From its inception in the late 19th century, the chiropractic profession has seen itself as offering distinct services from allopathic medicine.
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Chiropractic's unique approach necessitated justification, which was provided by the formulation by the founder, DD Palmer, of a novel theory of disease (or “dis-ease”) that centered on lesions of the nervous system (subluxations). The central tenet of early chiropractic theory was that most, if not all, disease was the result of such lesions.3
As a result, immunization, which is based on the concept that infectious disease processes arise from external challenge, was seen as unnecessary and any associated risks as unacceptable.1
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The extent to which anti-immunization views perpetuate the modern-day chiropractic profession is uncertain. The official 2002 policy of the American Chiropractic Association regarding vaccination reads as follows:
- Resolved, that the ACA recognize and advise the public that: Since the scientific community acknowledges that the use of vaccines is not without risk, the American Chiropractic Association supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination.
- The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual's right to freedom of choice in health care matters and providing an alternative/elective course of action regarding vaccination. (http://www.acatoday.com/pdf/2002_aca_policies.pdf)
The policy of the International Chiropractic Association is practically identical. By such noncommittal statements, both associations have distanced themselves from any official recognition of vaccination as an effective public health procedure. Although neither formally rejects vaccination, each emphasizes the risk aspect. The official policy statement of the Canadian Chiropractic Association is supportive of vaccination, stating, “The CCA accepts vaccination as a cost-effective and clinically efficient public health preventive procedure for certain viral and microbial diseases, as demonstrated by the scientific community” (Policy Manual; Motion 2139/93).
One might presume, therefore, that the Canadian chiropractic profession maintains a similar perspective on vaccination. Nevertheless, a recent survey of 621 students (75.2% response rate) attending the Canadian Memorial Chiropractic College (CMCC), the only English-language chiropractic college in Canada, found that approximately 29% of students graduated in the year 2000 with antivaccination attitudes, 40% being supportive of vaccination, with 31% unsure.
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Further, a 2002 survey of Alberta (Canada) chiropractors, many of whom will have graduated from CMCC, found that 27.2% advised patients against vaccinating themselves or their children.6
The antivaccination stance of some chiropractic organizations, and the writings and other activities of certain chiropractors,
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have placed the profession as a whole under scrutiny.5
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It is therefore appropriate to consider whether or not there is any justification for such a stance. Although most public health authorities would agree that vaccination constitutes one of the most cost-effective infectious disease control measures of the last century, few, if any, would argue that there are no problems associated with their use.23
Concerns about vaccine safety and efficacy are valid issues which continue to be addressed by public health experts in many countries. Nevertheless, in evaluating these concerns within the context of a vaccination program, it is essential that the risks and benefits be given the appropriate weight. Whether or not the curricula of most chiropractic colleges provide the necessary instruction to permit their graduates to provide this is questionable. In Ontario, the chiropractic profession is regulated under the Regulated Health Professions Act (1991) and the Chiropractic Act of 1991. With regard to vaccination issues, the Ontario Chiropractic College recently approved a standard of practice requiring its members to refrain from discussing these issues with their patients and the general public, on the basis that immunization/vaccination is outside their scope of practice. Contravention of this ruling may result in fines or even imprisonment (http://www.cco.on.ca/standard_of_practice_s-015.htm).It is certainly the case that most chiropractic writings on vaccination focus almost exclusively on the negative aspects, either ignoring the huge amount of evidence supporting the benefits of vaccination or summarily dismissing this as “bad science” or government/industrial propaganda.
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Such an approach, however, is akin to describing the airline industry entirely on the basis of flight delays, lost luggage, and air crashes.In this article, we offer a critical appraisal of published statements and consider some of the more common antivaccination arguments in chiropractic and associated writings. We have also provided a brief discussion on historical chiropractic philosophy in an attempt to explore why certain chiropractors continue to promulgate such arguments.
Discussion
Antivaccination Arguments
In almost all cases, antivaccination writings by chiropractors have appeared in non–peer-reviewed magazines or newspapers, or in paid advertisements.
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Consequently, most of these writings have not been subjected to the critical editorial process undergone by peer-reviewed articles in reputable journals. Few appear in any of the major medico-scientific databases. Our main sources, therefore, have been chiropractic trade journals, web sites, and local newspapers. We have elected to focus on a Letter to the Editor of the Burlington Post (Ontario, Canada) (May 12, 1999), written by a chiropractor and clearly advocating against immunization programs. The following are excerpts from this single letter, but we feel they illustrate claims that commonly recur in antivaccination chiropractic writings.Statement 1: “Catherine Diodati, Ontario's own vaccine researcher, has just completed a study on the biomedical ethics of vaccination…[she] feels vaccination has little to do with health care and everything to do with wealth care — and not yours or mine!”
Whether or not Diodati made these claims is not the major issue; however, the chiropractor writer is claiming that a noted public health expert is making a statement that would be a matter of grave concern to the general reader. But can Diodati be considered a noted public health expert? An examination of her background is instructive. Diodati holds a Master of Arts degree, University of Windsor, Ontario, Canada (1998), in which, according to a curriculum vitae posted on the Internet (http://www.freeyurko.bizland.com/diodaticv.html), her primary areas of study were theology, theodicy, philosophy and ethics. The study referred to above is a privately published book entitled Immunization. Health, Ethics, Law and Health,
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based on her Master's dissertation, which provides the statement that her interest in vaccines started after her child was (allegedly) vaccine injured. As far as we know, Diodati is not affiliated with any academic or private research institution involved in vaccine research. A MEDLINE search revealed only 1 publication by her, in 2002. She is the coauthor of a short article in Medical Hypotheses which suggests that vaccinating postpartum women with measles, mumps, and rubella (MMR) vaccine may cause autism in their children through breastfeeding.25
Although this might be a valid subject for a hypothesis, the premise is seriously compromised by having its basis in the responses of 62 self-selected women who completed a questionnaire posted on the Internet, the results of which were not published in any peer-reviewed journal. A recent systematic review has rigorously examined this topic and found no association between autistic spectrum disorder and the MMR vaccine.26
In reality, it seems that, contrary to being “Ontario's own vaccine researcher,” Ms Diodati has attained expert status only in the eyes of certain lay organizations and others such as chiropractors and chiropractic organizations that invite her to speak on the dangers of immunization.Statement 2: “proponents of vaccination, feel it is vaccination programs which have caused a decrease in the number of communicable diseases seen. This view is old and outdated. Current scientific research indicates that these diseases were beginning to decline long before the advent of vaccination. The reason for their decline is based on new sanitation protocols, cleanliness, better diet and nutrition, etc, not vaccination.”
Indeed, certain chiropractors have published articles that seemingly present evidence to substantiate the view that “diseases were beginning to decline long before the advent of vaccination.” An example of this is found in an article by Lanfranchi
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in the ICA International Review of Chiropractic. In it, he provides a figure giving evidence for this argument, and he even goes as far as to suggest that “mathematical modeling suggests recrudesce (sic) of measles in 1990-2010.” He claims to have obtained the data to plot the graph, starting from 1850, from the US Government's Centers for Disease Control and Prevention (CDC, Atlanta, Ga) which, in reality, has such statistical data only from 1940 onward (personal communication; July 19, 2001). The most recent published findings by the CDC28
reported “no endemic measles virus is circulating in the United States,” and emphasized that, “…maintaining immunity through high vaccination coverage levels is essential to limit the spread of measles from imported cases.”When Lanfranchi
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was contacted for clarification of this matter (RG Lanfranchi, written communication; Sept 7, 2001), he admitted that the statistics for the graph were not actually obtained from the CDC but were from a lecture presented at the “New York Chiropractic College back in the early 1990's.” Attempts to contact the purported author of this lecture were unsuccessful. The conclusion is that Lanfranchi may have misrepresented the source of this data in his article, and that the validity of the data is uncertain.The statement that communicable diseases were on the decline long before the advent of vaccines is an example of selective information. There is little doubt that advances in medical treatments and increased standards of hygiene and nutrition have contributed greatly to the control of communicable diseases. Diseases, such as measles, are more severe in malnourished individuals.
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Improved sanitation has been a major factor in the control of cholera30
and other infectious agents that make use of a fecal-oral route of transmission., 32
Antibiotics have greatly reduced the high rates of morbidity and mortality previously associated with many enteric and respiratory bacterial infections.33
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Nevertheless, this is only part of the story, as the following examples show. Although improvements in sanitation during the first half of the 20th century reduced the number of polioviral infections, these actually contributed to the increased incidence of paralytic poliomyelitis. Improved sanitation resulted in later first exposures to the virus, with a corresponding increase in pathogenicity.35
However, the almost complete global eradication of wild poliovirus, even from countries with primitive sanitation and poor nutritional standards, can only be attributed to the massive vaccination campaigns.36
Invasive disease due to Haemophilus influenzae (ie, meningitis) was prevalent until the early 1990s when an H influenzae (type b) vaccine (Hib) was developed. Before vaccine licensure, an average of 20000 cases occurred each year in the United States; in 2000, there were only 55 cases.37
It may be unreasonable to presume that this dramatic change was due, for example, to improvements in sanitation and diet since 1990.Statement 3: “One of the great concerns is there has been a drastic increase in the numbers of autoimmune diseases seen: everything from diabetes to asthma, autism, Crohn's disease, AIDS, cancer, etc. Many in the scientific community are convinced vaccination is to blame. A vast number of research studies have been done to prove this point.”
It is, of course, easy to make sweeping, unsubstantiated claims such as in the last 2 sentences. But are there really “vast numbers of studies” that prove this point? We can cite a few that provide questionable, although avidly quoted, support for them. An example is contained in a front-page headline in Dynamic Chiropractic (March 20, 2000) which read: “Do DPT and Tetanus Vaccinations Cause Asthma? New Study Shows Vaccinated Children Twice as Likely to Get Asthma and Other Allergy-Related Symptoms.”
This statement referred to a study reported in the Journal of Manipulative and Physiological Therapeutics
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which compared 13328 infants, children, and adolescents who reported being vaccinated with diphtheria-pertussis-tetanus (DPT) or tetanus to 284 who reported not being vaccinated. Within these respective groups, 5843 of 13328 had shot records documenting their positive DPT or tetanus vaccination status and only 22 of 284 had records available to attest to their nonvaccination status. Studies that use small groups, however, carry a substantial risk of false-positive or false-negative results. This can be illustrated by presenting the data with a point estimate of the effect, such as an odds ratio, and a measure of precision, such as a confidence interval (CI). In the Hurwitz and Morgenstern38
study, the adjusted odds ratio of asthma among the vaccinated subjects was reported as 2.00 (vaccinated subjects twice as likely to have asthma vs unvaccinated) with a 95% CI of 0.59 (a reduction of 41%) to 6.74 (an increase of 574%). Consequently, although the odds ratio is 2, the results rule out neither a substantial decrease in the risk of asthma nor a substantial increase in the risk of asthma for vaccinated subjects because the CI crosses over “1.” The Dynamic Chiropractic headline claim, therefore, cannot be justified.No vaccine is 100% safe or 100% effective, and this is true of any health care intervention. However, opponents of vaccination frequently emphasize or exaggerate the adverse effects of vaccines, but fail to consider the consequences of compromised vaccination programs.
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Furthermore, although it is true that a number of published studies have implicated vaccines in certain disorders, these have generally not held up under investigative scrutiny. For example, an oft-quoted 1998 study of 12 children by Wakefield et al39
suggested a link between MMR vaccination and the development of autism. What antivaccinationists may fail to note is that larger trials have failed to confirm these findings,40
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and that “serious allegations of research misconduct” have been made with regard to the Wakefield article.42
Indeed, 10 of Wakefield's 11 coauthors published an official retraction.43
There are numerous studies that have found no association between vaccines and asthma, diabetes, cancer, autism, AIDS, epilepsy, Crohn's disease, etc.26
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, - Moore DL
- Le Saux N
- Scheifele D
- Halperin SA
Members of the Canadian Paediatric Society/Health Canada Immunization Monitoring Program Active (IMPACT)
Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002.
Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002.
Pediatr Infect Dis J. 2004; 23: 568-571
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Statement 4: “In light of this, many experts, among them Dr. Viera [sic] Schreibner [sic], probably the single most recognized vaccine expert, now view the current vaccination program as human experimentation, which has been outlawed by the Helsinki Accord at the end of the Second World War.”
Again, one might question the qualifications, and numbers, of the “many experts” the writer claims to hold these extreme views. And is there any justification for the statement that Scheibner is “probably the single most recognized vaccine expert”? For more than a decade, she has been an outspoken antivaccination activist and is the author of the book Vaccination: 100 Years of Orthodox Research Shows that Vaccines Represent a Medical Assault on the Immune System.
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Her extreme antivaccination bias is apparent by her claim in a number of articles to have,60
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“…studied 60,000 pages of medical literature on vaccines and vaccinations” while finding “no evidence of [their] effectiveness or safety.”As an antivaccination spokesperson, Scheibner's published academic affiliation(s) are unclear, other than being a “retired Principal Research Scientist in Australia”
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with “90 papers in refereed scientific journals.”60
By her own admission, her formal training in health-related sciences has been limited to the study of human biology at university and a “year of medicine”.62
Indeed, her doctorate is not in health-related science. As Viera Scheibnerová she was a member of the Department of Geology, Comenius University, Bratislava, before moving to Australia and the Geological Survey of New South Wales. Her publications in scientific journals appear to be limited to geology/paleontology. A recent search of MEDLINE (1966-December 2004) came up negative for ‘Scheibnerova V’ and with 2 entries for ‘Scheibner V’ as the fourth of 5 authors of a study on the incidence of apnea in rats63
and as the author of an unedited letter62
responding to an article criticizing her position on vaccination.64
Her contribution to the animal study appears to be related to the use of Cotwatch, a breathing monitor developed by her (late) husband that provided the original stimulus for her interest in sudden infant death syndrome (SIDS) or cot death.63
Scheibner's work is commonly cited to support antivaccination arguments put forth by chiropractors. For example, one of us (LM) published what we consider to be a balanced (but nevertheless clearly provaccination) article on pertussis immunization
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in the Journal of the Canadian Chiropractic Association. Of 9 published letters responding to this article, 7 were strongly antagonistic. The following excerpts from 4 letters provide examples:Dr. Morgan's acknowledgement of the division in chiropractic on issues of immunization is quite correct. However, his implication that those who oppose it [vaccination] lack scientific support for their logic is both arrogant and short-sighted. Does he think he is the only chiropractor alive who takes the time to become informed on this controversial health issue? Dr. Vera [sic] Scheibner PhD…has produced the most comprehensive scientific search on the subject. The basic conclusion of this search is that inoculations are dangerous and ineffective, moreover that proponents of vaccination often misrepresent the results of trials and tests. .…
It is said that the worst enemy is the enemy from within. Dr Morgan has certainly spent a lot of time and effort in his research to reach his opinion supporting the pertussis vaccine and to criticize the chiropractic profession… Dr. Vera [sic] Scheibner PhD, an independent researcher…observed a relationship between the DPT vaccine and conditions such as leukemia, diabetes, asthma and SIDS.…
I can hardly believe that someone who has gone through the trouble of compiling information on this subject has managed to ignore or omit all the studies and papers showing that the pertussis vaccine is not safe…He has failed to look at Dr. Vera [sic] Scheibner's substantial work on the subject.
I think I understand why the JCCA is always presenting an allopathic model of chiropractic, rather than the vitalistic model, but the inclusion of a pro-immunization article is going too far. ….I suggest you commission Barbara Loe Fisher, Harris Coulter or Vera [sic] Scheibner to present the other side of the immunization story.
Despite persistent references by antivaccination chiropractors to the “extensive work” of Scheibner, the authors are not aware whether she has published her antivaccination arguments formally in any mainstream peer-reviewed scientific or medical journal (apart from the unedited letter in Vaccine).
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It may be possible that many of her arguments do not hold up under scrutiny and, consequently, would not be acceptable for publication in any of these. For example, one of Scheibner's claims is that pertussis vaccination of infants is a major cause of SIDS, and, as evidence, she cites the situation in Japan in 1975 after a shift in the age of pertussis (DPT) immunization from 3-5 months to 2 years.70
To quote from page 43 of her book,59
“When Japan moved the vaccination age to two years, the entity of cot death in that country disappeared [Cherry et al (1988)], while the amount of adverse reactions in 2-year-olds remained the same or increased.” The author continues on pages 62 to 63 that,59
“The seeming and widely perpetuated dilemma ‘is there or is there not a causal relationship between DPT injections and cot death’ has, quite adequately and indeed without a shadow of a doubt, been resolved by the Japanese experience with cot death.”This, however, is not an accurate representation of the facts. Scheibner's quotation of Cherry et al
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actually referred to data of Noble et al70
based on claims paid by the Japanese national vaccine compensation system. What happened was that, after the shift in minimum age of pertussis immunization to 2 years, no further claims were made through the national compensation system, which is a completely different issue from the incidence of cot deaths. Sudden infant death syndrome occurs primarily in babies between the ages of 2 and 4 months; consequently, with no DPT vaccinations being given at this age, there could be no Japanese claims for vaccine-related sudden deaths. Indeed, the incidence of SIDS in Japan has even been reported to have increased after this time,72
although a greater awareness of SIDS among Japanese pathologists and changes in reporting may have contributed to these elevated figures.Scheibner also ignores the evidence against a causal relationship between DPT inoculations and SIDS and other temporally associated major adverse events discussed by Cherry et al.
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She states on page xv that,59
“There is no evidence whatsoever that vaccines of any kind — but especially those against childhood diseases — are effective in preventing the infectious diseases they are supposed to prevent.” However, she makes no mention that, after implementation of the later vaccination schedule, the incidence of pertussis in Japan increased dramatically.70
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These are only some examples of her selective omissions of facts; however, Basser74
has conducted a detailed analysis of the accuracy of reporting in her book. One of his conclusions is that Scheibner is74
“At best sloppy, and at worst blatantly dishonest.” He provides numerous examples to justify his analysis.74
There appears to be a relatively small number of chiropractic (and chiropractic-associated) authors who continue to disseminate antivaccination views.
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Their arguments may appear to be valid until supporting references and data are investigated further. One common occurrence, documented above, is the use of questionable sources as the basis for antivaccination arguments.We hope that this article may stimulate some practitioners to examine critically the sources of their information. However, it may be unlikely that any measure of critical analysis will serve to sway many confirmed antivaccination chiropractors from their position, in that their views on immunization may not be based on evidence, or open to scientific scrutiny, but rather on the demands of their faith/belief system/philosophy.
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, To quote Nelson75
:I long ago ceased being embarrassed by the excesses, idiosyncrasies and quirks of my colleagues. In fact I rather enjoyed collecting the most egregious examples of chiro-babble…. My sense of amusement [however]…has vanished primarily because of a growing awareness that: a) the number of chiropractors who are animated by 19th century pseudo-science seems to be growing rather than shrinking, and b) these chiropractors will abandon their philosophy when hell freezes over.
He also states, “If you peel away all the arguments about the safety and effectiveness of immunizations, you will find at the core of this debate, chiropractic philosophy.”
It is therefore informative to briefly review aspects of historical chiropractic philosophy as may relate to current views on vaccination.
Chiropractic Philosophy
Chiropractic was founded by David D. Palmer and developed by his son Bartlett Joshua (BJ). The Palmers held that infectious disease was the result of spinal subluxations, and BJ in particular wrote extensively about how infectious diseases and other ailments (including cancers) can readily be cured by removal of the subluxation. For example, BJ wrote in 1909
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:Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox, I can prove to you where, in one, you will find a subluxation and you will find the same condition in the other ninety-nine. I adjust one and return his functions to normal and you could do the same with the other ninety-nine.
Although sometimes referred to as “chiropractic philosophy,” the doctrines originally espoused by the Palmers and maintained by modern fundamentalist chiropractors cannot be considered to constitute a true philosophy in that they are not subject to change. It is more correct to categorize historical chiropractic philosophy as a belief system, in that any true philosophy should be dynamic and is accountable to a methodological pursuit of knowledge.
The historical belief system of chiropractic, as advocated by the Palmers, does not allow for the acceptance of vaccination. According to DD Palmer
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:It is the very height of absurdity to strive to ‘protect’ any person from smallpox or any other malady by inoculating them with a filthy animal poison…No one will ever pollute the blood of any member of my family unless he cares to walk over my dead body to perform such an operation.
Historical chiropractic belief systems provide a number of benefits, however, including simplistic answers to complex problems and provision of a “unique” service among health care providers resulting in decreased competition. Because fundamentalist practitioners do not “cure” or “treat” conditions aside from subluxations, which may or may not be symptomatic, treatment frequency and duration are entirely determined by the practitioner. Consequently, the result of adhering to a belief system of practice that can be applied rapidly, and administered to each and every presenting patient on an ongoing, and often frequent, basis, has obvious financial implications. This scenario may offer some insight as to why some chiropractors adopt historical belief systems that entail negative views toward vaccination. As written by a third-year chiropractic student at CMCC, “I feel that chiropractic in Canada needs to go more towards a philosophical subluxation approach or we may no longer exist as a separate health profession. There is too much competition for patients at the evidence-based end of things.”
Conclusion
The chiropractic antivaccination position was established by DD Palmer by likening vaccines to “filthy animal poisons.”
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Palmer's views resulted not from any objective analysis of scientific data, but from a rejection of anything he perceived to be associated with the medical profession of the day.17
His anti-immunization position was a narrowly dogmatic one that did not allow for scientific advancements or the introduction of new data. In the face of now overwhelming evidence to show that vaccination is an effective public health procedure, Palmer's modern followers have turned to whatever sources they can to support chiropractic's archaic anti-immunization position. However, our preliminary discussion suggests that current chiropractic anti-immunization arguments rely heavily on biased and selective misrepresentations, or omissions, of the scientific literature by a small group of authors whose credibility as authorities on vaccination remains questionable. Opposition to immunization by some in chiropractic may be purely “philosophical,” not scientific; nevertheless, this does not justify the dissemination of innuendo, half-truths, and false information to support this position.References
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- Lack of association between pertussis vaccination and symptoms of asthma and allergy.JAMA. 1996; 275: 760
- A randomized controlled trial of the effect of pertussis vaccines on atopic disease.Arch Pediatr Adolesc Med. 1998; 152: 734-738
- Tests fail to support claims for origin of AIDS in polio vaccine.Nature. 2000; 407: 117
- Absence of measles viral genomic sequence in intestinal tissues from Crohn's disease by nested polymerase chain reaction.Gut. 1996; 38: 211-215
- Absence of measles virus in Crohn's disease.Lancet. 1995; 345: 199
- Exposure to measles in utero and Crohn's disease: Danish register study.BMJ. 1998; 316: 196-197
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- The cumulative incidence of childhood diabetes mellitus in Sweden unaffected by BCG-vaccination.Diabetologia. 1995; 6: 449-454
- Cumulative incidence of childhood-onset IDDM is unaffected by pertussis immunization.Diabetes Care. 1997; 20: 173-175
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- MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis.JAMA. 2004; 292: 351-357
- Lack of evidence of encephalopathy related to pertussis vaccine: active surveillance by IMPACT, Canada, 1993-2002.Pediatr Infect Dis J. 2004; 23: 568-571
- Poliovirus vaccination during pregnancy, maternal seroconversion to simian virus 40, and risk of childhood cancer.Am J Epidemiol. 2004; 160: 306-316
- Vaccination: 100 years of orthodox research shows that vaccines represent a medical assault on the immune system.New Atlantean Press, Santa Fe (NM)1996
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Article info
Publication history
Accepted:
January 2,
2005
Received in revised form:
August 11,
2003
Received:
April 2,
2003
Footnotes
Sources of support: No funds were received for the preparation of this manuscript. Dr Busse is funded by a Canadian Institutes of Health Research Fellowship Award.
Identification
Copyright
© 2005 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
