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April 19, 2000 -- Children make up a growing percentage of visits to chiropractors, according to a new study out of Harvard Medical School, but the care they receive may be inconsistent with traditional medical guidelines.
One main area of concern is what a chiropractor should and should not treat. "I don't feel that a chiropractor replaces a pediatrician at all; we have completely different scopes of practice and care for different conditions," says chiropractor Rich Pistolese. "Chiropractors have a limited scope of practice, which is the care of the spine. The [traditional medical] community has a much wider spectrum of care, and we don't presume to overstep our bound and treat infirmity or disease." Pistolese, DC, is research director at the International Chiropractic Pediatric Association (ICPA), one of two organizations that specialize in chiropractic care for children.
The Harvard study, published in the journal Archives of Pediatric and Adolescent Medicine, found that some chiropractors do, on occasion, treat patients who should have been referred to a traditional doctor -- for example, a two-week-old baby with a fever.
"Whenever the parent feels that there is a need to see an MD, I would say certainly take them," says Pistolese. "We don't advocate delaying or preventing proper prudent medical care for any condition that requires it."
Pistolese says parents who are considering sending their child to a chiropractor should find a well-qualified and well-respected chiropractor who takes "a responsible approach" to the care of children.
"Chiropractors who are members of a chiropractic pediatric organization -- I think that is a very good place to start," says Pistolese. "Also, look for somebody who has had postgraduate training in chiropractic pediatric care." Pistolese says the ICPA has a web site and a referral database to help parents find qualified pediatric chiropractors.
Chiropractors' positions on childhood vaccinations are another bone of contention in the medical community -- and within the chiropractic community itself.
"The vaccine issue is not a chiropractic issue, it is an issue of freedom of health care and informed consent," says Pistolese. He says the ICPA's official position on vaccinations is not to advise against vaccination, but to educate parents about its possible risks and benefits.
Referring to the ICPA's vaccination policy statement, Pistolese says that the loss or damage of some children's lives from vaccinations is not an acceptable risk to the ICPA. "We therefore do not support the concept of mandatory vaccination, regardless of risk. The ICPA fully supports the right to informed consent and the right of each parent to choose the type of health care that is best for their child," says Pistolese.
In contrast, various government and medical associations -- such as the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians -- recommend most, if not all, children be vaccinated.
James Campbell, PhD, of the University of Toronto, tells WebMD there are risks with vaccinations, but argues, "These are risks that as a population we have to take, basically for the good of the whole rather than the good of the individual."
Campbell is concerned about the small number of chiropractors who are against vaccinations, called anti-vaccinationists. "There is a among anti-vaccinationists to focus on the negative side [of vaccination] and forget all the positive sides," says Campbell. He also questions the sources some chiropractors use: "There are a number of publications that a lot of chiropractors have adopted to support their anti-vaccination attitudes that are full of erroneous information."
The history of why some chiropractors don't believe in vaccinations is a complicated one, filled with in-fighting that has left the profession divided to this day, according to Campbell, who wrote about the history in an article published in the journal Pediatrics.
Daniel D. Palmer, the original founder of chiropractic care in the late 1800s, believed that 95% of disease was the result of pinched nerves due to the spine being out of alignment. Properly aligning the backbone would result in a healthy body and a "cure" of disease, he believed.
Years later, around the same time the germ theory of disease was gaining acceptance, Palmer's son, BJ, was fostering the growth of the chiropractic profession. Like his father, BJ thought pinched spinal nerves, and not germs, caused infectious disease. Drugs and vaccines were viewed as poisons that interfered with the body's natural healing process. These beliefs earned chiropractors the hostility of the mainstream medical community.
The father and son's original theories would eventually divide the profession. Today -- despite medical progress and what some would say is plenty of evidence to the contrary -- there are still some adherents to Palmer's original theories; they are called the "straights." The more progressive "mixers" have attempted to integrate traditional medical and chiropractic approaches to health care.
Campbell says there is room for both traditional doctors and chiropractors. "Many physicians are taking a more holistic approach to medicine in general, and this is one of the benefits of the chiropractic approach," says Campbell. "If sharing information and approaches to health care can be encouraged, this can be beneficial for both."
"I think all physicians and chiropractors alike should work to educate and inform parents so that they are able to make the best health care choices for their children," says Pistolese. "I think that when health care professionals come together to work in the best interest of the child, to me that is what is of paramount importance."