NARRATION

Chiropractic therapy is a modern reinvention of the ancient art of spinal manipulation. In recent times, this practice has become steeped in controversy.

Emeritus Professor John Dwyer

Much of modern chiropractic, unfortunately, has descended into the realm of quackery.

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Universities are being accused of teaching pseudoscience.

Dr Michael Vagg

It would be misleading to present that to students.

Dr Aidan McGuigan

The results are really speaking for themselves. It comes down to 'the proof is in the pudding'.

Belinda

We've been coming for asthma.

Kirbie

A little bit of colic and reflux.

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This has the medical fraternity up in arms.

Dr Steve Hambleton

Well, this is a great concern of the medical profession, that there are some individuals taking their infants and young children to chiropractors.

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It's even created factions within the chiropractic industry.

Dr John Reggars

I am angered and I am embarrassed for the profession.

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Will chiropractors become the new family doctor, and are they putting our children at risk?

Dr Maryanne Demasi

Now, most people go to the chiropractor for back pain, and, despite its surging popularity, its proven benefit is fairly limited. A review of spinal manipulation showed that it could alleviate lower back pain, but it was no more effective than heat therapy, or even a good massage.

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Chiropractors have an important role in healthcare when it comes to treating musculoskeletal problems. But a new trend is emerging.

Emeritus Professor John Dwyer

It's the move into paediatrics, and the enormous number of chiropractors who are trying to set up paediatric clinics and claiming that they can cure a range of paediatric conditions, that is really troublesome.

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There have been reports that chiropractors are the new refuge for a range of health problems, like asthma, colic, reflux and autism.

Belinda

Last week, Jade had an asthma attack and I rang quickly, and said, 'Can you fit her in?' And they said yes straightaway. We put her in and it stopped, completely stopped.

Dr Maryanne Demasi

Wow.

Belinda

She was really... (Gasps wheezily) ..you know, the full-on wheezing.

Dr Maryanne Demasi

So, if your girls get sick, do you take them to the GP or the chiropractor first?

Helene

My first point of call is always the chiropractor. I didn't like to put drugs into their body if it wasn't necessary. So, that's what I found with a GP, that they were very quick to just - quick - write a script and off they go. I didn't feel as if there was a lot of caring, or individual care at least, with the children.

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Where babies used to be rare patients, they're now common in a number of clinics. Newborns and toddlers make up over a third of this chiropractor's client base.

Man

..areas of subluxation that I can feel there that are immediately improved after you adjust it like that.

Kirbie

I would definitely send her along to the chiropractor first to see that we couldn't settle her first. I think... her being a newborn, I think a nice way to approach it is to go as natural as possible, and to give them care that's gentle and... you know. I think that's more important than sending them along to a GP.

Dr Maryanne Demasi

Were you surprised that they could treat a whole range of medical conditions?

Belinda

Yeah, I've been very surprised, because I wasn't... I wasn't really expecting the answer to be yes to be able to sort out asthma.

Dr Aidan McGuigan

I've witnessed myself and read reports of improvements in colic, bed wetting, asthma. There's a lot of word-of-mouth information that is going around the public that someone's child has been helped in that way. So they've come to the chiropractor.

Dr Maryanne Demasi

Now, you may be wondering how adjusting the spine could possibly help conditions that have nothing to do with the spine. Well, perhaps a brief history lesson may help explain where this came from.

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Chiropractic therapy was founded in 1895 by an American magnetic healer called 'DD Palmer'. In his building worked a janitor who complained he was hard of hearing. DD Palmer decided to perform an adjustment on the man's spine, and, in a miraculous feat, claimed to have cured him of profound deafness. Palmer hypothesised that aligning the spine unblocked nerve flow through the body and restored the man's hearing. From this, he proposed that a misaligned spine was the cause of virtually all human ailments.

Dr Maryanne Demasi

Fast forward to today, and the Chiropractic Association still believes that curing deafness with spinal manipulation is plausible.

Dr Tony Croke

Well, it makes sense that... that fellow lifted something he held, heard a pop in his back and then he became deaf, and, 17 years later, DD did something and his hearing came back. It would suggest that there was a relationship there.

Dr Maryanne Demasi

Between hearing and the spinal column?

Dr Tony Croke

Yeah. Yeah. And there are neural pathways that run from where he was supposed to have been adjusted, up into the brain stem, that can impact on function.

NARRATION

John Cunningham, a spinal expert, disagrees.

Mr John Cunningham

There's no nerves that control hearing that have anything to do with the neck. They all come from the base of the skull, which simply cannot be influenced by any sort of spinal manipulation. I would have concern over someone's appreciation of anatomy if they were to claim that the middle ear and Eustachian tube is affected in any way by a nerve that comes from the spine.

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Tony Croke explains that even the slightest misalignment in the spine can act like a traffic jam in the central nervous system, and lead to disease. In chiropractic circles, it's called a 'subluxation'.

Dr Tony Croke

And so it's not necessarily that you have to compress the nerve root on the way out, but, in fact, the messages coming back in can be distorted because of that static in the nervous system travelling back upward.

Mr John Cunningham

(Laughs) I'm sorry. It's just senseless rubbish. Um... If there is a static, well, why haven't they shown it? If that is the mechanism, they've had all these years to describe it, to... document it, to study it, to perform experiments on it. Why haven't they?

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Dr Michael Vaggr is a pain specialist, and disagrees with the chiropractic theory about traffic jams in the central nervous system. During surgery, he deliberately scrambles the nerve signals to the spine, so that patients can get pain relief.

Dr Michael Vagg

We use spinal cord neuromodulators to electrically scramble the information that's going up and down the rear part of the spinal cord. And we see no evidence that that produces anything other than pain relief in most of our patients. So, I think, those observations are not consistent with the chiropractic view that optimum health depends on there being absolutely no interference with nerve function at all.

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Paediatrician Michael Fahey says the science doesn't stack up.

Dr Michael Fahey

The idea that there are energy flows up and down the spine that cause disease in organs doesn't fit with our current understanding of science. There's been a number of systematic reviews which examined chiropractic use for things like asthma, colic, bed wetting, ear infections, and don't show that there's any evidence that chiropractic is effective. If we look at the asthma trial, there's only been one done which has been conducted in a rigorous way, and they compared chiropractic therapy to a sham therapy. There was no change when they looked at the outcomes of respiratory function tests, the objective measures.

Man

That's it, let's get to the air flow.

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Experts say quality of research is lacking. Even though patients swear by it, therapies need to be tested in rigorous trials to remove bias and the placebo effect.

Dr Maryanne Demasi

Do you think it could be placebo?

Dr Tony Croke

I bring focus to the fact that I want them to feel... safe, and that one of the knock-on consequences of that, just as a side benefit, is that there may be a better placebo effect - that they might feel more confident and they might have a better outcome just because of that. I'm OK with that.

Dr John Reggars

Chiropractors have relied on anecdotal evidence, and, I think, because of their fervent belief in what they do, that they disregard or put aside the scientific evidence, which shows that it's either ineffective or inconclusive.

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John Reggars, a chiropractor, says he only treats musculoskeletal problems, and that adjusting newborns is ridiculous.

Dr John Reggars

Now you've got an infant. OK. The nervous system is not developed, its bony structure isn't fully developed. So I fail to see how anyone could find a problem with a one-week-old baby by touching their spine, and therefore...

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He says many paediatric conditions resolve spontaneously, like ear infections.

Dr John Reggars

We know, from all the literature, that 80 per cent of those children will be better within five to seven days without any treatment. So, if you take your baby to a chiropractor with a middle ear infection, he treats the baby, the baby gets better. Well, he's taking credit for it, and you also think that he's performed a miracle.

Dr Maryanne Demasi

What concerns you the most about chiropractors treating very young babies?

Dr John Reggars

I don't think the general chiropractor is trained well enough to actually diagnose problems with infants.

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And herein lies the irony. The Chiropractic Association has announced a bold ambition to become the new family doctor.

Dr Maryanne Demasi

So chiropractors really want to be the doctors of first choice?

Dr Tony Croke

It's a great idea.

Dr Maryanne Demasi

Are chiropractors qualified to handle a whole range of medical complaints?

Dr Tony Croke

We're five years university trained, and that gives us the capacity to assess and then redirect. So, of course, if you need your tonsils taken out, I'm not your guy. If you need brain surgery, somebody else needs to help you with that. My job is to find and assess whether you need to be just with me, whether you need to be co-managed, or whether you need to be referred completely.

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Not surprisingly, this aspiration has outraged the Medical Association.

Dr Steve Hambleton

Your first point of care in the Australia health system needs to be your family doctor, a medically-trained person, who's comprehensively trained from cradle to grave to look at you and your family and the environment.

Dr Maryanne Demasi

Is this a bad reflection on medicine that more and more people are turning to alternatives?

Emeritus Professor John Dwyer

I think it is. Dissatisfaction with a quickie turnover turnstile medicine approach is a factor that drives people into the misguided hands of people who are doing the patient no good at all.

Dr Michael Vagg

There is a lot wrong with mainstream medicine, but just because some planes crash doesn't mean we should start using flying carpets. So you have to have a plausible alternative if there is a problem.

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What's most disturbing about chiropractors being the first port of call in the health system is that many don't support vaccination, which is the most basic form of public healthcare. Chiropractors are the largest number of professionals that support one of Australia's most misleading anti-vaccination lobbies, of which Tony was a member.

Dr Tony Croke

I have been in the past, yeah. I'm not now. My reason for being involved was to access the data and have a look.

Dr Maryanne Demasi

So what's your view after you've viewed the data?

Dr Tony Croke

My view is the same as the Chiropractors' Association, that is that it's not what I do. People need to make an informed choice and need to chat to their GP about it.

Dr Maryanne Demasi

Are you personally for or against vaccination?

Dr Aidan McGuigan

I prefer not to. My own research and my own choices have been made, and that's personal to me. The Chiropractic Association does not deal with vaccinations. We're neutral.

Dr Steve Hambleton

Neutral is not good enough. If the Chiropractic Association takes some time, reads the evidence, they should conclude just like everyone else that there's a major benefit.

Emeritus Professor John Dwyer

In this day and age, that is completely reprehensible. Vaccination is probably the most successful intervention is medicine, period, and not to have a position is intolerable.

NARRATION

In 2010, Sydney chiropractor Nimrod Weiner was reported for making false claims, and inciting fear about vaccination. John Cunningham lodged a formal complaint to the Chiropractic Board.

Mr John Cunningham

Nimrod Weiner's website, I was concerned had information on it that didn't represent the best available evidence with regards to immunisation. For example, one of the claims that he made was that vaccination actually causes Sudden Infant Death Syndrome, whereas the larger studies that are being done show that vaccination actually halves your risk of Sudden Infant Death Syndrome. He also claimed that vaccination causes autism, when, in actual fact, a large Danish study of over half a million children has proven, without any shadow of a doubt, that there is absolutely no link between vaccination and autism.

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Nimrod Weiner declined to comment.

The Federal Government appoints a regulatory board to preside over chiropractors. They enforce codes of conduct and ensure public safety. But the integrity of this regulator has been questioned over their failure to encourage that chiropractors support vaccination.

Dr Phillip Donato

We're not here to promote clinical guidelines, all those sort of clinical areas.

Dr Maryanne Demasi

But you're supposed to be protecting the public.

Dr Phillip Donato

We are and where that has come to our attention as a notification, we've dealt with it satisfactorily.

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But it seems in vain. This waiting room is full of misleading information. Here, a booklet by AVN, a widely discredited anti-vaccination group. This book suggests that parents delay their child's vaccination program, and even recommends using scientifically unproven homeopathic vaccines as an alternative. Patients are enticed by celebrity endorsements and unscientific remedies. Websites are riddled with false information that chiropractic can help with conditions like autism, ADHD, even HIV. This from a profession that claims to be science-based, and yet it all appears to slip past the regulator.

Dr Phillip Donato

Well, I don't know. We haven't been made aware that that's still the case. We don't actually go out and look for it. The onus is on the public and members of the community to bring it to our attention.

Dr Maryanne Demasi

How is the public meant to know whether or not the information they're receiving is correct to bring it to the Board in the first place?

Dr Phillip Donato

I don't particularly have the answers for that. We're very conscious of not over-regulating - but, at the same time, not under-regulating. We're trying to always maintain a right touch, or a proportionate... what we call a proportional approach. Um... But it is difficult. That's certainly a challenge, and I take your point.

NARRATION

But when it comes to coughing up money, it's the taxpayer that loses. Last year, the government spent over ten million dollars on Medicare rebates for chiropractic services. A quarter of that was for paediatrics. Professor John Dwyer says it's abusing the public purse.

Emeritus Professor John Dwyer

Yes, absolutely, and that's why we wrote to the Health Minister, asking her to have the chief medical officers review of what practices the government puts money into, and the answer was, 'No, we won't do that for chiropractic, 'cause we've got a national registration board, which is going to protect the consumers.' Palpably, it's not. Look at the chiropractic websites and you'll see just how determined and how penetrative this nonsense is.

NARRATION

This Sydney-based chiropractor claims to correct the length of a child's leg with a clicking device called an activator.

Man

First we adjust this. No complaints there, and you get an instant lengthening. See?

Emeritus Professor John Dwyer

I mean, what can you ask more? Just a few clicks and the child's chronic problem is fixed.

Dr Maryanne Demasi

So, how unscientific is that?

Emeritus Professor John Dwyer

Well, it's totally unscientific. Obviously when you're positioning a child on a bench like that, you could do anything with your legs, and then he moves the legs until they're equal, and the random clicking away, from the buttocks to the upper spine, with the instant results, this is what is so objectionable.

Man

There is a muscle spasm around the vertebra...

Emeritus Professor John Dwyer

It was interesting, that the adjustor is then used on the neck, where there are no anatomical structures that, if you altered them in any way, would fix leg shortening.

Man

Good, she's done. Easy. Here she comes.

Emeritus Professor John Dwyer

If he does really believe that he's just cured a musculoskeletal problem that child had - a shortened leg - then that is really sad. That's really dangerous, because, as Chekhov said, the quacks that the most dangerous are the ones that really believe it.

NARRATION

There was a review of eight trials involving the activator which showed it had benefit. But that paper also concluded that all the studies had poor design, small sample sizes and no control groups.

Dr Maryanne Demasi

Now, you could argue that if parents want to spend their money on therapies that don't work, then that's their choice. But what if that therapy was causing harm?

Dr Tony Croke

There was a study published in 2011 which couldn't find a single significant adverse event in the care of children by chiropractors. Somewhere in the world, in the last 20-plus years, someone would've said something that would've ended up in the medical literature. At least somebody somewhere. But to have a zero result, that's pretty decent.

Dr Michael Vagg

I think Tony could've looked a little harder in the literature - because, without a lot of difficulty, I found a paper from 2007 in a very widely-known journal called Pediatrics, which documented some very serious adverse events, including two fatalities and including 20 delayed diagnoses of serious conditions like cancer and scoliosis, etc, where those people had been managed by chiropractors. So, that's just one study. When one looks through the literature, you do find these things if you look hard enough.

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The problem is, chiropractors don't have a formal system in place for recording adverse events. The regulator can see it's not ideal.

Dr Phillip Donato

What currently exists is really a lack of hardcore data in terms of, you know, is it or isn't it.

Dr Maryanne Demasi

Well, why not establish a register to record adverse events?

Dr Phillip Donato

Look, great idea, and I think that's something that was presented to the profession last year here, and there are certainly moves afoot now to sort of say, 'How do we do this and how do we set it up?' And that's important to know, and it's a responsible thing to do for a profession.

Dr Maryanne Demasi

The safety of manipulating a baby's spine has recently been brought into question. A three-month-old baby was rushed here to Monash Medical Centre after allegedly having its neck broken from chiropractic therapy. Dr Fahey has confirmed this on X-ray, but says further details of the case cannot be disclosed due to ongoing legal action.

NARRATION

And it's not just the risk to babies.

Lucie Snape

When I got there, he sort of said, 'Well, what's wrong with you?' and I said, 'Nothing.' 'I'm just here for a tune-up,' I think, was the words that I used. And, in hindsight, really, he should probably at that point have said, 'Well, if there's nothing wrong with you, there's no reason for you to actually be here.'

Dr Maryanne Demasi

Yet he continued to perform a manipulation on you.

Lucie Snape

Yeah. On my back and my neck, yeah. There was no reason. There was nothing wrong with my neck. There was no pain in my neck. He then held my head with his two hands, and lifted my head... You know, it felt like he was lifting my head up. And tilted my chin and then cracked that way and then cracked that way.

NARRATION

Unfortunately, this was the result. Lucie's vertebral artery, that runs down the side of her neck, has been dissected. These neck manipulations are known to be risky.

Dr Maryanne Demasi

Gee, that's confronting to watch, isn't it?

Dr Michael Vagg

Mm. It's the force of the thrust that is the thing that's believed to cause injuries.

Lucie Snape

I literally couldn't move my neck to the left or the right. It was stuck, yeah, and I was crying, I was incredibly distressed.

NARRATION

Lucie was very fortunate she didn't have a stroke. But there was no way she was prepared for what lay ahead.

Lucie Snape

That sort of was the beginning of what's been now three years of pain management, treatments, diagnosis, testing, a lot of money, a lot of time, a lot of emotional energy. You know, it's been a very difficult journey.

NARRATION

Lucie did sue for damages, but the legal bills became insurmountable, so she withdrew her case.

Professor Dwyer, who co-founded Friends of Science in Medicine, says he wants universities to stop teaching chiropractic therapy.

Emeritus Professor John Dwyer

I don't believe that there is sufficient science to warrant university education. I think they should get out of the chiropractic business. There simply isn't enough fundamental science in chiropractic to warrant a five-year course. And, I think, the universities, by supplying these courses, give credibility. Those people would be much better off spending their time enrolling in a physiotherapy course and learning a whole lot of practical evidence-based skills. There's no place for chiropractic in a really strong, academically-based university.

NARRATION

Professor Peter Coloe is the Pro Vice-Chancellor at RMIT, where they teach chiropractic. He rejects the criticism.

Professor Peter Coloe

We have a focus on strong evidence-based criteria, basic sciences, and we don't teach pseudoscience.

NARRATION

RMIT supplied me with lecture notes from the course, and I had Dr Vagg look over them.

Dr Michael Vagg

There is inaccurate material that's been presented alongside material that's completely wrong, alongside material that's completely speculative, alongside some very sound anatomy. So, if you're a student, and you don't have the training, or the background or the experience to tell what's what, then that, I think, is gravely concerning. Part of the responsibility of the university is to be a custodian of knowledge, and a dispenser and a trainer of that knowledge. It's not to try and put things over the students in a way that leads them to come out of uni and then find out that they've been misled, or that things have been misrepresented to them.

Professor Peter Coloe

If that information can be documented, I'll take it back to the school and get them to look at it.

NARRATION

But what hope is there when a staff member actually believes the pseudoscience? We found a casual employee of RMIT making unsubstantiated claims on her website about autism.

Dr Maryanne Demasi

Now, there's no evidence in the literature that chiropractic therapy can help with autism.

Professor Peter Coloe

Agreed.

Dr Maryanne Demasi

Are you not concerned that she may impart this pseudoscientific knowledge onto the students? They're very impressionable.

Professor Peter Coloe

Students are impressionable, yes. If we bring external experts in, that they would come in to teach a particular area, we're not bringing someone in to teach things like the effect of chiropractic on autism.

Dr Maryanne Demasi

It's a bad reflection on the university that RMIT graduates are going out there and practising non-evidence-based techniques.

Professor Peter Coloe

Well, our graduates, we don't control them once they go out.

NARRATION

When we approached Dr Willis for comment, she deferred us to RMIT. The university did approach her, and she has since removed the claim from her website. In a surprise move, but one that is applauded by the medical profession, Sydney's Macquarie University has recently announced their plans to scrap its chiropractic course in a bid to remain focused on science.

Dr Maryanne Demasi

Meanwhile, the conflict within the chiropractic union is palpable. But John Reggars still believes he can champion change so that opposing sides of the profession can move into alignment.

Dr John Reggars

We still have an opportunity to become spine specialists, non-surgical spine specialists. We have the skills and we have the training, and if we funnel our energies in towards that aim and that goal, and disregard the extraneous things that are going on within the profession, then we will prosper.