Chiropractors and Immunization

Stephen Barrett, M.D.

Many chiropractors advise against immunization. In 1992, 37% of 178 chiropractors who responded to a survey agreed that "there is no scientific proof that immunization prevents infectious disease" and 23% said they were uncertain [1]. Among the "unproven" group, 24% were American Chiropractic Association (ACA) members and 65% belonged to the International Chiropractors Association (ICA). Twenty-seven percent of the respondents said their own families had not been immunized, and 58% agreed with the statement "Immunization should never be given to people over 60 years of age." Before filling out the forms, the chiropractors were asked to read a 1979 American Public Health Association (APHA) policy statement warning that 40% of American children under age 15 had incomplete immunization against preventable diseases and that severe complications can result [2]. Only 14% agreed that "the chiropractic profession should fully support the APHA immunization policies for children and adults" Chiropractors who graduated before 1980 tended to be more negative than those who had graduated in 1980 or afterward [1].

A 1998 survey of chiropractors in the Boston area found that 30% reported actively recommended immunization, 7% reported recommending against immunization, and the rest (63%) reported that they did not make any recommendations or that they educated parents to allow them to make informed decisions [3]. However, the way they "educated" parents was not specified.

In 1999, Dynamic Chiropractic invited readers to state whether they have immunized their children. This method is not precise way to collect such data, but the answers were still interesting. Of 140 responses, the results were:

• My children have receive absolutely no vaccinations: 59 (42%)
• My children received only some of the usually required vaccinations: 31 (22%)
• My children have received all of the usual required vaccinations 50 (36%) [4]

Chiropractic's two largest organizations oppose compulsory immunization. The ACA has acknowledged "routine vaccinations have been a proven and effective campaign in the control of many diseases." [5] However, its current policy is:

The ACA supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination.

The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual's right to freedom of choice in health care matters and providing an alternative/elective course of action regarding vaccination. [Adopted in 1998]

The International Chiropractors Association (ICA)'s current policy states:

The International Chiropractors Association recognizes that the use of vaccines is not without risk.

The ICA supports each individual's right to select his or her own health care and to be made aware of the possible adverse effects of vaccines upon a human body. In accordance with such principles and based upon the individual's right to freedom of choice, the ICA is opposed to compulsory programs which infringe upon such rights.

The International Chiropractors Association is supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health. [Adopted in 1993]

The ICA does not acknowledge benefit and even sells a book called Vaccination: 100 Years of Orthodox Research Shows that Vaccines Represent a Medical Assault on the Immune System, which contends that vaccines are ineffective and dangerous.

The World Chiropractic Association, a smaller group "dedicated to promoting a subluxation-free world," is also opposed to compulsory immunization for children [6].

State chiropractic licensing boards also support anti-immunization activities. In 2002, the boards in 40 states and the District of Columbia approved the awarding of continuing education credits for attending the Third International Public Conference on Vaccination, a meeting sponsored by the National Vaccine Information Center (NVIC), a group that is rabidly opposed to immunization.

Chiropractors staunchly opposed the use of the polio vaccine in the 1940s and 1950s, and many still support that opposition, saying that the incidence of polio is cyclical and would have declined without any vaccination program. The fact is that since the vaccine's introduction, the incidence of polio has become extremely noncyclical. The present rate of polio is less than one hundredth its lowest level before oral immunization programs began, and public health officials have predicted worldwide eradication by the year 2000. This is one of the most dramatic success stories in the history of medical science's struggle to reduce suffering and early death. The same could be said of the vaccination program that rid the world of smallpox, a once prevalent deadly disease. Chiropractors claim that somehow this would have happened anyway. That simply is untrue.

In addition to denying the benefits, immunization opponents also magnify the risks. A small percentage of children given shots to prevent diphtheria, tetanus, pertussis (whooping cough), and measles will experience adverse effects-most of them trivial. However, the benefits of these shots vastly outweigh the improbable harm. Where immunization programs are lacking, preventable diseases continue to cause death and disability despite improved public hygiene. Within the past few years, several states that had belonged to the Soviet Union, for example, have experienced a diphtheria epidemic due to waning of their vaccination programs.

Chiropractic opposition to immunization appears to be based on a combination of philosophy and faulty reasoning. As far back as 1889, D.D. Palmer wrote that "Vaccination is a medical delusion" and that "All sick persons, except paupers, have the right to employ whom they please to treat them. If sick persons have the above right, should not well persons have the same privilege?" [7] In 1906, his son B.J. Palmer wrote:

The idea of poisoning healthy people with vaccine virus . . . is irrational. People make a great ado if exposed to a contagious disease, but they submit to being inoculated with rotten pus, which, if it takes, is warranted to give them a disease [8].

In 1941, a group calling itself the Chiropractors' Constitutional Rights Committee published a 158-page report called "The Horrors of Vaccination and Inoculation at Work." The report stated that :There is no more flagrant imposition upon our American freedom or impending danger to the welfare of our people than compulsory vaccination," which it considered "pollution of the human blood stream." The report also claimed that 60% of the people who were inoculated would get seriously ill, that vaccination does not prevent disease, and vaccinated persons acquired smallpox more readily than unvaccinated persons [9].

In recent years, the Palmers' philosophical descendent, ICA past-president Fred H. Barge, D.C., has stated:

I am a firm opponent of artificial immunization and the antiquated germ theory on which it is based. . . . I, myself, my three daughters and my six grandchildren have never been vaccinated for anything. I even try to avoid having my dogs vaccinated.

Chiropractic philosophy states that natural immunity is to be favored over any attempt to artificially immunize the body, and chiropractic's approach to health augments the body's innate immunological capacity. [11]

Barge's statement is not merely unsubstantiated. A recent study by chiropractors found that manipulative therapy produced no clinically significant effect on five types of lymphocytes that correlate with immune-system functioning [12].

Pediatric Chiropractic, which is chiropractic's major pediatric textbook, states that "rather than advising the parent(s) to vaccinate or not to vaccinate, the chiropractic doctor should focus on educating the parent(s) on the subject and allow the parent(s) to make the decision they feel is most appropriate for their child." [13] The book's 27-page chapter on these "issues" is devoted mainly to adverse reactions, contraindications, and "failures." Nothing in the chapter suggests that immunization is a good idea [14].

A recent study of students at Canadian Memorial Chiropractic College (CMCC) has found that negative attitudes toward vaccination increased progressively from year to year.

• The proportion of students who were "in favor of vaccination in general" fell from 60.7% in Year 1 to 39.5% in Year 4.
• The proportion who said that "vaccines should never be given to infants under 1 year of age" rose from 17% in Year 1 to 47% in Year 4.

The authors noted that progressive negative attitudes occurred primarily among students who relied primarily on informal sources (visiting lecturers) rather than "core CMCC lectures." [15] An accompanying editorial states that the study "suggests that even in the face of education to the contrary (provided by their own professional school) and despite the policies of [the Canadian Chiropractic Association], negative beliefs are still acquired or persist in a sizable minority of students." However, neither the surveyors nor the editorial writers noted how negatively the school's pediatric textbook (Pediatric Chiropractic) treats the subject.

A "Religious" Objection

In September 2000, the Syracuse Herald American reported that the mother of 5-year-old girl Victoria Turner was suing the local school district for denying her daughter's entrance into kindergarten. The lawsuit claims that the district is violating the child's constitutional right to religious freedom. The mother states that she belongs to the Congregation of Universal Wisdom, which preaches that injection of any medication or other man-made substance would violate the sanctity of the body. The school superintendent had determined that the mother's beliefs were sincere but not part of a legitimate religion -- that a similar case in another school district had revealed that the "Congregation of Universal Wisdom" had been formed by a chiropractor, required no real training for its ministers, and did not provide religious services or other regular contacts with its members [15].

Information about this group is distributed by Walter P. Schilling, D.C., who identifies himself as its Secretary-Treasurer. The documents he distributes state that the Congregation of Universal Wisdom is a "religious order" that was incorporated in New Jersey in 1975 and has a total membership of "4,423 Souls" in 24 states, with 2,427 members in New Jersey, 1,255 in Florida and 409 New York [16]. To join, families must state the name and birthdate of each family member and include a dated statement that they will aspire to live by the group's tenets. The "customary donation" for a family lifetime membership is $75, with an additional $12 for postage if express mail is desired. "Official notification of your family enrollment as well as a statement regarding our stand on immunization" is sent upon receipt of the letter and donation..

The group's "religious tenets" express fundamentalistic chiropractic theory in religious terms. The mother has followed these tents since 1990, the same year she began working as a chiropractic assistant [17]. The tenets state that "the ministry will be constituted by those sufficiently trained in the art, philosophy and theology of the laying on of hands to the vertebrae" and that "the laity . . . shall be composed of those seeking spiritual and physical health combined by unequivocal adherence to the principles of the Congregation and the laying on of hands on their vertebrae." They further state that the use of medication -- whether by ingestion, injection, application, or inhalation -- is a sacrilege [18].

Despite all this, in March 2000, the U.S. District Judge issued a preliminary injunction permitting Victoria to continue to attend school until he decides the case after a full trial [17].

Responsible Voices

Robert Anderson, M.D., D.C., believes that chiropractors "tend to evaluate all things medical in symbolic terms as hostile and harmful." In a paper tracing the history of chiropractic opposition to immunization, he concluded:

Conservative chiropractors [base] their opposition to immunization upon imperfections in vaccines that relate to the efficacy, safety and necessity of immunizations. Further, they persist in a belief that chiropractic spinal manipulation provides an alternative method for achieving immune status. This belief has not been subjected to testing in clinical trials or laboratory experiments, and thus becomes a matter of belief rather than of scientific verity. A refusal to advocate or submit to vaccines serves conservative chiropractors as an understandable cultural symbol, but it is a symbol with sinister health costs to those who translate it into non-immune status in a world otherwise still hostage to disease-producing organisms [19].

Consistent with this, Craig E. Nelson, D.C., suggests that "it is precisely because opposing immunization sets chiropractic apart from medicine that makes this position so attractive to some chiropractors. . . . By opposing immunization, chiropractic ensures that it will not become assimilated into the health-care mainstream" [20]. Lon Morgan, D.C., has urged his colleagues to support immunization against whooping cough (pertussis). [21]. But outspoken articles of this type are uncommon in chiropractic publications. Randy J. Ferrance, D.C., M.D., has urged his colleagues to "do what is right and let the facts, not our historicalk chiropractic theology, guide our advice." [22]

In March 2000, Cheryl Hawk, D.C., Ph.D., a researcher at Palmer College, candidly acknowledged that her profession "has not historically emph asized the areas of knowledge from which prevention methods evolved' and that:

Furthermore, a vocal proportion of the profession openly, completely, and without reservation opposes the most widely accepted and documented preventaive procedure available: immunization. They do tthis even though the risk of serious complications from the most well established immunization is . . . minuscule [23].

In April 2000, the medical journal Pediatrics published a detailed report on chiropractors and immunization. The authors, two of whom were Canadian chiropractors, concluded:

Because early chiropractic dogma eschews both the germ theory of disease and vaccines, adherents can reject the overwhelming scientific evidence that vaccination is a highly effective methods of controlling infectious disease because this does not conform to [chiropractic's] "major premise." However, not all antivaccination chiropractors fit into this category. Some may have been unduly influenced by the antivaccination literature, while others may have rejected it for less than altruistic reasons: for example, there may be a financial advantage in maintaining a health care practice that is totally distinct from medical care. Whatever their reasons, antivaccination chiropractors and the methods by which some disseminate their views are a continuing source of embarrassment to their more evidence-based colleagues [24].

I agree. Regardless of the reason, opposition to proven public health measures is irresponsible and can cause serious harm both to patients and to our society as a whole. Attitudes toward immunization offer a way to measure whether rank-and-file chiropractors wish to practice as cultists or scientists.

References

1. Colley F, Haas M. Attitudes toward immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics 17:584-590, 1994.
2. American Public Health Association. Policy statement 7805: Immunization against childhood diseases. American Journal of Public Health 69:298, 1979.
3. Lee ACC and others. Chiropractic care for children. Archives of Pediatric and Adolescent Medicine 154:401-407, 2000.
4. ChiroPoll. Dynamic Chiropractic, May 3, 1999.
5. An open letter to the readers of The Wall Street Journal. Advertisement, March 23, 1993, p A18.
6. World Chiropractic Association. Vaccinations and freedom of choice in health care. Position statement, 2000.
7. Palmer DD. The sick get well by magnetism. Brochure, 1889. Cited in Gielow V. Old Dad Chiro. Davenport, IA: Bawden Bros, 1981, pp 52-3.
8. Palmer BJ. The Science of Chiropractic: Its Principles & Adjustments. Davenport, IA: The Palmer School of Chiropractic, 1906, p 17.
9. Young VL and others. The Horrors of Vaccination and Inoculation at Work. St. Louis, MO: Chiropractors' Constitutional Rights Committee, 1941.
10. Sottile, RT. Mandatory Immunization and You? A Must for All Parents to Read! Marietta, GA: Life Foundation, circa 1976.
11. Barge FH. Final thoughts: possibly true? Today's Chiropractic 22(4):105, 1993.
12. Brennan PC at al. Lymphocyte profiles in patients with chronic low back pain enrolled in a clinical trial. Journal of Manipulative and Physiological Therapeutics 17:219-227, 1994.
13. Buerger MA. History and physical assessment. In Anrig CA, Plaugher G, editors. Pediatric Chiropractic. Baltimore: Williams & Wilkins, 1998, p 181.
14. Lafranchi R, Alcantra J, Plaugher G. Vaccination issues. In Anrig CA, Plaugher G, editors. Pediatric Chiropractic. Baltimore: Williams & Wilkins, 1998, pp 24-50.
15. Busse JW and others. Attitudes toward vaccination: A survey of Canadian chiropractic students. Canadian Medical Association Journal 166:1531-1534, 2002.
16. Pless B, Hibbs B. Chiropractic students' attitudes about vaccination: A cause for concern? Canadian Medical Association Journal 166:1544-1545, 2002.
17. O'Brien J. 'Medications' against beliefs. mom says. Syracuse Herald American, Sept 2, 2000, pp B1, B6.
18. Congregation of Universal Wisdom. Fact Sheet, July 12, 2000.
19. O'Brien J. Girl stays in school without shots: Judge says Liverpool district must admit child until court rules on mother's case. Syracuse Herald American, March 14, 2001.
20. Congregation of Universal Wisdom: A religious order. Undated, distributed in 2000.
21. Anderson R. Chiropractors for and against immunization. Medical Anthropology 12:169-186, 1990.
22. Nelson CF. Why chiropractors should embrace immunization. ACA Journal of Chiropractic 30(5):79-85, 1993.
23. Morgan L. Pertussis immunization: an update. Journal of the Canadian Chiropractic Association 41(2):86-90, 1997.
24. Ference RJ. Vaccinations: How about some facts for a change? Journal of the Candian Chiropractic Association 167-172, 2002.
25. Hawk C. Should chiropractic be a "wellness" profession? Topics in Clinical Chiropractic 7:23-6, 2000.
26. Campbell JB, Busse JW, Injeyan SH. Chiropractors and vaccination: A historical perspective. Pediatrics 105(4):E43, 2000. [Download PDF]

This article was revised on October 17, 2002.