New Study: Pediatric patients seeing naturopaths and chiropractors less likely to get flu vaccination


Despite the well-established safety and efficacy of vaccines, chiropractors and naturopaths (including naturopathic "doctors" and "physicians") are ideologically opposed to vaccination. This is why you find disgraced physician and anti-vaccination crank Andrew Wakefield giving the keynote address to a chiropractic "pediatrics" conference last weekend, and not for the first time. And this is why, instead of full-throated support for immunization, the American Association of Naturopathic Physicians is still "discussing its stance on vaccination."

A new study just published in Pediatrics adds to the growing body of evidence that this ideology is being imposed on pediatric patients, in the form of lower vaccination rates for influenza. Authors of the study, Complementary and Alternative Medicine and Influenza Vaccine Uptake in US Children, analyzed the data from around 9,000 children from the 2012 National Health Interview Survey (NHIS), looking at influenza vaccination uptake among those children who had ever used, among other forms of CAM, alternative medical systems ("AMS;" e.g. naturopathy) and manipulative and body-based therapies ("MBBT;" e.g. chiropractic manipulation).

The authors found that children who had ever used AMS or MBBT had lower odds of influenza vaccination. They reasoned that, since the second most prevalent type of AMS is naturopathy and the most prevalent type of MBBT was chiropractic or osteopathic manipulation, use of these specific types of CAM

"may require contact with CAM practitioners shown to have vaccine-critical viewpoints, advise against vaccine, or advise vaccine schedules different from those recommended by the federal government."

In fact, the association between chiropractic use and lower vaccination rates may be higher than shown in this study because osteopathic manipulation was lumped in with chiropractic manipulation. Osteopaths, the authors point out, are unlikely to hold the same anti-vaccination views as chiropractors.

Citing a number of studies and surveys, the authors note

"CAM has been implicated as lending support to antivaccine/vaccine-hesitant viewpoints via criticism of vaccination, public health, and conventional medicine from adults using CAM, as well as from CAM practitioners and practitioners-in-training. Even among CAM practitioners who generally support the concept of vaccination, a majority report they recommend a vaccine schedule different from the [CDC and Advisory Committee on Immunization Practices] schedule."

Influenza vaccination is sub-optimal among children already (43%). Rates for pediatric users of AMS or MBBT were even lower: 33% and 35%, respectively. This is concerning because children have the highest rates of influenza infection and are a major source of transmission in the family and community, according to this article. Children younger than 5 have a higher risk of influenza-related complications and comprise a substantial portion of influenza-related morbidity and care visits. Annually, influenza causes up to 200,000 hospitalizations, 49,000 deaths and an estimated $87 billion of economic burden.

The authors conclude that we could improve vaccine uptake and child health by "better engaging" CAM practitioners, practitioners-in-training and parents. I doubt it. Naturopaths and chiropractors eschew evidence-based practice and will continue to misinform parents as long as we allow them. After all, if they aren't convinced by the current evidence of the safety and efficacy of immunization, what do you think will sway them?

A better solution is to deprive them of the opportunity to counsel parents on vaccination. There is no reason chiropractors or naturopaths should be allowed to see children as patients at all. Note that the study's authors looked at MBBT as a surrogate for contact with a chiropractor; the specific treatment involved was chiropractic manipulation. There is no evidence that chiropractic manipulation is effective for any pediatric disease or condition, yet chiropractors regularly advertise it as effective for colic, ADHD, asthma and bedwetting, among others. They tell parents that "birth trauma" can cause the mythical chiropractic "subluxation" and that children must be periodically "adjusted" for good health. Naturopaths regularly use dietary supplements, homeopathy, IgG food intolerance testing, genetic polymorphism screening, heavy metal testing, "detoxification" and other dubious practices in treating children.

The states allow this veneer of legitimacy via chiropractic and naturopathic practice acts, which permit them to diagnose and treat children. In states where naturopaths cannot legally diagnose and treat, they thumb their noses at the law and openly advertise their services. Short of banning them from treating pediatric patients, the states could at least prevent them from giving advice on immunizations and requiring them to refer parents to competent medical professionals. Colorado, for example, requires naturopaths to give parents a list of the CDC/ACIP vaccination schedule and recommend they take their children to a real doctor.

The states' regulation of health care practitioners is based on its constitutional authority to protect the health, safety and welfare of the public. When a group of practitioners consistently demonstrates that its diagnoses and treatments do not serve that purpose, those practitioners lose their claim to the imprimatur of legitimacy bestowed by their practice acts. Advising patients against one of the most important public health accomplishments ever is simply one way naturopaths and chiropractors have forfeited the privilege of practicing a state-sanctioned health care profession. 

Points of Interest 12/18/2016
Points of Interest . 12/17/2016