For Immediate Release: ICPA’s Response to Nightline
Dr. Joel Alcantara, ICPA Research Director
On March 3, 2009, ABC aired a piece on chiropractic care and children, “Crack! Kids Head to the Chiropractor”. Reporter David Wright interviewed an ICPA member, Dr. Beth Forgosh and several parents of her patients. He also interviewed Lonnie Zeltzer, MD for her expert opinion on non-allopathic therapies.
Despite the biased reporting against chiropractic by David White on ABC News entitled, "Crack! Kids Head to the Chiropractor", Dr Beth Forgosh, DC and her patients are to be commended for their honest representation on the benefits and safety of pediatric chiropractic. Despite David White's claim of open mindedness on the part of Dr Lonnie Zeltzer, MD towards non-allopathic therapies, her comments regarding the safety and effectiveness of pediatric chiropractic appeared uninformed demonstrating ignorance on the topic.
Safety and effectiveness of pediatric chiropractic are of utmost importance to the ICPA on behalf its practitioner membership. Towards this end, we have initiated the largest practice-based research network (PBRN) in chiropractic. In the first phase of our PBRN study on the safety and effectiveness of pediatric chiropractic, the prevalence of adverse events in the chiropractic care of children is miniscule. Of 1161 clinical cases where all pediatric patients received chiropractic adjustments at each visit for a total of 10,249 office visits, less than one percent reported minor adverse events while 66% reported improvements in their presenting complaints and another 8% reported improvements unrelated to their presenting complaints (1,2). We encourage the profession to participate in the next phase of our safety study to further examine the incidence and risks associated with pediatric chiropractic (http://www.icpa4kids.com/research/PBRN/PBRN.htm).
The latest National Health Statistics Report on the use of complementary and alternative medicine (CAM) by adults and children indicate that for children, chiropractic is the most commonly used practitioner-based CAM therapy. The American Academy of Pediatrics (AAP) recognizes the continuing popularity of pediatric chiropractic and other forms of non-allopathic care of children and charged the AAP Task Force on Complementary and Alternative Medicine to address issues related to the use of CAM in children and to develop resources to educate physicians, patients, and families. As recently published in their official journal Pediatrics, Kemper and her colleagues (3) commented that, "Although anecdotal data suggest that severe complications are possible with chiropractic treatment of infants and children, such adverse effects seem to be rare." Perhaps there should be more concern about the risks of "off-label" medications for children (4), particularly in the specialty of pain management (5). In a 4-week period at 2 wards in a Childrens' Hospital; of 715 prescriptions for pediatric pain management, 33% were prescribed in an off-label manner.
We do not know the full context of Dr Zeltzer's comment when asked by David White, "What kind of impact did that have on an infant?" and she replied, "Well, it could paralyze the infant." In 1998, Lee and colleagues extrapolated that over 30 million pediatric visits were made to chiropractors (6). The continuing popularity of pediatric chiropractic would support the notion that by 2009, pediatric chiropractic visits are in excess of this 30 million. In over 100 years of pediatric chiropractic and millions of pediatric chiropractic visits, only two articles (7,8) in the scientific literature – a case of paraplegia in an adolescent girl and quadraplegia in an infant – have been associated with chiropractic spinal manipulation. Upon a more thorough reading of the articles, the two children had a pre-existing medical condition or had suffered neurological trauma prior to chiropractic care and questions the placement of fault on the part of the attending chiropractors.
It is unfortunate that Dr Zeltzer appeared to be uninformed about chiropractic care of children. Examining chiropractic care for children reveals that due to the unique biomechanical features of the pediatric spine, the chiropractic care of children has special considerations. In the ABC News featured, Dr Forgosh could be observed using the Activator instrument to deliver a low force adjustment. This is but one of the many techniques chiropractors use to deliver a safe and effective adjustment to children and adults. How could someone conclude that an Activator Instrument could paralyze a child? As for the high-velocity low amplitude thrusts-type adjustments, they are modified so that a gentle force is applied to the pediatric spine. Again, Dr Forgosh demonstrated this in her care of pediatric patients. The bottom line is, Dr Zeltzer appeared to be uninformed about chiropractic and this representation creates the usual diversity we are all so tired of.
- Pediatrics journal website. Accessed Jan 6, 2009. Available at: www.pediatrics.aappublications.org/cgi/eletters/122/6/1374
- Alcantara, J, Ohm, J. The safety and effectiveness of pediatric chiropractic: results from a practice-based research network. European Chiropractic Union Annual Convention May 2008 Brussels Belgium.
- Kemper KJ, Vohra S, Walls R, Task Force on Complementary and Alternative Medicine, Provisional Section on Complementary, Holistic and Integrative Medicine. American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics. Pediatrics 2008;122(6); 1374086.
- Pandolfini C, Bonati M. A literature review on off-label drug use in children. Eur J Pediatr 2005;164(9):552-8.
- Conroy S, Peden V. Unlicensed and off label analgesic use in paediatric pain management. Paediatr Anaesth 2001;11(4):431-436.
- Lee A, Li H, Kemper KJ. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154(4):401–407
- Shafrir Y, Kaufman BA. Quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma. J Pediatr 1992;120(2Pt1):266-269.
- Ziv I, Rang M, Hoffman HJ. Paraplegia in osteogenesis imperfecta. A case report. J Bone Joint Surg Br 1983;65(2):184-5.