Government Support and the Research Challenges of Chiropractic Pediatrics
Dr. Dennis Leduc, a McGill University pediatrician recently stated that “There are no physical ailments in childhood, whether they be ear infections, asthma, or other physical problems, that have ever been shown to be amenable to chiropractic manipulation or therapy.”
The story released Friday by The Star Phoenix reports that the concern is over 5,297 chiropractic pediatric treatments at the cost of $80,921 paid in Saskatchewan this last year.  The Health Ministry is considering if it will continue to subsidize chiropractic pediatric care in Saskatchewan.
The key issue is the rampant misunderstanding or intentional misuse of the original concept of evidence based care. Governments and the insurance industry often view evidence based care as treatment supported only by rigorous scientific evidence.
Sackets original concept of Evidence-based treatment has three components;
- the current scientific literature, which includes more than randomized controlled clinical trials,
- the clinical expertise of the health provider, and
- the desires and needs of the patient.
Recent attempts to deny chiropractic care in the U.S. and Canada have ignored these latter two elements and focused solely on limited components of the published literature.
Dr. Leduc was the past president of the Canadian Pediatric Society. The official journal of the Society is Pediatrics and Child Health. Ironically, a 2005 a review of evidence supporting chiropractic care appeared in the 2005 issue of that very journal.  This was the first chiropractic paper published in the journal of the Canadian Pediatric Society. An updated review was published in 2008.  Both reviews attempt to harvest the available scientific literature supporting chiropractic care of children and, although the quantity and quality of research supporting chiropractic care for children is limited, there is a growing body of literature supporting such care. This literature surpasses some of the limited literature used to support reimbursement for some medical interventions.
A recent chiropractic consensus process by Hawk, et. al. used a number of experienced pediatric chiropractors.  The level of consensus among that group relative to key concepts of child and infant care was high (80%). These consensus processes help fill some of the gaps in current evidence and help direct future research.
The difficulty of providing high quality pediatric research is very challenging for the chiropractic profession. There are added requirements in terms of bioethics and Institutional Review Board review constraints that create challenges. As one medical group put it “excessive regulatory oversight is seriously affecting translational research and quality improvement efforts.” They have identified 5 problem areas that restrict pediatric research. The same constraints apply to chiropractic research. 
Two other major impediments to chiropractic research in general are
- the limited number of the profession engaged in research, and
- the very limited funding available.
There are also only a hundred or so chiropractic researchers who have extremely limited funding to conduct their work. With this backdrop, it is more incumbent upon individual chiropractors and chiropractic organizations to support pediatric research.
1. Government may stop subsidizing child chiropractic treatment
The Star Phoenix
2. Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review
Paediatr Child Health. 2005 Mar;10(3):157-61
3. Chiropractic manipulation in pediatric health conditions – an updated systematic review
Chiropr Osteopat. 2008 (Sep 12);16:11
4. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process
J Manipulative Physiol Ther. 2009 (Oct);32(8):639-47
5. Grinding to a halt: the effects of the increasing regulatory burden on research and quality improvement efforts
Clin Infect Dis. 2009 Aug 1;49(3):328-35
Full-Text of “Grinding to a halt” is now available
Thanks to ChiroAccess for access to this material!