VOLUME 34, NO. 41, December 1, 1998
TORONTO - The widespread practise among chiropractors of "readjusting subluxations" in children is "quackery," a physician said here.
Readjustment of childhood subluxations by chiropractors is covered by provincial health plans in Alberta, British Columbia, Manitoba, Ontario and Saskatchewan. The governments of Nova Scotia, Newfoundland, Prince Edward Island and Quebec do not pay for pediatric chiropractic services. Chiropractors define a subluxation as partially dislocated or misaligned vertebra. This condition, they say, can be corrected with manual manipulations or "readjustments."
Speaking at the Hospital for Sick Children, Dr. Murray Katz, a staff member at the Montreal Children's Hospital, said the subluxations some chiropractors say they commonly see in the X-rays of minors simply don't exist.
"This is all a sham. There are no bones out of place. Readjustment is a treatment in search of a disease," said Dr. Katz during his lecture.
His statements contradict a textbook used by the Canadian Memorial Chiropractic College in Toronto where many of Ontario's 2,300 chiropractors trained. This book, titled Pediatric Chiropractic and edited by Claudia Anrig and Gregory Plaugher, instructs chiropractic students how to treat children with subluxations. The authors say a variety of conditions including learning disabilities, allergies, ear infections, colic and bed-wetting, can be treated by readjusting spinal subluxations.
Dr. Katz said X-rays provide no evidence that readjustments change the position of misaligned vertebra. "I invite chiropractors to show the difference between X-rays of the same patient before and after treatment of a subluxation," he said.
Dr. Katz, who has a private practice in Montreal, said there are some good chiropractors treating lower-back pain in adults, but he said there is no reason for chiropractors to be treating children in general and, more specifically, no reason for chiropractors to be treating children for "subluxations."
Dr. Marcel Reux (DC) , a Toronto-area chiropractor who attended Dr. Katz's lecture, agreed some chiropractors are providing bad care. "I'm the first to fight against these lunatics that you are talking about," he said.
But Dr. Reux, a physiotherapist and chiropractor, argued that the few chiropractors who treat childhood subluxations will eventually be pressured to stop practising.
"Good chiropractors don't treat children and we don't use X-rays. From within the chiropractic profession we will get rid of the bad practitioners," he said.
Dr. Katz disagreed that only a minority of chiropractors are treating pediatric subluxations. In fact, he argued treating children is standard procedure for chiropractors.
"It is not true that I am telling you only about the bad apples," he said. "We are talking about millions of visits each year."
In Ontario alone, chiropractors bill the provincial government more than $11 million annually for treatment of children. Canada-wide, chiropractors bill provincial public health systems almost $25 million annually for treatment of minors.
Dr. Katz is calling on radiologists in every province to follow the lead of their Alberta colleagues who have stopped providing X-rays for chiropractors who treat children, despite the fact that the cost of X-rays requested by chiropractors are covered by many provincial health plans, including Alberta's.
"A radiologist has the right to refuse a service that in their judgment is not appropriate. By providing chiropractors with X-rays of children, radiologists are contributing to the misconception that these are trustworthy people," he said.
On Sept. 20, at this year's annual meeting of the Alberta Society of Radiologists, the following resolution was passed unanimously: "Diagnostic radiologists in Alberta should not accept requests for consultation from chiropractors for diagnostic imaging of any type, on children 18 years and younger."
Dr. Katz was recently a witness at a coroner's inquiry into the death of a Saskatchewan woman, Laurie Jean Mathiason, who died after receiving treatment from a chiropractor. He warned radiologists that they might be liable if they provide X-rays to a chiropractor.
In an interview, Dr. Ray Foley, president of the Ontario Association of Radiologists (OAR), seemed wary that Dr. Katz is on a "crusade." However, the association is taking Dr. Katz's claims seriously. Dr. Foley said the OAR is forming a committee that will review "what happened in Alberta and consider the increasing concern among radiologists that they might be liable if they provide services for chiropractors."
Dr. Foley, who said radiologists are always concerned about exposing a patient to radiation, particularly a child, said OAR members are concerned that some X-rays might be performed for chiropractors unnecessarily.
"There are an astonishing number of pediatric X-rays being done for chiropractors and billed to the Ontario Health Insurance Plan." He agreed that some Ontario radiologists have already decided not to perform X-rays of children for chiropractors.
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