AMA concerns with chiropractors treating children

Subjects:         Chiropractors treating children

STEVE AUSTIN:    Should you send your child to a chiropractor? This is a story with many sides, and I wanted to get to the bottom of it this morning. It's been alleged that a Melbourne chiropractor manipulated an infant's neck and broke it. It comes from a case that was reported on in the Medical Observer of this month, it's been reported quite widely in the media. The Chiropractors' Association of Australia says it's an erroneous claim, they say no finding was made that any treatment performed by the chiropractor caused a fracture. 

Dr Alex Douglas, the United Australia Party state member for Gaven, put out a statement saying the Australian Health Practitioners Regulation Authority, which is a national registration body, was negligent in its behaviour regarding chiropractors. Dr Douglas reiterated what was in this Medical Observer magazine that a four month old baby, with a proven second vertebrae fracture was as a result of manipulation. 

And it's a question that often comes up, the Australian Medical Association president Dr Stephen Hambleton is with me in the studio, Stephen Hambleton, thanks for coming in.

STEVE HAMBLETON:    Good morning.

STEVE AUSTIN:    Should a parent get their infant manipulated, or their bones manipulated, by a chiropractor? What's the AMA's position?

STEVE HAMBLETON:    In the view of the AMA you shouldn't be doing anything with a young person that young without significant levels of quality evidence, and that's what we don't see here. So, our advice would be, unless there's sufficient evidence, the answer's no, you shouldn't do that.

STEVE AUSTIN:    Now there's some controversy, the Medical Observer, which is a medical publication that goes out to health professionals, doctors and more, and Dr Douglas, who's a politician, but is also a medical practitioner, has said this child's, you know, vertebrae was broken. The Chiropractors' Association of Australia put out a statement saying that's absolutely false, it's wrong. Can you help us clear the air on this, what's the actual circumstances of the matter?

STEVE HAMBLETON:    Well this is a very concerning matter that we're all seeking information on, and we've got a medical doctor saying that he had a patient with a fractured vertebrae, it's very, very serious. Now, thankfully the spinal cord wasn't damaged, but if you're fracturing a vertebrae, a few more millimetres might mean paraplegia. And we've got a Chiropractors' Association say the matter was investigated, there was no case to answer. 

Now, there's a problem in between. In the last few days we've been calling on the Chiropractors' Board, which after all is the body that's meant to be protecting the public, to clear up this mess. Now, we've been saying for a long time, where is the evidence that chiropractors should be treating children? And we know there's more and more chiropractors treating children, for all sorts of things, like infantile colic, like bed-wetting, like middle ear infections, all sorts of things for which it's simply biologically implausible that manipulation, or mobilisation, or doing anything with the spine, is going to make any difference. You do see videos of what happens when a child sees a chiropractor, and jiggling a baby, or making clicky noises behind their necks, simply - there - is biologically implausible that's doing anything at all.

STEVE AUSTIN:    So you think this is a pseudo-science in that regard?

STEVE HAMBLETON:    Well that's the controversy, and we've got two sets of chiropractors, one that's saying well look there is some evidence, and we would agree, that there is some evidence for musculoskeletal treatments in adults. Now, that doesn't apply to children necessarily. And these chiropractors are saying well let's stick to where the evidence is.

And then there's another group that talk about this subluxation theory, this innate intelligence theory that says that if your spine is not set up properly, it will affect all sorts of things. Well, simply biologically implausible, there's not a shred of credible scientific evidence that backs up that theory.

STEVE AUSTIN:    What is happening to a - in this case an infant, which is one matter, but the growing body? When do the bones start to solidify and lock into place? I assume it's sometime in adolescence due to hormones, but when is it?

STEVE HAMBLETON:    Well if you've ever had to take your child to a medical practitioner after a fall, and they've x-rayed the child, the doctors often said, look, a lot of the bones are cartilage at this age, and they do solidify over the age of the young person. But it's not until they're skeletally mature, so a bit younger in girls, 12, 13, 14, a bit older in boys, they're plastic and they can bend. We call that a greenstick fracture. So, it's really not safe to be doing short sharp thrusts or movements on these infants, or children. 
And they tell us they're not doing that, well if they're gentle treatment is so gentle that it's not affecting anything, it's not actually doing anything either.

STEVE AUSTIN:    My guest is the head of the Australian Medical Association, Dr Stephen Hambleton.      Today there are a number of parents sending their children to chiropractors. Is it the AMA's official position that they should not do it, wait until they're adults?

STEVE HAMBLETON:    We'd make it broader, we'd say that unless there's scientific evidence for any complementary therapies - we can't recommend that they go there, and that includes chiropractory.

STEVE AUSTIN:    But parents don't necessarily - you know, you can't get the right scientific evidence from the internet, it's very misleading. You know, we rely on professional bodies like yours to give clear guidelines to parents. What's your clear guideline in this case?

STEVE HAMBLETON:    Well we'd certainly say that we wouldn't be - and none of our members or practitioners would be sending any parents to chiropractors for children.

STEVE AUSTIN:    Are chiropractors part of the medical fraternity?

STEVE HAMBLETON:    Well, they're health practitioners, they're not part of the medical fraternity, no. They're actually grouped under AHPRA, which is the Australian Health Practitioners Regulation Authority, and they have a board. And that board, like the medical board, which has been in existence for a long time, and we've had some controversy right here in Queensland, is there to protect the public, and so is the Chiropractic Board. This is a national board whose role it is to actually look at treatments that are dangerous, and not safe, or not doing anything, and inform the public and say we'll withdraw.
    
Now, we actually had a victory with the Chiropractic Board recently when we were talking about vaccination. We said if they - if the chiropractors - if it's not scope of practice, if it's outside their area of expertise, they should get out of the pool. And the Chiropractic Board actually said that the chiropractors should not get involved in those discussions because they're simply not trained in that area. So, they do step up when we challenge them, we're asking them to step up again. Where is the evidence? If there's no evidence, they should stop chiropractors from acting in this area.

STEVE AUSTIN:    The Australian Health Practitioners Regulation Authority, do you want them to do anything more, particularly about this case where the infants - I think a Melbourne paediatrician reported this four month old baby's vertebrae was fractured, do you want them to do anything about this, anything more?

STEVE HAMBLETON:    Well we've got two stories here, we've got to clear up the mess. We've got a very, very worrying story about a child with a fractured neck, we just need to know, did this happen, or did it not happen? If it was a medical practitioner involved in this, it would be a public discussion about what happened, and what happened to the person who did it. And we don't have that information. We've got two stories coming out, we've got to clear it up.

STEVE AUSTIN:    Universities are offering courses in this, Central Queensland University here is offering a course, do you think it should be a university level course?

STEVE HAMBLETON: Look, there's a number of conversation about what should be taught at universities. Now, universities are places of science, places of evidence, where people investigate things. And, you know, that's what they should be teaching. So, again, there's some credible evidence that musculoskeletal treatments in adults is effective, and that from physical therapies. But it doesn't extend past that. So, the bit that should be taught is the bit where there is evidence. We don't want to constrain innovation, but it's got to be biologically plausible.

3 October 2013

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