"DC": Why did you feel that it was necessary to organize the statement by the 13 Canadian pediatricians denouncing chiropractic care of children? (See "Orthopractic Declares WAR on Chiropractic Pediatrics in Sept.
Dr. Katz: These pediatricians and I have seen over the last four or five years increasing involvement of chiropractors with children. Some of us were concerned. We had one pediatrician treating a child for recurrent ear infections and was told by a chiropractor to stop taking antibiotics and subsequently deteriorated. We had another pediatrician involved in this program who had a mother whose child had learning disorders and brain damage and was told to get involved with a chiropractor who could cure the learning disorders. So I think it's a reflection of the increased concern among doctors. It's not a question of me being the initiator of many of these things now. It's becoming more and more common to many doctors that there is a problem here.
"DC": When you spoke last May before the Ontario Medical Association in Toronto, you stated at that time that there would be 25 pediatricians behind you in making a public statement against chiropractors treating children. There were however only 13 pediatricians who signed it.
Dr. Katz: Did I mention that petition at that stage? I don't know if I did.
"DC": Yes, you did. Do you want me to quote it to you?
Dr. Katz: Sure.
"DC": "Now there is (sic) Canadian pediatricians all across Canadian, I'm the mouthpiece for that. I can tell you there is (sic) 25 people behind me, heads of all the hospitals, who are going to make a public pronouncement about this in the next couple of weeks and they are going to ask the media all over the province to stop treatment of children of pediatric age up to 18. That's going to be all across Canada."
Dr. Katz: There are a lot of people who are involved who are not the chiefs of hospitals. There are only 14 hospitals and one chief didn't sign because that person wasn't available, that's about it really. There were other people. If you look at the people who are listed as references to be contacted by the media, there were people from the Canadian Pediatric Society, there were people who were the heads of genetic departments, there were different people.
"DC": Why didn't the Pediatric Society sign it?
Dr. Katz: We didn't ask them to. We didn't want it to be from a society because we found in the past that whenever it's an association or an official medical group, all that happens is you get accused of protecting your own interests. It was felt that it would be more personal and more acceptable if it was the chiefs of hospitals that actually treat children rather than association members who might not even see children. The Canadian Pediatric Society was never asked to endorse it, and whether they do or not, that's up to them. There was a representative who was asked to be a media contact for any questions, who is an official of their society.
"DC": Now that you've initiated the medical pediatric community's attack on chiropractic pediatrics in the media in Canada, do you plan the same kind of effort in the United States?
Dr. Katz: There is no campaign to have chiefs of US pediatric hospital endorse a similar statement as in Canada. We feel this would be redundant and unnecessary. Much of the US media is fully aware of the statement from the Canadian pediatricians. However, the Canadian pediatric statement will be published in a US pediatric publication with access to some 50,000 pediatric care providers. Finally, the issue of chiropractic treatment of infants and children will continue to be brought to the attention of just about every significant federal bureaucrat involved in scope of practice decision making.
"DC": Will you be criticizing other aspects of chiropractic practice or do you see the focus being on chiropractic pediatrics for a while?
Dr. Katz: I guess the point we're making is that a person who treats an adult person's back, who treats a child for bedwetting or ear infections, we think would be better off treating the adult person's back. I think there's an analogy here where it follows that those chiropractors who don't claim to treat learning disorders and Down's syndrome tend to be, I think, more scientific and I suspect are more acceptable in terms of adults. I know from the inquiries we've had from government and insurance companies both in the United States -- I'd say predominantly in the United States -- and Canada, one of the things they seem to be looking at is identifying those scientific chiropractors and one of the criteria seems to be: "What are their claims in terms of treating children?"
I'd like to make one thing clear. The Orthopractic Society does not forbid all chiropractic treatment of children. On the contrary, and this was stated in the statements 9 and 10 of the chiefs of pediatrics, we believe that chiropractors can be very helpful in treating children primarily of the adolescent age who do have musculoskeletal aches and pains and can give advice regarding exercise, regarding posture, regarding avoidance of injuries, which can be very helpful. The limitation in regard to children relates basically to the treatment of organic, visceral diseases by manipulation therapy.
"DC": Your number 9 and 10 statements by the Canadian pediatricians must be different than mine. My number 9 speaks about adults, initially, and goes on to talk about unscientific claims about treating pediatric conditions. Number 10 says: "The musculoskeletal problems of infants and children can be managed in a safe, scientific, and responsible manner by the family physician, the pediatrician, the orthopedic specialist, the physical therapist, and with medical consultation, those chiropractors who adhere to the orthopractic guidelines." You seem to be requiring medical consultation only with chiropractors.
Dr. Katz: The word that was left out was "referral." We don't think that chiropractors need to work on a referral of a doctor at all. We think they can see these people directly.
"DC": But with medical consultation?
Dr. Katz: What it means really is that we would like the chiropractor to be close as possible to any medical personnel, to work in cooperation together.
"DC": So if a patient isn't seeing a medical doctor for the musculoskeletal condition then you would want those chiropractors to encourage the parent to have the child seeing both an MD and the DC?
Dr. Katz: That's right. The chiropractor certainly can see the child first, prescribe what they think is necessary, undergo the treatment, and encourage it. This was a big step because I think the pediatricians don't want chiropractors to have any contact with children whatsoever. It's very hard to find a pediatrician who will agree to any type of contact and I think you could ask 50 and see what you come up with. I think that the chiefs of pediatrics recognized that there are out there some very sincere and very scientifically capable chiropractors who we would like to develop more positive, more closer cooperation with, and that in the area of musculoskeletal problems of children -- a lot of chiropractors work with swim teams and athletic teams and do a very good job in terms of giving advice -- and we would like to work with those people. This was a big concession on the part of the pediatric community where the feeling is really strong about chiropractors' involvement with children.
"DC": Why have you declined to have your name mentioned in either the Consumers Report article or the Canadian pediatricians' statement? Do you see yourself as a behind the scenes operative?
Dr. Katz: There is a myth here, and the myth is that this is all Murray Katz. I am probably the most informed person on this issue in Canada, because I have the most information on it and I am the one person who actually wrote a paper which was published as part of a medical library and accepted as a standard medical reference. So I'm often asked for my opinion, but there should be no doubt that hundreds of other people in insurance industries, in the medical community, and government who believe in this. I was consulted as a reference not as a signature. I'm not the chief of pediatrics in a hospital, so there was no reason for me to sign it. I was one of several references. I was a researcher, and I was not the chief.
"DC": Earlier you spoke of certain issues, dealing of chiropractic treatment of some types of childhood disorders. Let's take otitis media with effusion, for an example. Can you explain your reasoning as to why you believe chiropractors shouldn't treat children with otitis media?
Dr. Katz: Because I believe that otitis media is an infectious disease, and it's also a disease which is due to eustachian tube dysfunction. It's a disease that tends to run in families on an inherited basis, and children outgrow this disease naturally between four and six years of age. As they get older, as the eustachian tube elongates, the shape of the tube changes. So when they are that young, three-year-olds for example, one out of six or seven of these kids will be there for an ear infection. The chiropractic claim that there is somehow some subluxation in the neck with a nerve being interfered with as it goes to the middle ear makes absolutely no anatomical sense and will never ever be proven. I admit that doctors do many things which are not scientifically understood, but we abandon those things we don't understand. If the chiropractic theory is that the glosaphangeal nerve is the problem (i.e., the nerve supply), I would respond that first of all that nerve does not go into the neck, and secondly the connection with the autonomic nervous system are very well anatomically known and there is no mysterious action of the autonomic nervous system that is not known on the middle ear.
If you follow it in chiropractic logic, if the child gets an ear infection in the left ear, we would suppose that there's a subluxation on the left side interfering with nerve or the autonomic nerve. In other words, those bones are out of place in some way, and you're going to adjust the back into place. On the right side, if it's a right ear infection, this would be taking place on the right side. Thirty percent of children have effusions in both ears which would be an anatomical impossibility for the bone to be broken on both halves or subluxated on both halves at the same time interfering with both ears. So it makes absolutely no sense whatsoever. Also, the nerve, as it starts in the brain and goes all along its route towards the face and the ear, supplies many organs, many muscles, and many tissues. And if you had 10 people hanging by different ropes on a cliff and someone cut the beginning of the rope, then all ten people would fall. It wouldn't be that you have a problem in the neck which cuts the rope and only the ear falls. So that all doesn't make any sense, and neither does this whole thing about lymphatic massage and so on.
What does make sense to the chiropractor is their own personal "clinical experience." What they have is a mother who comes to them and says, "I am tired of my child taking antibiotics, and my doctor has recommended a surgeon who wants to put tubes in my child's ear. I don't want to have tubes put in the ear. Is there something you can do? I'm a medical failure." And the chiropractor is then saying, "Well, we'll try. I can't guarantee you anything, maybe it will work and maybe it won't." The chiropractor is taught that by adjusting the neck, he will do something, or lymphatic massage. So from his own clinical experience, he begins his treatment. What he doesn't understand is that it makes no anatomical sense, although it makes personal sense to the mother involved. It makes emotional sense, rather than scientific sense, and what he doesn't understand is that eustachian tube dysfunction is something which goes and comes, so if he or she tells the mother, "Come to me once a week, and I'll adjust the neck," and he or she does that, and it gets better because the eustachian tube opens spontaneously, he or she feels they have done something. If it doesn't get better, he can say, "Come to me twice a week, it's a tough case. After all, it was going to need surgery," or "After all, you took too many antibiotics which poisoned the system." So in that set up, he never fails. But what is wrong with that system is that the treatment has no value and what is wrong with that system is that those children who do need surgical or antibiotic treatment, which I admit doctors do too often and that's our own problem, will eventually end up with perforated ear drums or more scarring or more problems. Not many, not many at all, but that will happen and that does happen.
"DC": So it's basically your contention that regardless of the theory behind it, chiropractic treatment will have no positive effects on otitis media with effusion?
Dr. Katz: It will have no effect whatsoever and can never be proven to have any effect because it's like saying a chiropractor can help a child with a learning disorder by manipulating his spine, when the learning disorder begins in the brain and not in the spine. Until such a day when the brain is between two vertebrae in the spine, it cannot and does not and will never make any anatomical sense. It does make emotional sense to a mother who is desperate and looking for any answer.
"DC": If these facts are as anatomically evident as you claim, wouldn't every medical doctor in the world share your same understanding of chiropractic treatment for otitis media?
Dr. Katz: I don't know if every doctor, because the fact that someone is a doctor doesn't mean that they follow a lot of beliefs. There are a lot of doctors who don't believe in immunizations, and other doctors who don't believe certain things. The fact that you have an MD training is not really indicative of how you think later on in life.
"DC": Wouldn't most prominent pediatricians think this?
Dr. Katz: I would say there are exceptions, and when you discuss with these doctors why they have those exceptions, they really don't have any reasonable explanation that makes sense to the majority. So I would say 95 percent of pediatricians or maybe 99 percent would agree, yes, but not 100 percent because not everybody agrees on everything. I know one sort of so-called prominent pediatrician has helped write a chiropractic book, a reference for ear infections. That's his opinion but I would say we are pretty well unanimous.
"DC": Are you aware of the Agency for Health Care Policy and Research of the United States department of Health and Human Services?
Dr. Katz: It rings a bell, but I'm not exactly sure.
"DC": This is an agency that sees to the development of national practice guidelines for the United States, and it's part of the federal government under the department of Health and Human Services. You're probably not aware then that they have just published national guidelines for the treatment of otitis media with effusion.
Dr. Katz: I'm not aware.
"DC": It might be something you would want to get.
Dr. Katz: Sure.
"DC": In the publication, they have a list of treatments that they recommend and a list of treatments that are not recommended. They also list different treatments that they don't have any recommendation for because they feel that they don't have enough evidence to make a decision one way or the other. Chiropractic did not end up in the list of treatments not recommended. Now, this is a panel made up of 20 of the most distinguished pediatric specialists in the country. Can you give me any explanation why what is apparently incredibly self-evident to you was mysterious to the American MDs who produced the AHCPR guidelines on otitis media?
Dr. Katz: I don't think that's the right question. I think you'd have to ask them why they did that. One thing I've discovered is that in the United States people in the medical community are very reluctant to enter into what could be a lawsuit regarding chiropractic because the past record is that they get legally involved, and so I think that there could be other considerations. I know with certain medications, that when panels do medication reviews, they will sometimes say "probably effective, we're not sure" types of things when in fact there really isn't very much evidence. I think the bottom line is that things have to make anatomical sense.
"DC": You're either suggesting to us that the American pediatric community is either so afraid of chiropractic, even under the care and the auspices of the federal government, that they still don't have guts enough to come out and say what's true about chiropractic, or that they just share your beliefs.
Dr. Katz: Well, I think you would have to ask them if they share the beliefs. I think they do, I don't know for sure, and I don't know why they put something in a certain category. Did they say it was effective?
"DC": No, what they did say is that they did not have sufficient evidence and they encouraged research into that area.
Dr. Katz: Sure, well they might not know what chiropractors really claim.
"DC": This is an organization that spent two to three years investigating every treatment of otitis media known to man.
Dr. Katz: Certainly, I'm not against any treatment which works to help children. I have no reason to be against it. Ear infections are very frustrating problems and if there is any possible treatment that would help a child, I really have no reason to be against it whatsoever. In the same way, I feel that back problems in adults are a very important problem, and I have no hesitation in saying that I think manual and manipulation therapy are of some value.
"DC": I guess what seems interesting is that this group which has gone through a thorough search of all the literature, through scientific debate, through public testimony, would feel comfortable in stating that there are several different types of surgical interventions and several different types of drugs that are not recommended and would come to a position of even encouraging research into areas like chiropractic, yet a non-pediatrician in Quebec (Dr. Murray Katz) tries to tell us that the facts negate any possibility that chiropractic care could have any effect whatsoever on otitis media with effusion.
Dr. Katz: The chiefs of 13 pediatric hospitals in Canada agreed with what I had to say. I really can't comment on the US report. I don't know the reasons why they would said what they did. I think that if you have any suggestion that they feel this would be valuable therapy, then I think you should interview them, and have them explain why.
"DC": The Canadian chiropractors are calling for an investigation of your Orthopractic Manipulation International corporation, and they plan to file a formal complaint against you personally. How do you feel about that?
Dr. Katz: I don't understand why that has anything to do with me personally.
"DC": That's what they said in their press conference.
Dr. Katz: Yes, I know, I saw that, it was sent to me. I don't understand what is wrong with the Orthopractic Society. I mean, in a nutshell, the Orthopractic Society endorses manipulation therapy as of value, the Orthopractic Society says that chiropractors can work on non-referral from doctors, the Orthopractic society says that there should be good communication between doctors, chiropractors and physical therapists. The level of communication has been fantastic in the last year. The only thing that the Orthopractic Society says "no" to basically is total body x-rays of children and claims to cure systemic diseases by manipulation. So they can complain to whom they like and attack me personally, but I'm not the problem. The problem is what the scientific evidence is, and I would ask a chiropractor who is interested in cooperating with physicians to name me the last time a medical pediatrician referred them a baby to be manipulated for colic or a child to be manipulated for acute asthma attack. I think what is happening now is that many of the outstanding chiropractors of North America, researchers, publishers, have asked themselves that question and said, "There is nothing wrong. It's about time." And that's why we see this real influx of what I would call the top chiropractic researchers and publishers joining the Orthopractic Society. They can complain and do what they like, but it really has nothing to do with whether pinched nerves cause bedwetting or not.
"DC": Doesn't your entire campaign against chiropractic pediatrics really amount to a war for patients by "the medical director of the largest children's center in Canada"?
Dr. Katz: This, again, is a red herring. I have absolutely no concern having more patients. Our particular center refuses between five and ten thousand visits a year because we just don't have the capacity to handle all the people we see. Again, this approach is to attack the motives, attack everything, but never talk about whether the colic study was really good or not; never talk about whether you treated colic at an age when it normally goes away; never talk about whether you change the definition of colic so that it was no longer colic; never talk about whether there was a control group in the study or not; and attack the medical profession and say that they want to control chiropractors. We have no time for that, we have no interest in that. It's not a financial issue, it's a scientific issue. It's not a political issue from our point of view. I'm pleased with the number of very important chiropractors who are joining, and the issue with kids has certainly begun to draw the line.
I would also say that within the American Chiropractic Association there are a number of people at what I would consider to be very high levels now who are afraid to speak out, but have made their feelings clear that they really detest the organization of these pediatric seminars and techniques and such things, and we're starting to hear that now. I don't know for sure but I would suspect that those people will be behind the scenes. They will speak out, especially now that this issue of the ACA trying to intimidate chiropractors who limit themselves to an orthopractic scope, trying to intimidate them with their licenses. That is a move which is backfiring behind the scenes to no end because we're just saying, "What is wrong with what we are doing? We only want to treat musculoskeletal conditions." That's what RAND said we should do, that's what the Manga report complemented us on. There was nothing in RAND or Manga about treating infants and children.
I feel quite strongly that six months or a year from now that I don't plan to be involved with this issue because I think that it's an issue for chiropractors themselves to settle with each other, and for physical therapists and those physicians who practice manual therapy to settle with each other. When the pediatricians' statement came out, the president of the Ontario Chiropractic Association wrote a letter to the Globe & Mail saying that he believed that he could treat colic, on behalf of all Ontario chiropractors, and I can tell you that we had a number of very significant, well-known Ontario chiropractors, including teachers and other people, who immediately offered their services to the Orthopractic Society saying that they were ashamed that the president of the association would quote a study claiming that chiropractors could treat colic in infants in a public newspaper. This is a study which has no control group, which changes the definition of colic, which treats the disease when it normally goes away, which has no anatomical rationale for treatment, and which was thoroughly reviewed by one of the top colic experts of the world, Dr. Ron Barr, who has probably published more articles on colic than anybody else, and also panned by Consumers Report in their review of it.
"DC": Thank you Dr. Katz.
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