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March 2007

WCA responds to Pediatrics article

A research report published in the January 2007 issue of Pediatrics magazine spurred an immediate and strongly worded response from the World Chiropractic Alliance (WCA), which issued a statement to the profession and distributed a press release through a major wire service. In its responses, the WCA made it clear that the article in Pediatrics, a research journal published by the American Academy of Pediatrics, was misleading and reached unsupported conclusions about the safety of chiropractic in children.

The press release was distributed through a wire service specializing in health and medical news and generated widespread coverage and media interest from as far away as India. It contained information from published research as well as quotes from Terry A. Rondberg, DC, WCA president, and Matthew McCoy, DC, editor of the Journal of Vertebral Subluxation Research. The WCA already has a position paper on chiropractic and children and strongly supports the right of parents to seek and obtain chiropractic care for all their children, regardless of age or presence or absence of symptoms.

The press release read, in part:

A report published in the January issue of Pediatrics journal may cause unfounded concerns about the safety of chiropractic for children, according to the World Chiropractic Alliance (WCA), an organization representing doctors of chiropractic around the world.

The article in Pediatrics, a research journal published by the American Academy of Pediatrics, reviewed 13 published research studies involving spinal manipulation on children and found 14 cases of adverse affects, of which 9 were considered serious. Those 13 studies were culled from nearly 14,000 published articles, the WCA pointed out, and specifically excluded studies where no adverse effects were reported.

"Obviously, the researchers were specifically looking for the extremely rare case of spinal manipulation causing injury," stated Terry A. Rondberg, DC, president of the WCA. "Although they warn about risks, they fail to note other research studies that have shown serious adverse effects occur in less than one out of a million chiropractic visits."

In addition, the WCA noted that while in one place the Pediatrics article states that "Each case involved a chiropractor," an accompanying chart shows that of the 14 adverse events, one involved manipulation performed by a physiotherapist, another by a medical doctor, and two by chiropractic students. In two others, the type of practitioner was unknown. Although just 8 of the 14 events actually involved licensed doctors of chiropractic, the report frequently refers to all as chiropractic cases.

The report also demonstrates a basic misunderstanding of the purpose and scope of chiropractic, Dr. Rondberg explained.

"Chiropractic is a non‑invasive and drug‑free health care approach that specializes in the detection and correction of vertebral subluxations, which are misalignments in the vertebrae that can cause interference in nerve function. Doctors of chiropractic do not diagnose or treat specific medical diseases." Yet, the Pediatrics report labeled failure to diagnose diseases such as cancer, diabetes and meningitis as additional "adverse effects."

To chiropractors, even the term "spinal manipulation" is incorrect when applied to their profession.

"Specific chiropractic adjustments to reduce or correct vertebral subluxation in children are not the same as gross, non‑specific spinal manipulations," stated Matthew McCoy, DC, editor of the peer‑reviewed Journal of Vertebral Subluxation Research (JVSR, www.jvsr.com) and vice‑president of the Council on Chiropractic Practice. "To determine whether a case actually relates to chiropractic, researchers have to find out if the practitioners first tested for the presence of vertebral subluxations and used specific chiropractic adjustments, or if they simply applied non‑specific spinal manipulations without first obtaining the objective findings that indicate the need for intervention."

According to Dr. McCoy, the researchers in the Pediatrics study failed to distinguish between spinal manipulation and chiropractic adjustments, and between chiropractors and other providers. They even admitted the weaknesses of their own research, stating that "our study has several limitations," and acknowledged that "serious adverse events may be rare." It was therefore premature, Dr. McCoy said, for them to caution families about "a range of adverse events" and frighten them away from chiropractors.

"There is simply not enough evidence to make any association between the adverse events reviewed and chiropractic, and such warnings to already worried parents may raise unnecessary fears about chiropractic care for their children," Dr. McCoy stressed. "This could lead them to consider potentially dangerous drug therapies or medical treatments rather than turn first to non‑invasive, drug‑free chiropractic care."

The issue of risk assessment of pediatric chiropractic care was first addressed over a decade prior to this study in a research report published in the Journal of Vertebral Subluxation Research, titled "Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient."

That article stressed that the benefits of chiropractic care must be weighed against any potential risk. For example, in one study, 73% of the parents of "sick" children reported that chiropractic care had been of benefit to their child. Children under chiropractic care have also been shown to demonstrate measurable improvement in conditions ranging from respiratory dysfunction, enuresis, and other health problems.

Although children account for more than 30 million visits to chiropractors every year, the Pediatrics study managed to find only 9 serious adverse effects. "It is clear that specific chiropractic adjustments to correct vertebral subluxations, performed by trained doctors of chiropractic, are extremely safe, especially when compared to medical treatment involving drugs or surgery," Dr. McCoy pointed out.

To ensure this excellent safety record is maintained, Dr. McCoy recommended all chiropractic educational institutions expand their basic training in pediatric care and all doctors of chiropractic be especially sensitive to signs and symptoms in children of potentially life‑threatening conditions for which a referral for co‑management is indicated.

"Parents who wish to incorporate subluxation correction in their child's health care and wellness program should not hesitate to do so," he added. "If they truly have the welfare of children at heart, the medical and pharmaceutical industries should encourage parents to seek safe, non‑invasive care rather than try to frighten them into turning first to medications and medical treatments."