that simple. The guidelines reject any philosophical notions about such therapy.

The limitations of a professional scop of practice to a specific area is a very common and accepted procedure in medicine. Some physicians decide just to practice pediatrics, others just radiology, etc., etc.

We fail completely to understand the assertion of the College of Chiropractors of Alberta, in a letter dated November 13, 1998, signed by the president, allan Halowski that adherence to the orthopractic guidelines "...is at best naive and at worst dangerous".

How can it be dangerous for a chiropractor to wish only to treat musculo-skeletal problems?

How can it be dangerous for a chiropractor to endorse routine immunization rather thatn vertebral manipulation as a means of preventing diseases?

How can it be dangerous for a chiropractor not to diagnose vertebral subluxations on an x-ray?

RECOMMENDATION FOUR: THE NEED FOR SCIENTIFIC STANDARDS

The government of Alberta should enter into discussions with the Canadian Orthopractic Manual Therapy Association (C.O.M.T.A.) and consider placing under its certification all those who will be eligible for public funding. It is fortunate that the President of that group is an Alberta citizen, Mr. Robert Syndenham of Edmonton.

ADDITIONAL COMMENTS

DEFLECTIONS FROM THE REAL ISSUE

The Pediatric Section of the Alberta Medical Association rejects any claims by chiropractors to deflect this issue by labeling it a "turf war", or a political battle, or an issue based on financial considerations.

The Pediatric Section of the Alberta Medical Association completely rejects the statement of the president fo the College of Chiropractors, Mr. Allan Halowski, that our genuine concerns for the welfare of children are a "political agenda".

It is worth noting that Alberta radiologists gave up millions of collars of income in order to take an ethical and a scientific position. Alberta radiologists are perfectly willing to give all the non-scientific turf to the chiropractors.

We would urge the public, the media and the politicians to reject such deflections from the real issue.

THE REAL ISSUES

The real issues are that the parents of Alberta's children are being told that their infants and children have so-called vertebral subluxations, when in fact they have nothing of the sort. Parents ar being told their children have unequal leg lengths an scoliosis (curvatures of the spine).

• Parents are being told that their babies should be examined by a chiropractor as soon after birth as possible.
• Parents are being made wary of immunizations and are told to rely on spinal adjustments instead.
• Parents are being told that the diagnosis of an ear infection, colic, or a learning disorder starts with the spine and not the ear, the abdomen or the brain.
• Chiropractic is a treatment in search of a disease.
• If all you have is a hammer, every disease is a nail.

WE ALL HAVE THE SAME BODY

The Pediatric Section of the Alberta Medical Association completely rejects the statement of the president of the College of Chiropractors, Mr. Allan Halowski that the Chiefs of Pediatrics, and by implication all teh pediatricians "cannot make a determination of judgement as to who can, or should receive chiropractic care".

We should remind the College or Chiropractors of Alberta that infants and children all have the same anatomy whether they are being treated by a chiropractor or by a pediatrician. Over 51 different medical specialties, from neurologists to orthopedic surgeons to general pediatricians all agree on the nature of the human body.

Only chiropractors do not.

We should remind the College of Chiropractors of Alberta that pediatricians spend an average of twelve or more years post secondary education before becoming certified as a pediatrician. The Calendar of the Canadian Memorial Chiropractic College, course CD-408 lists a total of 20 hours of instruction in "Child Care".

Anyone can read a book and learn to be able to "speak medicine".

However, real medical education, over 75% of a medical student and 100% of a specialization takes place in real clinics and hospitals.

The members of the Alberta Legislature should realize that Canadian chiropractors do not spend a single day in any supervised hospital training program anywhere in Canada.

One can well conclude that the chiropractic use of the title "doctor" is a political rather than an educational achievement.

It is not difficult to devise simple tests to show the falsity of these claims. We challenge the College of Chiropractors of Alberta to demonstrate in front of a group of Members of the Alberta Legislature and a group of Alberta pediatricians, their supposed diagnosis of vertebral subluxations in infants and children, and their supposed adjustments.

A CHILD'S STORY

You may all be familiar with the story by Hans Christian Andersen of the Emperor Who Has No Clothes.

Chiropractic theories of pediatric care have been dressed by well-sounding people who know how to "speak medicine".

It wears the hat of political acceptability.

It wraps itself in the coat of unknowing personal testimony that the Chiefs of Pediatrics warned against.

"Parents should regard with extreme skepticism claims made by other parents that their infants and children have been cured by chiropractic adjustments for such conditions as infantile colic, recurrent ear infections, learning disorders, asthma, chronic abdominal cramps or bedwetting."

"However well meaing, such personal testimony is unreliable and is not a subtitute for scientific fact".

It takes a child to cry out, "The Emperor has no clothes".