“Vaccine Shedding”: Time Up For Another Vaccine Myth

One myth often pulled out by antivaccination lobbyists to malign vaccine safety is the senseless term “Vaccine Shedding”.

Whilst in context we all know what is meant, it’s worth pausing to consider that the term is a byproduct, if you will, of the antivaccination movement’s skill at sowing misinformation. The unrivaled ability to scan a headline and regurgitate some ghastly tale about vaccines. To squeeze another fallacious vaccine “danger” onto the shelf, content in the knowledge it will soon have a life of it’s own.

The colloquial use of this nonsensical term seeks to convey that an individual who has been vaccinated can readily shed part of the vaccine and cause infection in the unvaccinated. Which by definition demands them to have shed not a vaccine but an infectious agent. Indeed a virus or bacterium. Which by extension demands the vaccine to contain a live virus or bacteria. This then opens the door to viral shedding the vast complexities of vaccine induced immunity and viable modes of excretion – aka shedding. That won’t stop your garden variety anti-vaxxer claiming any vaccine can lead to infection of the unvaccinated via this ghastly “vaccine shedding”.

But that’s only part of the story. “Vaccine shedding” is a double barrelled myth in that transmission is assumed to occur ipso facto. Shedding is not transmission. Period. Yet denial of vaccine efficacy requires internalisation of some whacky stuff. Including the erroneous belief that viral shedding follows MMR vaccination. Yet worse is the myth that inactivated vaccines pose the risk of infection due to “vaccine shedding”.  Pertussis often brings out the malicious side of anti-vaxxers. DTaP is inactivated. Indeed the pertussis component is acellular. Update: The acellular pertussis vaccine is an example of a subunit vaccine.

So, you may wonder at the nature of Cynthia Janak who writes in Will the vaccinated infect the unvaccinated? That is the question with Whooping cough:

Before I continue I want to tell you about a fact that is known by the CDC, etc. That is called vaccine shedding. This is the transmission of the virus from a vaccinated person to an unvaccinated person. [….] I want you to understand that this is true for vaccines including the Whooping Cough. What you could have happen is that all these parents and child care workers are going to get the vaccine and then take care of children. [….] The vaccinated have the potential to infect the unvaccinated child. This could cause the next epidemic of disease like what happened with the small pox epidemic.

So, in Cynthia’s mind “vaccine shedding” is, “…transmission of the virus from a vaccinated person to an unvaccinated person”. Wrong. And it’s true for whooping cough. Impossible. Yet Cynthia Janak asserts there’s potential for an epidemic like smallpox? Pure fiction. Contracting pertussis because an unvaccinated and infected child or adult who ignores boosters has breathed on someone is, however, a simple fact. Aiming to inflate the danger of her misguided concern about “vaccine shedding” as “known by the CDC”, Cynthia uses references to FluMist.

FluMist a live attenuated influenza vaccine (LAIV) sprayed into the nostrils and well understood regarding shedding. Concerns about administering a live virus this way should be respected. So should the facts about any risks. It sheds in low concentration for short periods via nasal discharge. It is not associated with person to person transmission. Given that wild type influenza sheds at far higher concentration, is found on fixtures, objects, skin and is strongly associated with transmission, severe illness and complications it seems Cynthia has been selective about what’s “known by the CDC”.

“Vaccine shedding” is better suited to mid 19th century notions like the infectious miasma, wafting about in terrifying unseen clouds held aloft by our lack of knowledge. Nor does the rare instance of shedding suddenly turn any agent into a virus with the infectious capability of Ebola. But anti-vax voices are often raised in triumph that the crime of “vaccine shedding” places the community at greater risk than the rising numbers of unvaccinated.

The scale of error associated with this belief is akin to the myth of potential vaccine injuries outweighing the benefits of vaccination. Serious injuries that do occur are primarily in populations genetically predisposed to latent complications and manifestation is extremely rare. Injuries, disability and death from vaccine preventable disease would occur at magnitudes many hundreds or thousands of times greater and can manifest in anyone. Vaccine injuries are artificially inflated by confusing correlation (sometimes years apart) with causation, and by including red marks, crying, sleep disturbance or omitting that event X was a serious allergic reaction to latex syringe components. Similarly, arguing ones unvaccinated child is at risk from, or has been infected by, a recently vaccinated child is quite a claim.

Viral shedding itself is by no means ignored by the medical community. It’s of primary concern in the management of immune compromised patients, pregnant women and newborns. Varicella is an excellent example in that a.) viral shedding is well understood and b.) the risk from shedding can be discerned from precautions taken. Following varicella vaccination, viral shedding can be detected in the stools for six weeks.

In the case of immunodeficiency disorders or immune suppression from drugs, transfusions, stem cell transplant, chemotherapy etc, the recommendations are to avoid contact with fecal matter of vaccinated subjects and to observe good hygiene. To put this in context, unvaccinated children who spend one hour in a room with an infected child (shedding varicella) stand a 95% chance of contracting varicella (chicken pox). This is why vaccination against varicella is vital and choosing to not vaccinate your child places him or her and by extension countless others at risk of serious complication.

For nursing mothers post natal varicella vaccination need not be delayed if they are varicella-susceptible as varicella hasn’t been found in breast milk post maternal vaccination. There is no problematic risk of viral shedding to newborns provided hand washing and other hygiene measures are followed.

Whilst rare, a post-varicella immunisation vesicular rash can form. Again whilst quite rare, viral shedding can occur at this site. Plainly stated it’s incredibly rare for an unvaccinated child to be infected with varicella from a vaccinated subject and a series of events, including transmission, must occur within a small window of opportunity. Greatest precautions must be taken in the case of immune suppression. Writing in Vaccines in immunocompromised patients, Janet R. Serwint, MD Consulting Editor notes:

Because the varicella virus rarely can be shed through a postimmunization vesicular rash that may develop, recommendations include avoiding contact until the rash resolves.

In March this year there was an interesting case of viral shedding. The antivaccination lobby bellowed that Varicella zoster virus DNA had been found in the saliva of people over 60 vaccinated with the live Zostavax vaccine manufactured by Merck. In this age group Herpes zoster (shingles) is the target. Shingles is the result of infection with VZV earlier in life which may reactivate as immunity declines or from novel infection. Despite blog headings like Vaccinated people SHED LIVE HERPES for up to a month AFTER vaccination, be aware it was 2 of 36 “vaccinated people” who made the grade.

There was no indication of infection risk at the time. Today transmission is considered rare. Packet inserts carried the standard warnings found in varicella immunisations to avoid contact with infants, nursing mothers and immunocompromised individuals. “Doctors never tell you this”, lied the anti-vax lobby. The end result is that, fortuitously, it appears a saliva test could be developed allowing for detection and antiviral therapy before the painful rash appears. All up with rare potential for transmission from about 5% of recipients of a vaccine that’s not widely used it was a non event.

With MMR the lack of viral shedding renders any risk of horizontal transmission in this manner null and void. If challenged with the claim of “vaccine shedding” specific to Measles, Mumps, Rubella vaccination you’re being misled.

Peak shedding of Rotavirus occurs on “post-vaccination days 6 through 8”. Published in The Lancet Rotavirus vaccines: viral shedding and risk of transmission, notes:

Immunocompromised contacts should be advised to avoid contact with stool from the immunised child if possible, particularly after the first vaccine dose for at least 14 days. Since the risk of vaccine transmission and subsequent vaccine-derived disease with the current vaccines is much less than the risk of wild type rotavirus disease in immunocompromised contacts, vaccination should be encouraged.

The “vaccine shedding” bogeyman got a free kick with the FluMist LAIV vaccine. You may remember the hype. The spraying of “living influenza virus” straight into children’s brains was going to lead to mutation and death on an unprecedented scale. It would genetically revert to the wild type. Transmission would thus be uncontrolled. It would quickly prove useless against changing seasonal strains. ADR’s would rise…. and so on. Ultimately the cost proved to be a deterrent. Mayo Clinic have produced a welcome article on LAIV Myths.

In a comprehensive 2008 study with a sample aged 2 – 49 years, shedding “of short duration and at low titers” was detected in nasal swabs on days 1 – 11. LAIV recipients “should only avoid contact with severely immunocompromised persons for 7 days after vaccination”.

On Shedding and Transmission of Vaccine Viruses, in a larger piece on influenza vaccination of HCP, the CDC write:

One concern regarding use of LAIV among HCP has been the potential for transmitting vaccine virus from persons receiving vaccine to nonimmune patients at high risk. Available data indicate that children and adults vaccinated with LAIV can shed vaccine viruses for >2 days after vaccination, although in lower titers than typically occur with shedding of wild-type influenza viruses. Shedding should not be equated with person-to-person transmission of vaccine viruses, although transmission of shed vaccine viruses from vaccinated persons to nonvaccinated persons has been documented in rare instances among children in a day care center.

One study conducted in a child care center assessed transmissibility of vaccine viruses from 98 vaccinated persons to 99 unvaccinated controls aged 8–36 months; 80% of vaccine recipients shed one or more virus strains (mean duration: 7.6 days). [….] The estimated probability of acquiring vaccine virus after close contact with a single LAIV recipient in this child care population was 0.6%–2.4%.

It was also documented that should HIV positive children be exposed to LAIV shedding, “… serious adverse outcomes would not be expected to occur frequently”. So the combination of live virus shedding and immune deficiency in the case of LAIV presents low risk. Certainly the overall risk associated with the rare transmission following shedding after LAIV is insignificant given the risk of regular influenza virus transmission.

We’re running out of dramatic scenarios for the antivaccination lobby to cling to. With polio the wild virus replicates in the intestine and is shed in stools for up to a month. Transmission in developed nations is thus faecal-oral like other stool shed viral components. It is of course so rare as to be unheard of. However, given that the IOM report into evidence and causality of vaccine adverse effects found a causal link between the oral polio vaccine (OPV) and vaccine associated paralytic polio (or Vaccine Derived Polio Virus), we should seriously consider shedding in areas where this is documented.

In fact the question has been asked if prolonged VDPV shedding could be a source of reintroduction following polio eradication. The more compromised the immune system the more likely the individual is to have problems with vaccine induced immunity. A study looking for VDPV shedding in immune deficient subjects in Abidjan, Cote d’Ivoire found no cases in a sample of 419, and therefore a “minimal risk of reintroduction [after eradication]”. In respect of general exposure to shedding in these environments transmission of the wild type polio virus eliminates any concern over post vaccination viral shedding. Crowding, sewerage, water quality etc all contribute to wild polio spread in ways that do not apply to the developed world.

Remembering that viral shedding is of paramount concern in the management of immune deficiency and immunocompromise, let’s revisit the Janet R. Serwint, MD of Vaccines in immunocompromised patients. Rather than warn against exposure to immunised children the recommendation is to ensure schedules are up to date and an annual inactivated influenza vaccine is on board. Pay attention to reference to MMR, varicella and rotavirus:

One strategy worth emphasizing is the immunization of household contacts, particularly other children and adolescents in the family. This procedure is essential to try to minimize exposure of the immunocompromised patient to household contacts who might contract vaccine-preventable illnesses. Pediatric health-care clinicians need to update and review the vaccine status of all siblings and pediatric-age household members. Annual influenza vaccination of all family members with inactivated influenza vaccine is recommended in addition to ensuring routine immunization of all other recommended vaccines.

MMR, varicella, and rotavirus vaccines, although live viral vaccines, are recommended for immunocompetent household contacts because transmission of the virus is rare. The lack of viral shedding with MMR eliminates concern regarding transmission. Because the varicella virus rarely can be shed through a postimmunization vesicular rash that may develop, recommendations include avoiding contact until the rash resolves. For the rotavirus vaccine, avoidance of contact with the stools by the immunocompromised patient and good hand hygiene measures by all family members for at least 1 week after vaccination should be implemented.

In conclusion it’s clear that “vaccine shedding” is a nonsense phrase. The lack of accounts of children transmitting viruses to younger siblings and friends after vaccination is a dead giveaway. Whilst viral shedding is a reality we can be confident that:

  • Viral shedding applies only to live virus vaccines and is significantly low, low risk
  • Post vaccination viral shedding of rotavirus and varicella is detected in the stools for 4-6 weeks respectively. It’s of such low risk as to be of cautionary interest regarding immunocompromised individuals
  • Genuine concern about viral shedding in these groups is managed with sound hygiene and avoiding contact with stools
  • In rare cases of post varicella immunisation vesicular rash shedding may occur. Transmission is still unlikely
  • The lack of viral shedding following MMR eliminates any concerns about transmission
  • Claims of DTaP shedding and transmission are bogus
  • Stories about whooping cough transmission from vaccine shedding are demonstrably false
  • Stories of polio infection being a risk due to shedding are designed to scare
  • Antivaccination lobbyists use false and incomplete information about shedding to create fear of vaccines/the vaccinated
  • Shedding of LAIV is at markedly low concentration, short duration and transmission is dwarfed by seasonal influenza transmission
  • Accurate information about the topic is drowned out by antivaccination sites and “mothering” forums making inaccurate claims

Update: April 13th 2015 – Added references;
Is the MMR vaccine spreading the measles virus?: The question of shedding

Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20649
Live Attenuated Influenza Vaccine [LAIV] (The Nasal Spray Flu Vaccine): http://www.cdc.gov/flu/about/qa/nasalspray.htm
Live Attenuated Vaccines (LAV): http://vaccine-safety-training.org/live-attenuated-vaccines.html
Measles – Q&A about Disease & Vaccine: http://www.cdc.gov/vaccines/vpd-vac/measles/faqs-dis-vac-risks.htm
Measles: Questions and Answers: http://www.immunize.org/catg.d/p4209.pdf?q=measles
Measles Vaccination: http://www.cdc.gov/measles/vaccination.html
Rotarix WHO leaflet – tube: http://www.who.int/immunization_standards/vaccine_quality/Rotarix_liquid_tube_product_insert_text_2009.pdf?ua=1
Rotavirus: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rota.pdf
Transmission of Measles: http://www.cdc.gov/measles/about/transmission.html

Meryl Dorey’s trouble with the truth: Part 3 – Lies and Fraud

You were shocked, astounded and aged beyond your years with Part One. Fearing collapse, you sent your family away and took leave to stay home and read Part Two.

And now, the frequent rumours. The disturbance in the Force. The smell of Supreme Court cases in the morning. It could only mean…

Meryl Dorey’s trouble with the truth: Part 3 – Lies and Fraud

© Full attribution, Mr. Ken Mcleod

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Blackmores, Pharmacy Guild saving face

Last we visited the Blackmores, Guild Alliance there were serious doubts about evidence from Blackmores or understanding from the Guild.

Not much has changed on admitting fault, even with the removal of the Gold Cross endorsement. Which, by the way, was the fault of “ill informed and inflammatory” media reporting leading us goofy consumers to exhibit a “strong level of public concern”. I wonder where the Guild gets off trying this one on. There’s something missing from this sudden awakening in which “the Guild has listened to these concerns and accepts – mutually with Blackmores… to withdraw the endorsement arrangement”.

For example the AMA, according to president Steve Hambleton, considered the deal “outrageous” and that, “There’s no place for commercial interference in the clinical decision making of the pharmacist”. This was and is reflected in GP’s responses, including some writing notes with scripts to not include the “companion range”. Professor Paul Glasziou, director of Bond University’s centre for research in evidence-based practice had, on ABC, called Blackmores’ bluff on supporting evidence.

Chemist Warehouse had publically and loudly protested, promising to not participate in the deal. “Our pharmacists recommendations are not for sale” and “Professionals Practicing Professionally” stated their defiant flyer. Ouch!

Many individual pharmacists were, to put it mildly, infuriated and appalled at the Guild’s total stuff up which effected the integrity of all pharmacists.

Stuart Baker, a pharmacist from Western Victoria quit the Guild in protest. In view of the decision to drop the Gold Cross endorsement he still won’t be returning. Damage done there it seems. In light of the Guild’s inability to accept responsibility for such poor decision making the damage could be both more widespread and persistent.

Jane McCredie recently wrote in MJA Insight:

PHARMACISTS have long felt like the poor relations in the broader family of health professionals when it comes to status and respect, if not monetary reward.

In recent years, their representative bodies have lobbied for expanded prescribing rights, for recognition of their role as front-line “clinicians” and against allowing pharmacies in supermarkets for fear this would undermine the quality of health care provided.

It’s going to be a lot harder to make those arguments convincingly in the wake of the spectacularly ill advised deal between the Pharmacy Guild and Blackmores that created such a media furore last week.

October 5th saw the Pharmacist Coalition call on the Guild to dump the scheme. AusPharm News reported in part:

The Pharmacist Coalition for Health Reform (PCHR) has called on the Pharmacy Guild of Australia to axe their deal with Blackmores, following the Guild’s admission that the computer prompts to upsell dietary supplements were a pilot only and would be reviewed.

PCHR spokesperson and Chief Executive Officer of the Association of Professional Engineers, Scientists and Managers, Australia (APESMA), Chris Walton, said that pharmacists had rejected the deal and it was now time for the Pharmacy Guild to scrap the pilot. “A Pharmacist Coalition poll of over 460 people has shown that 94 per cent of community members, including pharmacists and pharmacists-in-training, disagree with the Blackmores’ deal and believe ‘it undermines the professionalism of pharmacists’.

“This has been further supported by The Age online poll which revealed that of over 2,000 voters, 94 per cent do not approve of the ‘Pharmacy Guild of Australia’s deal with Blackmores to recommend Blackmore’s supplements’. [….] PCHR spokesperson and Chief Executive Officer of The Society of Hospital Pharmacists of Australia (SHPA), Yvonne Allinson said The Pharmacy Guild has lost credibility and a failure to scrap the pilot would damage their reputation further.

Gold Cross is a fully owned subsidiary of the Guild. Now that the Gold Cross endorsement has been cancelled their logo, if you like, won’t appear on Blackmores companion range. Nor will the pilot project of software prompts at point of sale go ahead. The decision was “made in conjunction with Blackmores”.

The mutual decision has been taken in view of the strong level of public concern about the proposal, based on some media reporting of the endorsement which was ill-informed and inflammatory.

The last thing the Guild would ever want to do is deplete the credibility of community pharmacists, or damage the trust in which they are held by Australians. That trust and confidence is of paramount importance to the Guild and to our Members. The Gold Cross endorsement arrangement with Blackmores was entered in good faith, with absolutely no intention of undermining the professionalism and integrity of participating pharmacists. [….]

Additionally, an optional prompt containing clinical information for the patient to consider in relation to one product of the Companions range was to be available through the dispensary IT programs, on a pilot basis. The software pilot was not intended to commence until at least November, and will now not proceed.

Chris Walton CEO of APESMA Pharmacist division said in response:

This is a pathetic back down by an out of touch organization. The Guild has been dragged kicking and screaming to the decision and still will not take responsibility. They describe their decision to enter the deal as one made in good faith. Good faith must now be code for a bag of coin.

The profession should never forget that the Guild was willing to trade on the good reputation of pharmacists for commercial gain. While the same people are in charge why would we ever trust them again. Any pretence that they represent the pharmacy profession is over.

Still insisting that the “need for these natural health supplements for some consumers is underpinned by a body of scientific evidence”, Blackmores released a statement also with soothing noises about having listened. But they go one further and point out the “considerable confusion” in waking up to their scam. Hmmm. Perhaps they have a supplement for that? Either way, also from October 5th:

We have listened to the feedback on the Companions range and it is apparent that there is considerable confusion regarding the positioning of this range which we believe is detracting from the potential underlying benefit of these products to consumers.

As a result, and following discussions with Gold Cross, Blackmores will remove the Gold Cross endorsement from the four products, we will not feature these products on the proposed IT dispensary software and we will update the product names to reflect the key ingredients, under the Companions brand.

Blackmores have published research on their professional page for “health professionals” which is well summarised here. I suspect in response to the NPS review of evidence to sustain (cough) claims made in defence of the “companion range”. Christine Holgate opens her heart here about “misconstrued” information and accurate representation of “integrity”. Basically, it’s all good and they’re doing Aussies a favour. No, really.

All up, it’s rather shameful. The Guild haven’t in effect admitted being at fault. At most they seem to grudgingly admit to a type of PR blunder. Blackmores is sticking to it’s guns pleading misunderstanding on the part of the public and a raft of health professionals. Marcus Blackmore bemoaned that a full scale assault on complementary medicines had grown out of the same misunderstanding. ABC have a comprehensive write up with audio and video.

Jane McCredie finished her MJA Insight article in style:

The Pharmaceutical Society of Australia is due to release a new code of ethics for its members — along with a vision for the profession’s future — at its annual conference later this week. It would be nice to think that code might require pharmacists to disclose the level of evidence for any non-prescription medication they sell — hardly an unreasonable demand of people who want to be recognised as clinicians.

I’m imagining the conversations now if this code is implemented. Pharmacists selling homoeopathic remedies will be required to tell each and every customer: “There’s not a skerrick of evidence this works, but if you want to throw your money away…”

Therein lies the very source of the problem. Blackmores’ deal stood out because it officiated upselling and would have included entirely unwarranted prompts. Both the Guild and Blackmores knew it to be a grab for money. So did everybody else. Yet pharmacists do recommend and sell junk to consumers. Assistants do little if anything to dissuade from spontaneous buying.

Doctors will testify to patients at times admitting to taking large amounts of useless supplements. It’s documented that patients are reticent to admit to doctors they use alternative products. In the main doctors are missing out on vital information they need to properly treat their patients.

The only durable solution is for the TGA to move forward with sharp teeth and legislation to call CAM what it really, in the main is.

Unproven and unnecessary.

Pediatric Chiropractic integrity faces new challenges

Yesterday the BBC reported that the University of Wales is to cease validating “other degrees”.

Accrediting degrees from private colleges has no doubt been lucrative for the Uni of Wales. But it’s also proven to be a slur on expected standards. Early last November the BBC reported on the Uni. of Wales suspending accreditation of degrees from a controversial Malaysian business college. Overseas accreditation was always a risky venture and this debacle led to Leighton Andrews, Minister for Education in Wales to claim that Wales itself had been brought into disrepute. The university he said, had let down Higher Education. The Quality Assurance Agency for Higher Education ultimately requested that the Uni. of Wales review the entire caper.

The decision places doubt upon McTimoney Chiropractic College, having its degrees approved. This is nothing less than tremendous news for thinking Australians and anyone concerned about a discipline that runs “seminars” designed to lure paying customers into entrusting their child’s health to unproven guesswork. Such as, How to create the ‘It’s normal for children to be adjusted’ mindset with your clinic and your community, or How to have the majority of your patients as children. These are just a couple of the gigs run by RMIT graduate Glenn Maginness of the Mt. Eliza Family Chiropractic Clinic.

All this comes together if we consider that McTimoney College offer degrees in the McTimoney Chiropractic Method, named after the late John McTimoney. These guys are famous for ordering all members to remove their entire websites at the beginning of the Singh libel case because they were veritable cornucopias of bogus claims. McTimoney always knew they were in the business of scamming when it came to claims about children and feared justified complaints. They also hold claims to fame for having atrocious academic standards in “make believe degrees” as espoused by David Colquhoun.

One of the “special” degrees from McTimoney College happens to be in Pediatric Chiropractic. Indeed, to my knowledge the only degree worldwide in Pediatric Chiropractic comes from McTimoney, and is validated by The University of Wales. From this hub radiates the dangerous and unproven practices and claims from the RMIT pediatric clinic – subject to a highly supported request to close it down reported in the BMJ – the greed of people like Glenn Maginness, potentially lethal antivaccination misinformation from Warren Sipser and Nimrod Weiner and the overarching mystical philosophy of Simon Floreani’s Chiropractors’ Association of Australia.

One hopes this abuse of Higher Education will be challenged, given the lack of evidence for chiropractic in general and the total absence of evidence for pediatric hanky panky. You may have heard of the KiroKids franchise chain in Victoria. In which case you’ll be delighted to know that the “course leader” for the Masters Degree at McTimoney is none other than the brains behind the unconscionable KiroKids scam. Not-a-real-doctor Neil J Davies himself. He boasts:

The MSc degree course now offered to the chiropractic profession by McTimoney College of Chiropractic was designed and written by the Course Leader, Dr Neil J Davies in conjunction with a group of leading paediatricians and other medical specialists and chiropractic advisors.

The course was in development for a period of 4 years and in August 2003 it was duly validated by the University of Wales. The course has been so well accepted by the chiropractic profession that enrolment applications have been received from 14 different countries including the United Kingdom.

Davies waffles about Intelligent Neurological Chiropractic. He has not one research paper published. He does have a text book however, and has won the auspicious Fishslapper of the week prize. Given that UK criticism of chiropractic has been scathing of the “new breed” of outright cons if you will, it may be that validation of McTimoney chiropractic degree ceases. This will put a welcome abrupt halt to the growth of one of the most unfortunate exploitations of vulnerable parents ever witnessed. But it goes further than just scamming a gullible public. They not only cause harm to children’s musculo-skeletal integrity and inflict stroke and death through cervical manipulation. By peddling misinformation and indirectly sustaining falsehoods about conventional medicine their status as a one stop shop for quackery is firm.

Consider this from the abstract of Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers:

Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1-17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Use of provider-based complementary/alternative medicine by other family members was not independently associated with early childhood vaccination status or disease acquisition.

Pediatric use of complementary/alternative medicine in Washington State was significantly associated with reduced adherence to recommended pediatric vaccination schedules and with acquisition of vaccine-preventable disease. Interventions enlisting the participation of complementary/alternative medicine providers in immunization awareness and promotional activities could improve adherence rates and assist in efforts to improve public health.

Still, we must remember whilst the claims of chiropractic are primarily nonsense, John Reggars, past president of the Chiropractors Registration Board of Victoria and present vice president of the Chiropractic and Osteopathic College of Australasia, is a voice of sanity. Reggars has been scathing toward tactics (presently backed and encouraged by the CAA), used to increase income for chiropractors and. His article Chiropractic at a crossroads or are we just going around in circles, [Archived copy] published in Chiropractic and Manual Therapies, May 2011, is a compelling read.

Reggars claims the “all-encompassing alternative system of healthcare is both misguided and irrational”. And;

“Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the vertebral subluxation complex to an ignorant public,” Mr Reggars said.

“Phrases such as ‘double your income’, ‘attract new patients’ and ‘keep your patients longer in care’, are common enticements for chiropractors to attend technique and practice management seminars.” Mr Reggars, who stressed his support for the “mainstream majority” in the profession, also condemned the use of care contracts, where patients signed up to a fixed number of treatment sessions.

“Selling such concepts as lifetime chiropractic care, the use of contracts of care, the misuse of diagnostic equipment such as thermography and surface electromyography and the X-raying of every new patient, all contribute to our poor reputation, public distrust and official complaints.”

“For the true believer, the naive practitioner or undergraduate chiropractic student who accepts in good faith the propaganda and pseudoscience peddled by the VSC teachers, mentors and professional organisations, the result is the same, a sense of belonging and an unshakable and unwavering faith in their ideology.”

Integrity like that of Reggars reminds us that the option of subjecting students to proper education will always come up in this debate. Many will argue that a change at the institutional level will result in professionalism at the clinical level. Yet chiropractic has always had difficulty selling its song as much more than a jingle. It hasn’t just recently gone awry with brats the like of Floreani, Weiner and Davies, all of whom should be vigorously prosecuted for false claims and fraud under the appropriate health act and advertising codes. There have always been crooks and there probably always will be.

It’s not a discipline. It’s a belief system and it peddles subjective faith on so many levels. Many like Reggars have done an admirable job and we can remain thankful for the attempts of the Chiropractic Boards to address complaints. Yet today chiropractors are expected to provide for the new age worried well. In the eyes of so many real disciplines they are not health practitioners. They practice rituals. The superstitious “result” is achieved by so-called “patients” who think themselves into a state of wellnesss – whatever that is.

The very last demographic we need pushed into this anything-goes nonsense are impressionable children. Let’s hope the decision by the University of Wales has far reaching consequences.