Chiropractic Antivaccination Arguments

From its inception in the late 19th century, the chiropractic profession has seen itself as offering distinct services from allopathic medicine.1Palmer BJ The philosophy of chiropractic. vol. V. The Palmer School of Chiropractic, Davenport (Iowa)1909: 172-173Google Scholar, 2Palmer BJ The science of chiropractic: its principles and philosophies. vol. I. The Palmer School of Chiropractic, Davenport (Iowa)1906: 359Google Scholar 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.3Gatterman MI Advances in subluxation terminology and usage.Adv Chiropr. 1995; 2: 461-469Google Scholar 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.1Palmer BJ The philosophy of chiropractic. vol. V. The Palmer School of Chiropractic, Davenport (Iowa)1909: 172-173Google Scholar, 4Palmer DD The chiropractor's adjustor. Portland Printing House Company, Portland (OR)1910: 854Google Scholar 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.5Busse JW Kulkarni AV Campbell JB Injeyan HS Attitudes on vaccination: a survey of Canadian chiropractic students.CMAJ. 2002; 166 (Available from:): 1531-1534http://www.cmaj.ca/cgi/reprint/166/12/1531.pdfPubMed Google Scholar 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.6Russell ML Injeyan HS Verhoef MJ Eliasziw M Beliefs and behaviours: understanding chiropractors and immunization.Vaccine. 2004; 23: 372-379Crossref PubMed Scopus (30) Google Scholar The antivaccination stance of some chiropractic organizations, and the writings and other activities of certain chiropractors,7Lanfranchi RG Vaccination: natural versus artificial immunity.Am Chiropr. 1994; 16: 16-18Google Scholar, 8Gunter GT Immunization: a review for chiropractors.Today's Chiropr. 1996; 15: 15-18Google Scholar, 9Kent C Gentempo P Immunization, facts, myths and speculation.Int Chiropr Assoc Rev Chiropr. 1990; : 13-21Google Scholar, 10Koren T The vaccine dilemma: another viewpoint on the issue.Chiropr J. 1993; : 1-28Google Scholar, 11Barge F Immunization and unity.Dynamic Chiropr. 1992; 10: 36-37Google Scholar, 12Koren T Is vaccination a chiropractic issue?.Today's Chiropr. 1997; 16: 86-87Google Scholar, 13Koren T Autism and encephalitis: bad luck, bad genes or bad vaccines?.Can Chiropr. 1998; 3: 46-48Google Scholar have placed the profession as a whole under scrutiny.5Busse JW Kulkarni AV Campbell JB Injeyan HS Attitudes on vaccination: a survey of Canadian chiropractic students.CMAJ. 2002; 166 (Available from:): 1531-1534http://www.cmaj.ca/cgi/reprint/166/12/1531.pdfPubMed Google Scholar, 6Russell ML Injeyan HS Verhoef MJ Eliasziw M Beliefs and behaviours: understanding chiropractors and immunization.Vaccine. 2004; 23: 372-379Crossref PubMed Scopus (30) Google Scholar, 14Anderson R Chiropractors for and against vaccines.Med Anthropol. 1990; 12: 169-186Crossref PubMed Scopus (10) Google Scholar, 15Colley F Haas M Attitudes on immunization: a survey of American chiropractors.J Manipulative Physiol Ther. 1994; 17: 584-590PubMed Google Scholar, 16Friedlander ER Opposition to immunization: a pattern of deception.Sci Rev Altern Med. 2001; 5: 18-23Google Scholar, 17Campbell JB Busse JW Injeyan HS Chiropractors and vaccination: an historical perspective.Pediatrics. 2000; 105 (Available from:): 1-8http://www.pediatrics.org/cgi/content/full/105/4/e43Crossref PubMed Scopus (78) Google Scholar, 18Ernst E The attitude against immunization within some branches of complementary medicine.Eur J Pediatr. 1997; 156: 513-515Crossref PubMed Scopus (36) Google Scholar, 19Marko N Chiropractic vs. immunization. Chiropractors say they're not anti-immunization. Their web sites tell a different story. Canadian Online Explorer.http://www.canoe.ca/PedChiro/immunization.htmlGoogle Scholar, 20Homola S Is the chiropractic subluxation theory a threat to public health?.Sci Rev Altern Med. 2001; 5: 45-53Google Scholar, 21Lee ACC Li DH Kemper KJ Chiropractic care for children.Arch Pediatr Adolesc Med. 2000; 154: 401-407Crossref PubMed Scopus (76) Google Scholar, 22Kemper KJ APA presidential address. Holistic pediatrics=good medicine.Pediatrics. 2000; 105: 214-218PubMed Google Scholar 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.23Ada G Vaccines and vaccination.N Engl J Med. 2001; 345: 1042-1053Crossref PubMed Scopus (222) Google Scholar 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.17Campbell JB Busse JW Injeyan HS Chiropractors and vaccination: an historical perspective.Pediatrics. 2000; 105 (Available from:): 1-8http://www.pediatrics.org/cgi/content/full/105/4/e43Crossref PubMed Scopus (78) Google Scholar 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. In almost all cases, antivaccination writings by chiropractors have appeared in non–peer-reviewed magazines or newspapers, or in paid advertisements.17Campbell JB Busse JW Injeyan HS Chiropractors and vaccination: an historical perspective.Pediatrics. 2000; 105 (Available from:): 1-8http://www.pediatrics.org/cgi/content/full/105/4/e43Crossref PubMed Scopus (78) Google Scholar 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,24Diodati CJM Immunization.History, ethics, law and health. 2nd ed. Integral Aspects Incorporated, Windsor1999Google Scholar 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.25Yazbak FE Diodati CJ Postpartum live virus vaccination: lessons from veterinary medicine.Med Hypotheses. 2002; 59: 280-282Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar 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.26Wilson K Mills E Ross C McGowan J Jadad A Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence.Arch Pediatr Adolesc Med. 2003; 157: 628-634Crossref PubMed Scopus (58) Google Scholar 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 Lanfranchi27Lanfranchi RG Vaccinations: think before you embrace.Int Chiropr Assoc Int Rev Chiropr. 1993; : 43-49Google Scholar 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 CDC28Centers for Disease Control and Prevention (CDC) Epidemiology of measles—United States, 2001-2003.MMWR Morb Mortal Wkly Rep. 2004; 53 (Available from:) ([Accessed December 26, 2004]): 713-716http://www.cdc.gov/mmwr/PDF/wk/mm5331.pdfPubMed Google Scholar 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 Lanfranchi27Lanfranchi RG Vaccinations: think before you embrace.Int Chiropr Assoc Int Rev Chiropr. 1993; : 43-49Google Scholar 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.29Caballero B Global patterns of child health: the role of nutrition.Ann Nutr Metab. 2002; 46: 3-7Crossref PubMed Scopus (55) Google Scholar Improved sanitation has been a major factor in the control of cholera30Sutherland J EXTRACTS from appendix (A) to the Report of the General Board of Health on the Epidemic Cholera of 1848 & 1849(a).Int J Epidemiol. 2002; 31: 900-907Crossref PubMed Google Scholar and other infectious agents that make use of a fecal-oral route of transmission.31Cairncross S More water: better health.People Planet. 1997; 6: 10-11PubMed Google Scholar, 32Datta B Defeating “the worm” in Rajasthan. Women and water: India.People Planet. 1993; 2: 26-29PubMed Google Scholar Antibiotics have greatly reduced the high rates of morbidity and mortality previously associated with many enteric and respiratory bacterial infections.33Alam NH Ashraf H Treatment of infectious diarrhea in children.Paediatr Drugs. 2003; 5: 151-165PubMed Google Scholar, 34Gray GC Blankenship TL Gackstetter G History of respiratory illness at the U.S. Naval Academy.Mil Med. 2001; 166: 581-586PubMed Google Scholar 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.35Nielsen NM Aaby P Wohlfahrt J Molbak K Melbye M The polio model. Does it apply to polio?.Int J Epidemiol. 2002; 31: 181-186Crossref PubMed Scopus (13) Google Scholar 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.36Progress toward global eradication of poliomyelitis, 2002.MMWR Morb Mortal Wkly Rep. 2003; 52 (Available from:) ([Accessed December 26, 2004]): 366-369http://www.cdc.gov/mmwr/PDF/wk/mm5216.pdfPubMed Google Scholar 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.37Summary of notifiable diseases—United States, 2000.MMWR Morb Mortal Wkly Rep. 2002; 49 (Available from:) ([Accessed December 26, 2004]): 1-102http://www.cdc.gov/mmwr/PDF/wk/mm4953.pdfGoogle Scholar 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 This statement referred to a study reported in the of Manipulative and E H of or vaccination and respiratory children and in the United Manipulative Physiol Ther. 2000; 23: Full Text Full Text PDF PubMed Scopus Google Scholar which and who reported being with or to who reported not being these of their DPT or vaccination status and only of to to their that use however, a risk of or This can be by the data with a of the such as an and a of such as a In the and E H of or vaccination and respiratory children and in the United Manipulative Physiol Ther. 2000; 23: Full Text Full Text PDF PubMed Scopus Google Scholar the of the was reported as as to have with a of of to increase of Consequently, although the is the results neither a decrease in the risk of a increase in the risk of for the The Dynamic Chiropractic headline therefore, be vaccine is or and this is of any health care However, of vaccination or the adverse effects of but to consider the of compromised vaccination JB Busse JW Injeyan HS Chiropractors and vaccination: an historical perspective.Pediatrics. 2000; 105 (Available from:): 1-8http://www.pediatrics.org/cgi/content/full/105/4/e43Crossref PubMed Scopus (78) Google Scholar although it is that a number of published studies have vaccines in certain these have not under example, an study of children by A J M and disorder in 1998; Full Text Full Text PDF PubMed Scopus Google Scholar a between MMR vaccination and the of may to is that have to these B E Li J and measles, mumps, and rubella vaccine: no epidemiological evidence for a Full Text Full Text PDF PubMed Scopus Google Scholar, E B MMR and evidence against a 2001; PubMed Scopus Google Scholar and that of research have been made with regard to the H A statement by the of The 2004; Full Text Full Text PDF PubMed Scopus Google Scholar Indeed, of published an official A DH M M of an 2004; Full Text Full Text PDF PubMed Scopus Google Scholar There are studies that have found no association between vaccines and asthma, cancer, autism, AIDS, Crohn's disease, K Mills E Ross C McGowan J Jadad A Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence.Arch Pediatr Adolesc Med. 2003; 157: 628-634Crossref PubMed Scopus (58) Google Scholar, J K M J vaccination and in PubMed Scopus Google Scholar, J of association between vaccination and of and 1996; PubMed Google Scholar, B A of the of vaccines on Pediatr Adolesc Med. 1998; PubMed Scopus Google Scholar, to support claims for of in polio 2000; PubMed Scopus Google Scholar, K K H H of measles viral in from Crohn's disease by 1996; PubMed Scopus Google Scholar, M M S of measles virus in Crohn's 1995; 345: Google Scholar, NM Melbye M M M Aaby P to measles in and Crohn's 1998; PubMed Scopus Google Scholar, F adverse or 1998; Full Text Full Text PDF PubMed Scopus Google Scholar, M J E R vaccination and incidence of in 1997; PubMed Scopus (55) Google Scholar, G The incidence of diabetes in by 1995; 6: Scholar, H G incidence of is by 1997; PubMed Scopus Google Scholar, C E vaccination and a 2004; Full Text Full Text PDF PubMed Scopus Google Scholar, M A Wohlfahrt J P vaccination and of and 2004; PubMed Scopus Google Scholar, N of the Canadian Canada Immunization of evidence of to vaccine: by Canada, J. 2004; 23: PubMed Scopus (36) Google Scholar, J N vaccination during to virus and risk of J Epidemiol. 2004; PubMed Scopus Google of many the single most vaccine view the current vaccination as which has been by the at the of the one might the and of the the writer claims to these is there any justification for the statement that is the single most vaccine more a has been an antivaccination and is the author of the book Vaccination: of Shows that Vaccines a Medical on the Vaccination: of research that vaccines a medical on the New Scholar antivaccination is by her in a number of articles to Chiropractic A on of American attitude to (sic) by Chiropr Assoc 1996; Scholar, P C Vaccines and an with (May in the of an with & Scholar of medical on vaccines and “no evidence of or As an antivaccination published academic are other being a in Chiropractic A on of American attitude to (sic) by Chiropr Assoc 1996; Scholar, P C Vaccines and an with (May in the of an with & Scholar with in scientific Chiropractic A on of American attitude to (sic) by Chiropr Assoc 1996; Scholar By her own her in has been to the study of at and a of to and on as a public of 2003; PubMed

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.