How Two "Pediatric Chiropractic" Leaders Advise
Chiropractors to Undermine Pediatrician Credibility

Stephen Barrett, M.D.

Stuart Warner, D.C., and his wife Theresa Warner, D.C., operate a clinic in Point Pleasant, New Jersey, at which the majority of patients are children. They also run a "pediatric chiropractic" practice-management program called Future Perfect that teaches how to promote subluxation-based chiropractic care for children from birth onward. One technique they recommend is to use questions to subtly suggest that pediatricians are not thorough enough. The following article, posted on their Web site in 2004, included seven of their favorite strategies, each followed by my comment in boldfaced bracketed type.

Top 7 Strategies to Shift Credibility from the Pediatrician to the Chiropractor

Drs. Patricia & Stuart Warner

When most parents bring their children in for chiropractic care, they are faced with a pediatrician that is not supportive. Many times the parents trust in the allopathic system interferes with their chiropractic care. This list is part of a process that will more than level the playing field. It will plant doubt in the parents mind of their medical beliefs and increase their confidence in chiropractic. The thrust of this approach is to ask questions, be subtle and direct, not condescending and use proper timing.

  1. When a parent is holding a prescription for an antibiotic for their child's first ear infection ask this question. "Is your pediatrician following the federal guidelines published by our government that suggests that antibiotics should not be the first approach?" Pause and let the parent answer the question. Then respond, "Why do you think that your pediatrician did not share that with you?" [As new evidence developed, medical treatment for ear infections has been gradually shifting away from routine use of antibiotics for ear infections [1]. It might be appropriate for a pediatrician to discuss the evidence if a parent has concerns or questions or the doctor wants the parent to share in a decision about whether to use an antibiotic. Otherwise, there would be little reason to mention any guidelines. The Warners imply that failure to discuss whether or not to use an antibiotic is a sign of pediatric incompetence. Even if that were true (which it is not), that would not justify trusting a chiropractor for advice on ear infections. No published studies indicate that spinal manipulation or any other type of chiropractic treatment is effective against ear infections. Nor is there good reason to believe that the average chiropractor is qualified to examine a child's ear to determine whether it is infected and what type of treatment is needed.]

  2. After the parent fills out the new patient pediatric history form and your asking a few follow up questions, ask a question such as this, "Did your baby nurse equally from one breast as to the other?" (suggesting subluxation and range of motion). Pause and let the parent answer the question. Then respond, "Did your pediatrician ask you this question?" The answer is always no and then move on. [Many pediatricians do ask about this, but not for the reason implied by the Warners. Infants commonly nurse more on one side than the other, but this has nothing whatsoever to do with spinal problems or a need for chiropractic treatment.]

  3. Another question to ask during the history is one like this. "Did your child ever fall off their bed or take a tumble down the stairs?" Pause and let the parent answer, then respond, "Did your pediatrician ask you that? After the answer move on. [Some chiropractors would like parents to believe that minor falls cause spinal misalignments that can lead to serious problems if untreated. This is a scare tactic with no basis in reality.]

  4. When performing a surface EMG (subluxation station) pediatric chiropractic examination ask this question. "Did your pediatrician perform this test on your child?" The answer is always no, then move on with the next test. [The "Subluxation Station"is a diagnostic device that uses surface electromyography (SEMG) and several other invalid diagnostic tests to sell unnecessary long-term treatment plans [2].

  5. When checking the child's A-P and lateral posture ask, "Did your pediatrician check your child's spine this way?" After they answer move on to the rest of the exam. [Pediatricians normally check posture but not necessarily with the fanfare used by some chiropractors.]

  6. When performing a skin temperature measurement, ask the same question, "Did your pediatrician do this test." Respond, "Interesting" then move on. [Skin-temperature measurement is an invalid diagnostic test used by chiropractors to find "subluxations" that they claim need treatment [3].

  7. When a parent is frustrated that their child is on their 7th dose of antibiotics for reoccurring ear infections ask this question. "Is your pediatrician aware of the JAMA article that demonstrates that children that take antibiotics for otitis media have 2-6 times more reoccurrences than the children that took the placebo?" After the parent responds no ask, "Does your pediatrician keep up on the latest research and information concerning your child?" [Neither the parent nor the chiropractor is likely to be able to determine whether the child is being appropriately managed. This is simply another way to generate distrust.]

You will appreciate that the parent will see that you do something very different than their pediatrician and that what you are doing is logical and makes sense. [It would only make sense if the practice of detecting and correcting "subluxations" from birth onward made sense.] The parent will realize that you are very thorough and informative compared to their pediatrician who did not ask the appropriate questions nor perform the necessary tests to detect vertebral subluxation. Remember, keep rapport with the parent and don't over do it. In our practice after parents get over the frustration and expense of having their kids sick and on drugs frequently, and now as a result of chiropractic care their kids are healthy and off the drugs, 75 percent of our patients never go back to their pediatrician unless it is for a life threatening situation. When parents answer questions instead of being lectured to, they begin to shift and own the concepts. These strategies will help parents adopt the chiropractic lifestyle for their children's health care. Obviously after a couple of weeks, chiropractic results will speak louder than anything but this will help get you there quicker. [There is no scientific evidence that "detecting and correcting subluxations" has any health value. In fact, as far as I can tell, no well-designed study has even tried to determine this.]

In 2008, the New Jersey Board of Chiropractic Examiners disciplined the Warners for rendering bills that "represented multiple charges for the same chiropractic services" to three children of the same family [4,5]. The agreements settling their cases required payment of a penalty ($3,000 for Stuart, $2,000 for Theresa) plus $1,591.50 each to the state for costs and $25 per incorrect billing to either the patient's parents or their insurance company. Stuart's agreement, which mentioned the above article, also required him to stop "engaging in unprofessional dialog with parents of minor patients that is intended to undermine the relationships they have with other health care providers."

References

  1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Clinical Practice Guideline: Diagnosis and management of acute otitis media. Pediatrics 113:1451-1465, 2004.
  2. Homola S. Dubious use of surface electromyography (SEMG). Chirobase, April 15, 2005.
  3. Barrett S. How the Nervo-Scope and similar heat-detection devices are used to sell unnecessary chiropractic treatment. Chirobase, May 18, 2008.
  4. Barrett S. Disciplinary action against Stuart Warner, D.C. Casewatch, May 18, 2008
  5. Barrett S. Disciplinary action against Theresa Warner, D.C. Casewatch, May 18, 2008.

This article was posted on May 28, 2008.