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Baby spinal manipulation sees Minister request ‘urgent explanation’


Chelsea Heaney


13/06/2024 4:52:17 PM

Mark Butler will write to the Chiropractic Board after it quietly re-introduced the practice last November following a four-year ban.

Chiropractor manipulating baby's spine
Chiropractic manipulation of infants’ spines was banned for four years but returned via a members’ only update.

Federal Health and Aged Care Minister Mark Butler is seeking clarification in the wake of revelations that recently released Chiropractic Board of Australia (CBA) guidelines permit spinal manipulation  for babies under two years of age.
 
A spokesperson for the Minister told Nine Newspapers he is also set to raise the issue with state and territory counterparts at a meeting on Friday.
 
‘The Health Minister is writing to the Chiropractic Board seeking an urgent explanation on its decision to allow a resumption of spinal manipulation of infants under two, in spite of two reviews concluding there was no evidence to support that practice,’ the spokesperson said.
 
The practice was shut down by an interim CBA ban in 2019 after the Council of Australian Governments (COAG) Health Council responded to community concerns about spinal manipulation on children and agreed to investigate the practice to see if there was a public safety risk.
 
The outrage came in response to a video of a two-week-old infant being held upside down by a Melbourne-based chiropractor, who then used a spring-loaded device on the child’s spine.
 
The CBA put out a statement in November last year to its members to clarify the ‘range of treatment modalities’ in caring for children and included mobilisation, soft tissue therapy and manipulation.
 
Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, told newsGP CBA’s decision to add manipulation back into its guidelines is ‘very concerning’.
 
‘There is no safety data on spinal manipulation and children,’ he said.
 
‘There is good reason to be concerned that there may be safety issues given the anatomy and softness of children’s spines, them being more flexible and particularly more prone to damage by manipulation.’
 
Safer Care Victoria and Cochrane Australia released a report and a review, respectively, that found a lack of evidence on the efficacy and safety of the practice.
 
The major finding in the Safer Care Victoria report was that ‘the evidence base for spinal manipulation in children is very poor’.
 
The treatment has often been touted as a solution to childhood conditions such as colic, back/neck pain, headache, asthma, ear infections or torticollis, but Dr Best says ‘there is no evidence at all’ that it helps.
 
‘Why would you be doing something that is potentially dangerous when there are current indications there is no evidence of benefit?’ he asked.
 
The treatment often involves moving spinal joints outside the normal range of motion using high-velocity thrusts.
 
Dr Best said the risks in treatment could include damage to ‘the tissues or the spinal column’ as well as damage to ‘soft tissues, blood vessels and muscles’.
 
In response to questions from newsGP, an AHPRA spokesperson said the CBA is a ‘risk-based regulator’ committed to ensuring patient safety ‘while recognising the rights of parents to make choices about the healthcare their children receive’.
 
‘The Board has carefully looked at the evidence and yes, there isn’t currently sufficient evidence of effective care but also there isn’t evidence of harm,’ they said.
 
‘The updated guidance includes increased focus on informed consent, where parents are empowered to make a decision about their children’s healthcare with the knowledge and understanding of known risks and benefits involved.
 
‘The updated guidance also clearly states that practitioners must practice within the scope of their education and training.’
 
In 2016 the RACGP told members not to refer patients to chiropractors following the release of a similar video showing another Melbourne chiropractor cracking the back of a four-day-old baby.

Then-president Dr Frank Jones called on the Federal Government and private health insurers to stop compensating policy holders for the questionable treatments, which he described as ‘cruel’.

A baby’s neck was also broken by a chiropractor in 2013, which again led to calls from doctors to ban the treatment.
 
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A.Prof Christopher David Hogan   14/06/2024 8:50:19 AM

When one group has its clinical performance challenged this usually leads to blow back against General Practice with the "Just a GP' rant.
We must be ready to rigorously defend our discipline.
1) The title of Specialist GP is a protected title & available only to Fellowed GPs.
2) Very few know what GPs do. We provide life long holistic health care for patients individuals & families
3) Our superpower is Continuity of Care
People who see the one GP or the one small group of GPs regularly have up to a 30% life long better outcome than people who see fragmented multiple primary care providers
4) GPs don't follow Guidelines. or "GPs should"
They are Guidelines not tramlines & often do not apply to the GP setting
For a patient with a single morbidity there are over 400 guidelines, for people with 2 comorbidities there are less than 10 Guidelines & for people with more than three comorbidities ( which is not at all rare in GP land) there are only deprescribing guidelines.


A.Prof Christopher David Hogan   14/06/2024 10:08:09 AM

Another issue is " ED is full of GP's mistakes"
Well first are they specialist GPs & what type of mistakes are they?
Second Specialist GPs make no more mistakes that other specialists in other disciplines but are much more visible.
The main effect is selection bias- of course non successful care ends up in ED- one o f t he reasons for the existence of EDs is when a patient experiences a significant & unexpected event ! Also when expecting GP failure only adverse events are remembered & not the successes- confirmation bias


Dr Paul   14/06/2024 1:43:46 PM

Vertebral artery dissection in a 9 month infant post chiropractor manipulation (see link below). What more is there to say? Also why doesn't APHRA consider the financial costs of these purported treatments as harm? These services are also payable via private health funds affecting everyone’s premiums (collective harm). By saying there is no current evidence of efficacy but there is also no evidence of harm is incorrect logic. There are cases of serious and significant harm (spinal injury, vertebral artery dissection) but there is economic harm every time that ‘treatment’ without evidence is paid for (patient and/or health fund members). The response from APHRA is telling - it would appear they are simply an establishment of bureaucrats who aim appease the wills and wants of any and all except doctors (whom they target).

https://www.researchgate.net/publication/347693589_736_Chiropractic_Treatments_and_Stroke_With_Arterial_Dissection_in_an_Inf


Dr Paul   14/06/2024 2:35:43 PM

Ill add to the comment on “ED is full of GPs mistakes”
Majority of the time GPs refer patients to ED whom there is a concerning undifferentiated presentation where there is neither the funding/time/space/nursing, timely diagnostic services or sub-specialist support to safely manage in a community setting and whom need timely exclusion of serious underlying disease. ED has a NEAT target of 4 hours to work-up patients (with allocated 1:4 nursing support), in addition to onsite 24/7 pathology (with 1-2 hour blood result turn around), 24/7 radiology and access to 24/7 internal subspecialty consults with onsite review (via the on-call registrars). I wonder how ED would fare without all those ancillary services before feeling safe to discharge that patient home?…. Welcome to GP. Hospitals (including ED) have their own equivalent metric called “failed discharges” or “avoidable hospital readmissions” - 7.4-10.9% of all discharges were readmitted in Australia 2022.


Dr Peter James Strickland   15/06/2024 4:01:51 PM

Manipulation of young children and especially normal happy babies has NO place in assisting anything of significance as stated by chiropractors --it is all "snake-oil" country! The amount of damage to cartilage, bone, blood vessels and the spinal cord and all the nerves into the limbs could carry permanent disabilities for life. If you know a child has been manipulated, record it well in your medical notes as to whom did the manipulation, why the manipulation occurred, and any problems get a neurology and orthopaedic opinion, and especially in late childhood/early adolescence.


Dr Vuchuru Anila Prem Reddy   22/06/2024 4:37:28 PM

Unscientific garbage and it’s a disgrace that it is considered a science by the Australian medical system