Response of the Canadian Memorial Chiropractic College to the statements by the pediatricians and resultant media article of August 30, 1994 [as communicated to the Faculty of Pure and Applied Science ad hoc committee on chiropractic, May 1998].

1. Statement One: Chiropractic spinal manipulation is NOT required as a preventive therapy to maintain a child's health.

Response: The chiropractic profession recommends that children should have a periodic neuromusculoskeletal examination, especially after significant falls or other trauma. This is to asses joint integrity and range of motion. Where a manipulable lesion is found, manual treatment including spinal manipulation, may be deemed appropriate. Chiropractors are qualified by their training and education to provide such examination and treatment.

2. Statement Two: Chiropractic spinal manipulation is NOT an alternative for pediatric immunization. Books sold at the Canadian Memorial Chiropractic College in Toronto are anti-immunization in nature.

Response: To state that this is the chiropractic position is incorrect. The Canadian Chiropractic Association (CCA) has the following policy on immunization:

"The chiropractic profession accepts vaccination as a cost-effective and clinically efficient public health preventive procedure for certain viral and microbial diseases, as demonstrated by the scientific community.

The scientific community and the CCA recognize that the use of vaccines is not without risk. The Association supports each individual's right to freedom of choice in his/her own health care, based on an informed awareness of the possible adverse effects of vaccination. In accordance with same, the Association is opposed to any compulsory programs which infringe upon the said right."

The Canadian Memorial Chiropractic College operates a bookstore which contains required textbooks and general interest books. The books referred to are of general interest and authored by medical practitioners.

3. Statement Three: Chiropractic does NOT alter the course of nor does it prevent in any way childhood illness such as ear infections, asthma attacks, bed-wetting or infantile colic.

Response: This is a interesting statement from academic leaders in medicine because it is dogmatic, and not based on fact. There is insufficient scientific evidence to justify an absolute statement either way -- that chiropractic management does or does not have benefit for children with these conditions. It is noted:

a) This statement refers to both infectious diseases and functional disorders. Chiropractors do not treat infectious disease. Children with such conditions are referred for medical care.

b) There is substantial empirical evidence in the chiropractic, medical and osteopathic literature that some childhood functional disorders respond to manual therapy. Chiropractors are actively researching this area. With infantile colic, for example, a multicentre prospective study in Europe has confirmed clinical experience that there are excellent results with appropriate patients. This study called for a controlled trial, which is now being conducted in the United States.

c) Medical and osteopathic practitioners prominent in the field of manual therapy agree that spinal movement restrictions may influence these and other disorders in children. The indication for treatment is the presence of neuromusculoskeletal disorders.

d) Chiropractors welcome a cooperative approach from medical practitioners. It will often be in the child's best interests to have both chiropractic and medical care.

4. Statement Four: Chiropractic use of x-rays of infants and children to diagnose so-called vertebral subluxations is unscientific and of no value whatsoever. These xrays can contribute without any benefit for the child, to the future risk in the child of cancers and genetic damage. Parents should never allow their children's spines to be x-rayed by a chiropractor.

Response: These comments are extreme and misrepresent chiropractic use of x-rays.

There are various circumstances where x-rays of children are essential -- for example, following significant trauma or when a fracture is suspected.

Chiropractors, by virtue of their education, government licensure, regulation and nationally established clinical practice guidelines, are competent in the use of diagnostic x-ray examinations for children when clinically necessary. With respect to practice guidelines we refer you to the guidelines for Diagnostic Imaging from the CCA's Clinical Guidelines for Chiropractic Practice in Canada. (For specific reference to infants and children, see para E, P.29.)

5. Statement Five: There is no scientific evidence whatsoever that the so-called chiropractic spinal adjustment results in any correction to a child's spine. These adjustments are ineffective and useless.

Response: The statement that chiropractic spinal manipulation (adjustment) is ineffective and useless as a treatment to correct a joint dysfunction in a child's spine is unfounded. Literature supports that manipulation for neuromusculoskeletal dysfunctions is effective.

6. Statement Six: School boards should not authorize and parents should not allow their children to attend elementary school screening programs organized by chiropractors to detect scoliosis or any other posture deformities in children. Posture deformities of children such as scoliosis, kyphosis or unequal leg lengths are not effectively treated by manipulation. In the great majority of instances, what a chiropractor may diagnose as scoliosis in a child is in fact a minor variation of a perfectly normal spine.

Response: Elementary school screening programs in Canada for scoliosis and other postural abnormalities have been conducted by different groups of health professionals, including chiropractors and nurses. These programs are all conducted in a similar manner regardless of the health professional involved. Having regard to their education and scope of practice it is appropriate that chiropractors should participate in any such programs.

Chiropractors appreciate the difference between significant abnormalities, minor scoliosis and other spinal variations. The claim that "posture deformities of children such as scoliosis, kyphosis and unequal leg lengths are not effectively treated by manipulation" is broad and unclear. Chiropractors are qualified to know which abnormalities may respond to chiropractic management, and which should be referred for other care.

With respect to the criticism in the final sentence of the above statment, the authors have been challenged to produce any scientific evidence in support of their claim.

7. Statement Seven: Parents should regard with extreme scepticism claims made by some other parents that their infants or children have been cured by chiropractic adjustments for such conditions as: infantile colic, recurrent ear infections, learning disorders, asthma, chronic abdominal cramps or bed-wetting. However well-meaning, such personal testimony is unreliable and is not a substitute for scientific fact. Parents should read the June 1994 issue of Consumer Reports magazine in which the clear recommendation is made not to allow any chiropractor to solicit children for chiropractic treatment.

Response: Personal testimony is relatively unreliable and is no substitute for scientific fact. Parents know better than anyone how well their children have responded to any treatment or therapy -- chiropractic, medical, or other. To dismiss their observations as only worthy of "extreme scepticism" is insulting.

The U.S. Consumer Reports article was general journalism rather than a scientific report, based upon biased medical sources.

8. Statement Eight: We understand the concern of parents, in regard to ear infections that they may feel their child has taken many antibiotics or may require a surgical procedure. These concerns should not lead the parents to believe that chiropractic adjustments, which have the emotional appeal of being medication free or "natural, " are an alternative to what may very well be in the best overall interests of the child.

Response: It is presumptive on the part of the authors to assume that the legitimate concerns of parents regarding their children's welfare and efficacy of any intervention is irrational and proceeds to unfounded beliefs.

9. Statement Nine: We welcome the scientific guidelines of the Orthopractic Manipulation Society International, under which manual therapy can be given in a responsible manner to adults who may require such care. We welcome warnings made in these guidelines about the unscientific use of x-rays and unscientific claims about treating pediatric conditions. We would encourage parents to seek their own personal care from those physical therapists, physicians and chiropractors who adhere to the scientific guidelines of the Orthopractic Manipulation Society International.

Response: The guidelines of the OMSI for manual therapy (attached as Appendix A) are presented under a scientific rubric. It is ridiculous to assume that belonging to a society which has no qualifications, save for title and a registration fee, ensures adherence to scientific practice. The emphasis on science in this statement is designed to obscure the political nature of OMSI. It is for this reason that questions are raised regarding the true intent of this statement. For example:

a) The OMSI was established this year by a long-term antagonist of chiropractic who practises pediatrics, Dr. Murray Katz of Montreal. In a recent address to the Ontario Medical Association, Dr. Katz repeatedly emphasized that the OMSI is a political movement -- "I am going to be talking about politics ... we are not talking about clinical competence, not talking about science. We are asking governments to fund orthopractic only."

b) Orthopractic is a name coined by Dr. Katz "to mimic chiropractic." It has no background in medicine - there is no specialty with this name, no supporting educational program, or standards of practice.

The OMSI, and now the signatories of this media statement are encouraging parents and the public at large to seek care from members of this new society, notwithstanding that Dr. Katz and others involved in the formation of it "have no idea whether the people joining are good or bad (at manual therapy) and quite frankly we don't care."

c) Dr. Katz has been a bitter critic of chiropractic for decades. Earlier this year in an article in The Medical Post Dr. Katz made libelous comments about chiropractic education and practice. Confronted with the threat of legal proceedings, there was a full retraction and apology from Maclean Hunter, publishers of The Medical Post, endorsed by Dr. Katz.

10. Statement Ten: The musculoskeletal problems of infants and children can be managed in a safe, scientific and responsible manner by the family physician, the pediatrician, the orthopedic specialists, the physical therapist and with medical consultation, those chiropractors who adhere to the orthopractic guidelines.

Response: The dogmatic nature of the guidelines of the OMSI, as appears in their pamphlets, is not based upon scientific facts. To adhere to the orthopractic guidelines would, firstly, exclude chiropractors from managing pediatric musculoskeletal problems. Secondly, the insinuation that chiropractic care of such problems is unsafe, unscientific and irresponsible is unfounded.

Chiropractors are primary contact practitioners, licensed in the Province of Ontario to provide a neuromusculoskeletal diagnosis without the need for medical referral. Chiropractic has been, and continues to be, a safe, scientific and efficacious form of therapy. To suggest that this approach to health care be restricted to a certain segment of the population reflects a fallacious misunderstanding of a distinct profession's scope of practice.

11. Statement Eleven: We believe it to be irresponsible and a total waste of our limited financial resources for the governments of Ontario, Manitoba, Saskatchewan, Alberta and to be providing millions of dollars of public funds for chiropractors to treat infants and children. This public fiscal support gives parents the false impression that society endorses such treatments. We call upon these governments to immediately suspend all chiropractic payments in the pediatric age group, ie. up to age 18 years.

Response: The signatories could have approached the appropriate chiropractic associations with their concerns, instead of asking for an immediate suspension of funding for chiropractic management of infants and children to age 18 years. There is no evidence that public funds are being wasted in the chiropractic treatment of infants and children, which is both safe and effective. In Ontario the total amount for all chiropractic services for children to age 10 in the last fiscal year was approximately $4.3 million, or 0.03% of the province's total health care budget of $17.5 billion.

This statement further implies that all medical treatment is inherently scientific and therefore entitled to full public funding and endorsement. In fact, independent research reveals that approximately 85% of all medical treatments and technologies have no scientific evidence of effectiveness (Rachlis, M., Kushner, C. (1989) Second Opinion: What's Wrong With Canada's Health Care System and How to Fix It, Collins, Toronto).