"My Crystal Clear Stance on Vaccination" #7: Flawed Research--No Evidence For Babies' Immune System Function

The chiropractor went on to say (emphasis added)

When I bring this point up, I'll get the skeptic asking for specific reference of an infant not producing anti-bodies sufficiently.  Honestly, I don't have it, it's my own logic.  

In other words, another example of the "common sense fallacy", or the arrogance of ignorance.

Image description: traffic-type sign reading "I stick to my opinion. Please do not confuse me with FACTS"

To that I say,

Image description: traffic-type sign reading "Everyone is entitled to their own opinions. They are not entitled to their own facts."

The chiropractor goes on to write,

In the same breath, if I ask them to produce specific reference for an infant that can produce anti-bodies sufficiently, they cannot produce that evidence either.  Pro-vaccinators can't attack the vaccine choice crowd as unscientific with arguments that are unscientific.

Let us take just one example (in addition to the copious sources below),


Neonatal immunization: where do we stand?

PURPOSE OF REVIEW:
Recognition of the high burden of disease in early life and advances in the understanding of neonatal immunology have resulted in renewed interest in maternal and neonatal vaccination. This article reviews existing information and recent advances in neonatal human immunization.

RECENT FINDINGS:
Recent findings have demonstrated the neonatal immune system not to be immature but rather specifically adapted for early postnatal life. This includes the preferential induction of memory B cell rather than antibody-secreting plasma cells and polarization of neonatal T-cell responses away from potentially deleterious T-helper type 1 cytokines. Recent neonatal acellular pertussis and pneumococcal conjugate vaccine trials have proven that a birth dose of acellular pertussis and/or pneumococcal vaccine, in limited samples sizes, are well tolerated and immunogenic; however they have identified vaccine interference as a critical issue to address.

SUMMARY:
Neonatal immunization may be a well tolerated and effective preventive strategy against early life pathogens. Research to better understand how neonatal vaccine responses are elicited and to identify optimal early life adjuvants and formulations may broaden neonatally vaccine-preventable diseases to pertussis, rotavirus and possibly influenza, further reducing disease burden in this vulnerable group. Hurdles to neonatal vaccination include safety concerns, both immunological and clinical, demonstration of vaccine efficacy and public acceptance.

Neil deGrasse Tyson: "The good thing about science is that it's true whether  or not you believe in it"

Summary:
The chiropractor has counter-factual opinions about the evidence for the robustness of the infant immune system.  His claims are in fact unscientific.

Additional Sources on the Neonatal and Infant Immune System:

Catani A,  Pediatric Allergy, Asthma and Immunology Springer; 2008 edition


Chatterjee , O'Keefe C Current Controversies in the USA Regarding Vaccine Safety Expert Rev Vaccines. 2010;9(5):497-502.  http://www.medscape.com/viewarticle/722174_6

Cohn, M. and Langman, R. E. (1990), The Protection: The Unit of Humoral Immunity... Selected by Evolution. Immunological Reviews, 115: 7–147. doi: 10.1111/j.1600-065X.1990.tb00783.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1600-065X.1990.tb00783.x/abstract


Fadel S, Sarazotti M. Cellular immune responses in neonates. Int Rev Immunol.2000;19 :173– 193 http://www.ncbi.nlm.nih.gov/pubmed/10763708?dopt=Abstract

Holt PG, Jones CA, The development of the immune system during pregnancy and early life (2000), . Allergy, 55: 688–697. doi: 10.1034/j.1398-9995.2000.00118.x http://onlinelibrary.wiley.com/doi/10.1034/j.1398-9995.2000.00118.x/full

Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, and Landry S, (2002) Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? Pediatrics Vol. 109 No. 1 January 1, 2002
pp. 124 -129  (doi: 10.1542/peds.109.1.124) http://pediatrics.aappublications.org/content/109/1/124.full

Siegrist CA. Neonatal and early life vaccinology. Vaccine.2001;19 :3331– 3346 http://www.ncbi.nlm.nih.gov/pubmed/11348697


Wood N, Siegrist CA. Neonatal immunization: where do we stand? Curr Opin Infect Dis. 2011 Jun;24(3):190-5. doi: 10.1097/QCO.0b013e328345d563. http://www.ncbi.nlm.nih.gov/pubmed/21415741

Screen Capture of Chiropractor's Claims 

Source:  "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC,  posted May 2012

"My Crystal Clear Stance on Vaccination" #6: Flawed Research-- Too Many Vaccines Too Soon for Babies' Immature Immune Systems

The chiropractor makes the following claim:

Even if the whole vaccine theory really worked, it would be absolutely pointless to inject a baby of 6 months or less with a vaccine.  With a child’s immune system being very immature until age 2, the overload of 36 vaccines by the age of 18 months seems about as logical as drinking from a fire hydrant.

This is really a silly, ignorant claim, a strawman with two arms, first positing that infants' only immune challenges are from vaccinations, then claiming that infants can't respond to immunological challenges.

Babies' immune systems begin developing in utero and are presented with trillions of challenges from the moment they enter the birth canal (or emerge into the world, in the case of c-sections).  The immune challenge from vaccinations is trivial compared to the daily encounters even babies in the cleanest, most hygienic households face.  The fire hydrant is daily life.

source: tinyurl.com/kiss-antigens

Text from image:
The average healthy adult human mouth is home to more than 600 unique species of bacteria and a very high number of viruses.  Every milliliter of saliva contains over 100 million bacteria. 

Every time a mother kisses her baby, the baby's immune system is exposted magnitudes more antigens than are present in the entire US childhood immunization schedule. 

A well-functioning immune sysstem is a marvel, protecting against countless viruses and bacteria even in the youngest children. It can handle the challenge presented by the US immunization schedule and it can handle the even-greater challenge from every mother's kiss.

Do not worry about 'too many, too soon'.  Vaccinate your baby on-time, every time.

A more light-hearted approach:

Source: http://tinyurl.com/babies-antibodies

Summary:
The chiropractor has counter-factual opinions about the robustness of the infant immune system and the relative challenges of daily life and immunization.

Sources:

Catani A,  Pediatric Allergy, Asthma and Immunology Springer; 2008 edition

Cohn, M. and Langman, R. E. (1990), The Protection: The Unit of Humoral Immunity... Selected by Evolution. Immunological Reviews, 115: 7–147. doi: 10.1111/j.1600-065X.1990.tb00783.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1600-065X.1990.tb00783.x/abstract


Fadel S, Sarazotti M. Cellular immune responses in neonates. Int Rev Immunol.2000;19 :173– 193 http://www.ncbi.nlm.nih.gov/pubmed/10763708?dopt=Abstract

Holt PG, Jones CA, The development of the immune system during pregnancy and early life (2000), The development of the immune system during pregnancy and early life. Allergy, 55: 688–697. doi: 10.1034/j.1398-9995.2000.00118.x http://onlinelibrary.wiley.com/doi/10.1034/j.1398-9995.2000.00118.x/full


Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, and Landry S, (2002) Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? Pediatrics Vol. 109 No. 1 January 1, 2002
pp. 124 -129  (doi: 10.1542/peds.109.1.124) http://pediatrics.aappublications.org/content/109/1/124.full

Siegrist CA. Neonatal and early life vaccinology. Vaccine.2001;19 :3331– 3346 http://www.ncbi.nlm.nih.gov/pubmed/11348697


Screen Capture of Chiropractor's Claims 

Source:  "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC,  posted May 2012

"My Crystal Clear Stance on Vaccination" #5 :Flawed Research--Giving Infants the Same Dose of Vaccines As Adults Doesn't Make Sense

The chiropractor wrote,

Giving a child a vaccine with an adult dose and assume they would react the same way doesn't make sense.

This is an error of common sense (appeal to common sense fallacy), equating the biological activity of a medication (like aspirin, for example) with a vaccine. It's the sort of error you would expect from a person who had no medical education, but it is surprising from someone who belongs to a profession claiming to have an education equal to an MD. Surely this would have included basic pharmacokinetics and pharmacodynamics?

Roughly speaking, medications work by being distributed throughout the body, and achieving a certain concentration in the entire bloodstream.  Thus, adjusting the medication dose for the size of the patient makes sense.

Vaccines, on the other hand, do not circulate evenly throughout the body.  For injected vaccines, the immune response generated by vaccination typically occurs at or near the injection site.  As we saw in a previous post, when the immune system recognizes a vaccine component as "not-self",  cells of the immune system flock to the area and activate the immune system to respond to the invader. Likewise, adjuvants also only act locally.  Once the immune response has succeeded in protecting the body from the invader, a small number of cells -- memory B and T cells--remain, to recognize the specific antigen provided in the vaccine.

Further, not all vaccines given are in the same dosages for children and adults. For example, the adult version of the hepatitis A vaccine, hepatitis B vaccine, and influenza vaccine contain higher doses than the one for children, while Tdap vaccine used in adolescents, teens and adults contains lesser quantities of the diphtheria and pertussis antigens.

Source: Refutations to Antivaccine Memes, http://tinyurl.com/RtAVM-15Sneezes

Source: Refutations to Antivaccine Memes, http://tinyurl.com/RtAVM

Summary:
The chiropractor's thinking about how vaccines work is naïve at best.

Sources:


American Society of Health-System Pharmacists, Concepts in Clinical Pharmacokinetics, Introduction to Pharmacokinetics and Pharmacodynamics http://www.ashp.org/DocLibrary/Bookstore/P2418-Chapter1.aspx


Children's Hospital of Philadelphia Vaccine Education Center, Questions About the Vaccine Schedule http://www.chop.edu/service/vaccine-education-center/vaccine-schedule/vaccine-schedule-qa.html

Offit PA, Moser CA, Vaccines and Your Child: Separating Fact from Fiction (excerpt) http://cup.columbia.edu/book/978-0-231-15307-2/vaccines-and-your-child/excerpt

Screen Capture of Chiropractor's Claims 

Source:  "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

"My Crystal Clear Stance on Vaccination" #4b :Flawed Research--Infants' Signs of Immature Nervous Systems

The chiropractor wrote,

Infants cannot talk, a sign of a mature nervous system.  Infants cannot walk, a sign of a mature nervous system. Infants cannot control urination or defecation, a sign of a mature nervous system.

This is the level of understanding the chiropractor brings to discussions of the maturation of the human nervous system?  This would be acceptable in a paper from a child in elementary school, but far too jejune for even a middle-school discussion.

Elsewhere, he claims the following about his credentials

.... uses his Chiropractic degree and combines his background of biochemistry and genetics with the application of physiology, neurology, and psychology to provide a T.R.U.E. approach to healthcare for his patients and corporations.

Summary:

The chiropractor does not demonstrate the level of understanding of human neurological development commensurate with his claims of expertise.

My Crystal Clear Stance on Vaccinations: The Nervous System Controls the Immune System

Source:  "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

"My Crystal Clear Stance on Vaccination" #4a :Flawed Research--The Nervous System Controls The Immune System

The chiropractor asserts:

A mature nervous system (which controls your immune) system doesn't happen that early. 

This is manifestly not true (discussed below) but I did try to find a source for this assertion.  I found several, all from site run by chiropractors, such as the one below:

source: Mahalko Family Chiropractic E-Newsletter

Text from Mahalko Family Chiropractic E-Newsletter

Strengthening Your Immune System Naturally
There are many things that you can do naturally to help boost your immune system, that is not in the form of a shot. 

The best thing you can do is to get regular chiropractic adjustments. Chiropractors focus on the nervous system, which controls every organ, muscle, tissue and cell in the body. When the vertebra in our spine misalign (subluxate), it puts pressure on the corresponding nerve(s). Whatever the nerve is controlling is thus affected. Since the nervous system controls the immune system, it makes sense to get adjusted once a month to make sure that your nervous system is working properly or even more often if you are feeling sick.

No, the nervous system does not control the immune system. 
A simple way of thinking about this is to consider persons with spinal cord injuries, especially high spinal cord injuries.  Their nervous systems are impaired.  Other than having a higher risk of infectious disease from the functional aspects of their disabilities, their immune systems are intact.

A more reliable source: The National Institute of Allergy and Infectious Disease


http://www.niaid.nih.gov/topics/immunesystem/pages/nervoussystem.aspx

The Immune System and the Nervous System

Evidence is mounting that the immune system and the nervous system are linked in several ways. One well-known connection involves the adrenal glands. In response to stress messages from the brain, the adrenal glands release hormones into the blood. In addition to helping a person respond to emergencies by mobilizing the body’s energy reserves, these “stress hormones” can stifle the protective effects of antibodies and lymphocytes.

Another link between the immune system and the nervous system is that the hormones and other chemicals that convey messages among nerve cells also “speak” to cells of the immune system. Indeed, some immune cells are able to manufacture typical nerve cell products, and some lymphokines can transmit information to the nervous system. Moreover, the brain may send messages directly down nerve cells to the immune system. Networks of nerve fibers have been found connecting to the lymphoid organs.

Summary:
The chiropractor's understanding of the relationship between the nervous system and the immune system is counter-factual.

My Crystal Clear Stance on Vaccinations: The Nervous System Controls the Immune System

Source:  "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

"My Crystal Clear Stance on Vaccination" #3: Flawed Research--Vaccines for the Elderly and Infants Don't Work

The chiropractor believes that giving vaccines to folk with reduced capacity to respond is useless.

The 2 populations that have limited production of anti-bodies [sic] are infants and geriatrics, the 2 most heavily vaccinated populations. 

First, is it true that infants and geriatrics are the two most heavily vaccinated populations?  Let's look at the vaccine schedule from birth to 18 years, and the adult schedule, as recommended by the CDC

Source: http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-schedule-landscape-chart.pdf

Source: http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf

Sometimes it is difficult to tell what argument the chiropractor is making, because his language is so imprecise.  Is the chiropractor talking about the number of diseases protected against, or the discrete number of injections the person receives? Let's look at both.

Children between birth and 24 months = protected against 14 diseases with up to 27* injections
Children between 2 years and 4 years =  protected against 14 diseases with an additional 3* injections
Children between 4-6  = protected against 14 diseases with an additional 6* injections

Children between 7-10  protected against 14 diseases with an additional 3* injections

Children between 11-12 = protected against 16 diseases with an additional 7* injections
Children between 13-15 = protected against 16 diseases with an additional 3* injections

Children between 16-18 = protected against 16 diseases with an additional 6* injections

Adults between 19-22 = protected against 16 diseases with an additional 4* injections
Adults between 23-60 = protected against 16 diseases with 1 annual influenza and 1 td (tetanus, diphtheria) booster every 10 years.
Adults 60-110 (or death) = protected against 16 diseases with 1 annual influenza and 1 td (tetanus, diphtheria) booster every 10 years, plus the Zoster immunization (1 injection) and the pneumococcal injection (1 injection).

---
*assuming that all are immunized within the recommended time frame, and assuming all receive an annual influenza immunization

-----

So yes, infants receive the most injections, followed by children children 11-12, children 4-6, and children 16-18.   Those between 60 and 65 are scheduled for two additional injections.

So the chiropractor is not quite accurate in his claims here, either.  One wonders if he has actually studied the CDC recommendations, or is just parroting someone else's opinion.

Now, is it true that the elderly and infants are alike in having "limited production of antibodies"?  Not really.  

First, let's consider what happens to the immune system as a person ages.  As I pointed out in the first in this series, the chiropractor seems to have an unusual and perhaps limited understanding of the human immune system.  Let us go into some depth. Recall that the body recognizes "me" and "not me", or antigens.  A subset of antigens are pathogens, or things that can cause disease. Recall that there are three aspects of the immune system:

1. Surface immunity (physical, chemical, and biological)
2. Innate immunity (generalized responses to antigens, including pathogens--viruses and bacteria)
3. Adaptive immunity (specific responses to pathogens)

There is a general process in aging called "immunosenescence", which is the collective term for the ways that the innate and adaptive immune systems become less efficient in responding to antigen challenges.

One aspect is that as we age, our innate immune cells become less efficient in communicating with each other, leading to a slower or less efficient response to antigens.  

Another aspect in immunosenescence has to do with the immune system's T cells.   T cells exist in two states: a "naïve state", before a specific T cell has been recruited to recognize a specific antigen, and a "memory state" (or "memory cell") after it has been recruited to combat a particular antigen.  Once a T cell transits to the "memory cell" state, it is primed to attack a specific pathogen, and will persist in the body for decades.  As a person ages, his or her suite of T cells have faced many, many antigens. On balance, the body produces fewer naïve state T cells.   This is why people in their 50s, 60s, and 70s and beyond,  have a less robust response to vaccines, because vaccines generally require naïve T cells to produce a protective immune response.  This T cell response is also why the Zoster vaccine against shingles has been so successful in preventing shingles in adults previously infected with varicella (chicken pox) : shingles are produced by the chicken pox (varicella) virus re-emerging from a dormant state in the body.  The Zoster vaccine, as it were, reminds the memory T cell system that it has "seen" the varicella vaccine before, and provides a robust response.

So adults over 60 have a lessened response to antigens (including pathogens) but not a non-response. A lessened response is not, however, "no response".  Indeed, the lessened response is exactly why certain vaccines are recommended for this age group: to educate the immune system against these diseases before the individual encounters the wild pathogen, giving a greater chance at avoiding the disease, or having a lessened illness if the disease is acquired.

Turning to infants: the infant immune system isn't a defective version of the adult immune system.  It begins developing during pregnancy, and while little challenged in the sterile uterine environment, is robust enough (in nearly all children) to respond to the many thousands of microbes that the neonate encounters in the process of vaginal birth, or in the first moments of life. (The development of the infant immune system will be discussed in greater depth in a later post.)

 If their ability to produce anti-bodies is low, then the vaccine would be pointless.

I am really grateful that the chiropractor stated this so clearly.  This is a variant example of the the "Nirvana Fallacy", which runs like this:


The Nirvana Fallacy assumes the middle cannot exist and a solution is either absolutely perfect or entirely without worth. This is then used to argue that a solution is useless because some part of the problem will remain after it has been implemented.

To return to the chiropractor's claims:

If their ability to produce anti-bodies is low, then the vaccine would be pointless.  The whole premise of the vaccine is that you get injected with a foreign invader and you produce anti-bodies against it.  If you can’t produce anti-bodies well then what’s the use of injecting something to try and stimulate that reaction?

The chiropractor goes on:

With kids, their ability to produce any anybodies until after age 6 months is very limited. This is why breast milk is so important to infants.  Mom passes the anti-bodies to baby, that usually last about 6 months.  The immune system is very primitive that young.  The baby needs to spend way more energy in growth phase opposed to protection phase.

The chiropractor is mixing up several things here.  Yes, infants do not make antibodies to some microbes, but that does not mean the infant produces no microbes. The benefits of breastfeeding are many, including the acquisition of some antibodies via passive immunity from the mother's breastmilk. This has nothing to do with the state of the infant's immune system maturity. Furthermore,  recent research has indicated that the infant immune system is fundamentally different than the adult immune system, not "more primitive" -- a topic that will be discussed in several later posts.

As to the following assertion:

The baby needs to spend way more energy in growth phase opposed to protection phase.

I am really not sure what the chiropractor is trying to say.  I have no idea what "the protection phase" of infant development.

Source: "My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

Summary:
The chiropractor has some quaint and counterfactual ideas about the human immune system in infancy and old age, as well as some counterfactual ideas about the process of acquiring immunity through vaccination.

Sources:


Goldman AS. The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties [review]. Pediatric Infect Dis J. 1993;12:664 –672. Medline

Hanson LA. Breastfeeding provides passive and likely long-lasting active immunity [published correction appears in immunity. Ann Allergy Asthma Immunol. 1999;82:478] [review]. Ann Allergy Asthma Immunol. 1998;81:523 –533. Medline
Larbi A et al., The Immune System in the Elderly: A Fair Fight Against Diseases? Aging Health. 2013;9(1):35-47.  http://www.medscape.com/viewarticle/780507_1

National Institute on Aging, IMMUNE SYSTEM: Can Your Immune System Still Defend You As You Age? http://www.nia.nih.gov/health/publication/biology-aging/immune-system-can-your-immune-system-still-defend-you-you-age

"My Crystal Clear Stance on Vaccination" #2: Flawed Research--No Randomized, Controlled Trials on Vaccines Have Ever Been Done

The chiropractor seems to have some counter-factual beliefs about how vaccines are developed and tested, as well as not-very-nuanced ideas about clinical research.

FLAWED RESEARCH: The scientific mantra of vaccines is that they are safe and effective based on their research.  Their research is flawed and is a double standard from any other drug product studied.  The Gold Standard in research design is the double blinded, randomized controlled trial (RCT). 

This means that people are split into 2 groups randomly and participants are given either the real thing or the fake thing being tested.  Then progress is charted on who gets better, who gets worse, and the like.  In theory there should be no bias as to reporting because the researchers don’t know who is in the placebo or the real intervention group.

Commentary:
This is a very cursory, but essentially accurate description of RTCs.  A better description would be:

A quantitative study in which selected people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control condition may be an inert substance ("placebo" or "sugar pill"), or no intervention at all. In a single-blind study, the study subjects do not know whether the are in the control condition or the experimental condition. In a double-blind study, neither the subjects nor the researchers know which participants are in which study conditions. Very careful study design and execution is required to avoid confounders --  a third variable that can make it appear (sometimes incorrectly) that the variable of interest is associated with an outcome, by affecting the measured outcome. Confounders lead to bias that distorts the magnitude of the relationship between two factors of interest.

The chiropractor is partially correct that RTCs are the "gold standard".  Here is a graphic of one version of "the hierarchy of evidence".

Back to the chiropractor's post:

How many vaccines have ever been studied in this manner?  ZERO!  The reason?

This is an inaccurate claim in several dimensions.

First, in 1954, Salk's polio vaccine was tested in an RTC

In all, over 1.3 million children participated in the trial. The trial was a randomized, double-blind test, meaning that children were randomly assigned to either the control group or the vaccine group. Neither the children (or their parents) nor health officials knew which children had received the vaccine and which had received the injected placebo fluid. (A smaller control group received no injection. Rather, officials observed them throughout the trial period for signs of polio infection.)

The outcome?  There were 609 cases of paralytic polio in the unvaccinated children, and only 71 cases of paralytic polio in the vaccinated children.

As to RTC vaccine safety studies, they are almost too many to count, as each new vaccine is tested in the process of development.  

The chiropractor seems blissfully unaware of the stages of vaccine development.  If the infographic below isn't clear enought for you, The History of Vaccines website has a useful overview, as does the HIV Vaccine Trials Network, if you don't like the infographic from the CDC. 

Source: http://www.skepticalraptor.com/skepticalraptorblog.php/study-rule-all-the-vaccine-deniers-dream/

This is a common question from anti-vaccine true believers.  For example, here is a question posed by a naturopath, answered by Mark Crislip MD, an infectious disease specialist, at the Science Based Medicine post Nine Questions, Nine Answers

Show me one double-blind, placebo-controlled study that can prove the safety and effectiveness of vaccines? 

One trial? It took me 55 seconds to find  "Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial” and that included time to boot the browser and mis-spell the search terms.  ’Vaccine’, ‘efficacy’,  ’randomized’ and  ’placebo control trial’  results in 416 Pubmed references; add ‘safety’ to the search terms, you get 126 returns. 416 is easily more than one.  Of course, to find them you have to look.

However,  evidently the chiropractor is demanding an RTC in which some children are not vaccinated at all. He is not alone; this demand has been made often enough that it's known as The One Study To Rule Them All.

Allison Hagood writes (here and here)

Multiple studies in multiple countries using multiple research models and multiple research groups, with multiple funding sources, have found no link between vaccines and autism. They have also found no links between vaccines and a long list of other conditions, such as ADHD, asthma, diabetes and auto-immune disorders, that anti-vaccine propagandists attempt to link to vaccinations. 

What would it take to conduct "the One True Study" of all vaccines? An alternate universe. 

These studies have been dismissed by those anti-vaccine propagandists as having the wrong funding source, the wrong research design, the wrong focus, not separating out antigens from other vaccine ingredients, separating antigens from other vaccine ingredients inappropriately, not testing this or that, or some other reason that likely lacks validity.

Meanwhile, those in the anti-vaccine movement want ONE study. The One Study To Rule Them All. The One Study that tests every possible aspect of every vaccine and finds them all, together and separately, through this One Study, to be completely effective and completely safe for all children and not linked to any conditions. 

Back to the chiropractor's post:

The researchers will say they cannot perform an RCT because it would be unethical to NOT give a child a vaccine because if that child dies of something that could have been prevented, then they don’t want to be responsible.  

That's not quite right. In the United States, approval for research involving humans is governed by the Code of Federal Regulations, TITLE 45: PUBLIC WELFARE DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 46 PROTECTION OF HUMAN SUBJECTS, which requires human subject studies to be authorized by Institutional Review Boards (IRBs).

There are three principals fundamental to determining if a research proposal is ethical.

1. Respect for Persons: Subjects must give voluntary consent to participate in research; that subjects are adequately and thoroughly informed about the research and what is required, and that subjects' privacy and confidentiality are protected. 
2. Beneficence: The risks of participating in a research project are justified by potential benefits to the individual or society;  the research design is such that those risks are minimized. 
3. Justice: The risks and benefits are distributed equitably,  meaning that one subset of a population should not take on all the burden of risk and reap all of the rewards; risks and rewards should be applicable and available to all subsets of a community.

We can already see that a vaccinated vs. non-vaccinated trial in children would flunk all three principles. It's not necessary that an unvaccinated study subject dies; many of the vaccine-preventable diseases have high risk of other poor outcomes (think of the measles and encephalitis, for example.)

ToddW, who has been part of a number of IRBs, has written a useful series of blog posts on the topic of ethics in research:

• Vaccinated vs. Unvaccinated Part 1 - An RCT Overview
• Vaccinated vs. Unvaccinated Part 2 - A History of Medical Research Ethics
• Vaccinated vs. Unvaccinated Part 3 - Ethical Evaluation
• Vaccinated vs. Unvaccinated Part 4 - The Legal Perspective

Back to the chiropractor's post:

But if someone dies in their trials from taking their anti-depressants, it must be ok.

Wow, what a non-sequitur!  The risk of suicide in clinical trials of antidepressants has been studied.  At any rate, the chirpractor's comments again shows how naive he is about clinical trials for medical interventions.

Back to the chiropractor's post:

Hey drug companies, I will volunteer my child to be in the placebo group and compare him to the health and well being of those that have gotten all the recommended vaccines.  I’m sure I can gather a few hundred thousand more to be in the placebo group to create a large sample.

Again, some naiveté about clinical trials.  Let us recall the idea of "randomized".  Assigning a child to a known treatment arm violates the idea of randomization.  I wonder if the chiropractor would be willing to enroll his child in a true RTC study, in which his child might receive all vaccines?  

Back to the chiropractor's post:

Instead of research to see safety and effectiveness, they instead see if the person builds anti-bodies to the antigen (the foreign invader) that is in the vaccine.  If antibodies are built, then it’s ‘safe and effective,’ or so they lead us to believe. These studies are rarely, if ever done on kids younger than 4 years old.  How can you say it's safe or effective for a baby if it's never studied on a baby?

I don't know where the chiropractor gets the idea that the only research that's done in the process of vaccine development is assessing antibody response.  It's clearly not true.  Look at the Phase I, Phase II and Phase III trials for new proposed vaccines, for example. Also, the bit about "studies rarely done on kids younger than 4" is also clearly false, as a quick look through PubMed will reveal, here are just two out of hundreds: Danchin et al. and Kulkarni et al.

Summary:
The chiropractor seems quite ill-informed, or ill-educated,  about the development of vaccines, and ongoing research into vaccine safety and efficacy.  I have been mulling over whether the chiropractor's statements can accurately be called a series of straw men. I don't think so, quite, because the I suspect that the chiropractor sincerely believes in the inaccurate statements he makes. In other words, if you have been taught falsehoods, and use those falsehoods to argue against a scientific reality, you aren't making a dishonest argument, but an ignorant one.

Screenshot:

"My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

Sources:


Danchin M, Kirkwood CD, Lee KJ, Bishop RF, Watts E, Justice FA, Clifford V, Cowley D, Buttery JP, Bines JE. Phase I trial of RV3-BB rotavirus vaccine: a human neonatal rotavirus vaccine. Vaccine. 2013 May 28;31(23):2610-6. doi: 10.1016/j.vaccine.2013.04.008. Epub 2013 Apr 16.

History of Vaccines, Polio http://www.historyofvaccines.org/content/timelines/polio

Thomas Francis, Robert Korn, et al. "An Evaluation of the the 1954 Poliomyelitis Vaccine Trials." American Journal of Public Health 45 (1955), 50 page supplement with a 63 page appendix.


Kulkarni PS, Sapru A, Bavdekar A, Naik SS, Patwardhan M, Barde P, Pandit AN. Immunogenicity of two diphtheria-tetanus-whole cell pertussis-hepatitis B vaccines in infants: a comparative trial. Hum Vaccin. 2011 Sep;7(9):941-4. doi: 10.4161/hv.7.9.15994. Epub 2011 Sep 1.

"My Crystal Clear Stance on Vaccination" #1: Vaccination Is Not Immunization

Some chiropractors (and other alternative medicine types) claim that "vaccination is not immunization". Here is a sample claim (there's also a whole book, which I will review later).

"My Crystal Clear Stance on Vaccinations" by Kurt Perkins DC, posted May 2012

The essay by the chiropractor has a number of factual inaccuracies, which I will address in a series of posts.

Text version of image, above:

Clarification needs to be created regarding VACCINATION vs. IMMUNIZATION.  I’m all for immunization.  The problem created by media and pharmaceutical influence is that people equate immunization with vaccination.  Vaccination is simply injecting something into your body.  This does not create immunity for your body.  These are 2 totally separate entities.

Commentary:
The chiropractor does not explicitly define what he means by "immunization".  The accepted medical meaning is "the process by which an individual's immune system becomes fortified against an infectious agent".  The chiropractor also has a unique definition of vaccination, "simply injecting something into your body". (Note: not all vaccines are injected; some are inhaled or ingested. But onwards.) The accepted medical definition of "vaccination" is something like "introducing a killed or weakened infectious organism into the body in order to stimulate the body's immune response to said organism, without eliciting disease."  Immunity is defined as "Protection against a disease".

Note that the chiropractor does not provide references for his assertion.

The assertion that "vaccination does not create immunity for your body" is factually wrong.  See for example the primer at Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book), which is available free online at http://www.cdc.gov/vaccines/pubs/pinkbook/index.html. At the foot of the post I've listed some free, online videos on the immune system. Or you could peruse the resources at the National Network for Immunization Information, NNii, starting with How Vaccines Work, http://www.immunizationinfo.org/parents/why-immunize/how-vaccines-work.  The very shortest version possible:

How vaccines work

1. Specific antigens are introduced into the body (injected, inhaled, swallowed)
2. Antigens evoke immune response (B and T cells)
3. B cells produce antibodies
4. Antibodies destroy antigen
5. Memory B and T cells are formed

Back to the chiropractor's essay:

Text version, with comments

Another thing that urks [sic] me is my ‘mom’s’ comments about me leaving out stuff and therefore destroying my credibility.   I would like to add I make ZERO money off of this blog.  I may book some speaking gigs from it but those revenues will come nowhere near the $20 BILLION per year the makers of vaccines cherish.  Who do you think has more weight on their shoulders to hide information?  Huh, mom?  Huh?

The assertion: vaccines are profit centers for pharmaceutical companies, therefore they are suspect, if not frankly bad. The chiropractor derives no income from the blog, therefore everything he says is true. I am sure the logical holes in the assertion are easy to spot.

The $20 billion figure is not far off, according to FierceVaccines, but it is important to note that the $20 billion is revenue, not profit. If the chiropractor doesn't understand the distinction, he won't remain in business long.

Turning back to the chiropractor's comments:

With building immunity, it’s a natural process.  With that natural process, your body uses many defenses.  The first layer of defense is your skin.  This blocks out any harmful opportunistic buggers. With a vaccine, this law of nature is totally bypassed by injecting you with a needle full of stuff your skin would never allow past it. 

First, yes, the skin is an important organ in the body's defense, providing a mechanical barrier against invasive organisms, but technically it isn't part of the "immune system" as medical professionals know it. Second, the chiropractor is invoking some sort of imaginary "law of nature".  That is, he is making the argument that vaccination is unnatural and therefore bad.  Well, there are natural things that are "bad" -- think of poison oak, for example, or the thorns on plants, or even infectious bacteria or viruses. They're natural too. The chiropractor is suffering from the logical fallacy known as "the appeal to nature".

Turning back to the chiropractor's comments:

You also have a respiratory system that also aids in defense.  You cough, you sneeze, and you blow your nose, in attempt to expel the potential invader.  Coughing, sneezing, and snorting are results of your immune system working.  Don’t suppress it with fever reducers, anti-histamines, etc.  You’re just making it easier for the invader.

Yes, the respiratory system is an important defense mechanism against infectious agents and other noxious particles in the air, courtesy of the cilia and mucous membranes lining the respiratory tract. Coughing and sneezing can also be a response to an existing infection, rather than a way of repelling an infectious agent.  Second, how does the chiropractor imagine that respiratory viruses like measles spread from person to person?  I don't know about his beliefs, but the facts are, measles are spread via the respiratory system. So the respiratory system is also a vehicle for infection, a point the chiropractor seems to have missed.

Turning back to the chiropractor's comments:

You also have your gut-associated lymph system to fight with the stronger stuff.  If your system is so deficient to get past these natural defenses,  the potential invader, live or dead, enters the blood stream.  Once something is in your blood stream, it can be transported any anywhere in your body, not good at all.  It’s like open bar at a chiropractic convention. 

First, this is rather a naive understanding of the utility of the lymph system, and the inter-relationship between the lymph system, the blood system, and the immune system. In particular, the chiropractor doesn't seem to understand that the immune system consists of elements in both the blood system and the lymph system.  Second, there's the chiropractor's assertion that if an infectious organism gets past the lymph system, then the patient's lymph system (or maybe he means the immune system, it's hard to tell) is somehow "deficient".

Turning back to the chiropractor's comments:  

A vaccine violates all laws of natural immune defenses by taking a potential pathogen along with all the TOXIC ingredients (aluminum, formaldehyde, adjuvants, etc) directly into your blood system.  This process would never occur in building natural immunity. That last sentence is kind of an oxy-moron [sic]. Immunity is a natural thing.  Vaccines are an artificial thing.

First, there are no "laws of natural immune defenses", nor is vaccination any more a violation of "natural immune defenses" than a bee-sting or a laceration.

Second, injected vaccines (as opposed to oral or inhaled vaccines) aren't injected "directly into your blood stream", but into muscle tissue (IM) or under the skin (SC) as this image illustrates:

Image Source: http://www.immunize.org/catg.d/p3085.pdf

Third, the chiropractor doesn't seem to understand the process of attenuating or killing any pathogens used in vaccination, or is dishonestly alleging that the ingredients of vaccines can themselves always cause disease.

Fourth, the chiropractor yells "Toxic!" without appearing to have any sort of understanding of the role of aluminum or formaldehyde in vaccine design and manufacture (safety of ingredients and the role of each will be discussed in a later post), or that aluminum and formaldehyde are naturally present at all times in the human body.  (See http://www.atsdr.cdc.gov/phs/phs.asp?id=1076&tid=34 and http://www.chop.edu/service/vaccine-education-center/vaccine-safety/vaccine-ingredients/formaldehyde.html.

Fifth, the chiropractor doesn't seem to understand that aluminum (in the form of gels or salts) are the only vaccine adjuvants currently licensed for use in the United States. (source http://www.cdc.gov/vaccinesafety/concerns/adjuvants.html ) This basic mistake does not increase my confidence in the chiropractor's deep understanding of vaccines. 

Sixth, the chiropractor commits the genetic fallacy, an error in logic in which the proponent shifts the focus onto attributes or origins.  It leverages existing negative perceptions to make give a negative slant to an element, without actually presenting a case.

Finally, the chiropractor is again indulging in  "the appeal to nature".

Summary:

The chiropractor appears to lack a basic understanding of high school level biology.

Within so many errors in a public statement such as this, one wonders what other medical errors and mistakes he commits on a daily basis with patients. 

For the Curious:

A brief, nontechnical description of the immune system, starting with a graphic representation of the layers of the immune system:

Source: http://www.softchalk.com/lessonchallenge09/lesson/ImmuneSystems/index.html

The immune system is composed of organs, tissues, cells, and chemical messengers that interact to protect the body from external invaders and its own internally altered cells. The chemical messengers are cytokines which are secreted by cells of the immune system that direct immune cellular interactions. Lymphocytes (leukocytes that are categorized as either B cells or T cells) secrete lymphokines. Monocytes and macrophages secrete monokines. Interleukins are a type of cytokine that send messages among leukocytes to direct protective action. The best way to understand this system is through the body's various levels of defense. The goal of pathogens is to breach these levels to enter the body, reproduce, and subsequently exploit healthy tissue, causing harm. The immune system's task is to stop them. 

The above graphic illustrates the levels of defense. The two outside circles represent nonspecific immunity and its two levels of defense. the inner circle represents the various mechanisms of specific immunity, which can be natural (genetic) or acquired in four different ways. Most pathogens can be contained by the first two lines of nonspecific defense. However, some pathogens deserve a "special" means of protection, which is discussed under "Specific Immunity."

Specific Immunity
Specific immunity may be either genetic - an inherited ability to resist certain diseases because of one's species, race, sex, or individual genetics - or acquired. Specific immunity is dependent on the body's ability to identify a pathogen and prepare a specific response (antibody) to only that invader (antigen). antibodies are also referred to as immunoglobulins (lg). The acquired form can be further divided into natural and artificial forms, which in turn can each be either active or passive.  

Specific immunity is dependent on the agraulocytes (lymphocytes and monocytes) for its function. The monocytes metamorphose into macrophages, which dispose of foreign substances. The lymphocytes differentiate into either T lymphocytes (they mature in the thymus) or B lymphocytes (they mature in the bone marrow or fetal liver). Although both types of lympocytes take part in specific immunity, they do it in different ways. 

The T cells neutralize their enemies through a process of cell-mediated immunity. This means that they attack antigens directly. They are effective against fungi, cancer cells, protozoa, and unfortunately, organ transplants. B cells use a process of humoral immunity (also called antibody-mediated immunity). This means that they secrete antibodies to "poison" their enemies.
Types of Acquired Immunity
Acquired immunity is categorized as active or passive and then is further subcategorized as natural or artificial. All describe ways that the body has acquired antibodies to specific diseases. 

Active acquired immunity can take either of the following two forms:

• Natural: Development of memory cells to protect the individual from a second exposure.
• Artificial: Vaccination (immunization) that uses a greatly weakened form of the antigen, thus enabling the body to develop antibodies in response to this intentional exposure. 

Passive acquired immunity can take either of the following two forms:

• Natural: Passage of antibodies through the placenta or breast milk.
• Artificial: Use of immunoglobulins harvested from a donor who developed resistance against specific antigens

Another quick canter through the immune system: 

Source:OneMinuteMedicalSchool, http://oneminutemedicalschool.com/2013/02/13/immuneoverview/

Source: http://tinyurl.com/vaxvswild

What's the difference between a vaccine-induced immune response and a wild-disease induced one? The way the immune system responds is the same. It only differs in terms of the scale and size of the response. You get a full blown immune response to the wild disease that may involve serious sickness, hospitalization or even death. Vaccination reduces or prevents disease and is far, far safer. 

Sources

Agency for Toxic Substances and Disease Registry, Public Health Safety Bulletin on Aluminum  http://www.atsdr.cdc.gov/phs/phs.asp?id=1076&tid=34

Atkinson W, Wolfe S, Hamborsky J, eds.  Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) Course  12th Edition Second Printing (May 2012) http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

Centers for Disease Control and Prevention Vaccine Safety,  http://www.cdc.gov/vaccinesafety/index.html

Children's Hospital of Philadelphia Vaccine Information Center, http://www.chop.edu/service/vaccine-education-center/home.html

Immunization Action Coalition http://www.immunize.org/

McNair JC, Baltimore Community College, The Lymphatic and Immune Systems http://www.softchalk.com/lessonchallenge09/lesson/ImmuneSystems/index.html

National Institute of Allergy and Infectious Disease, The Immune System http://www.niaid.nih.gov/topics/immunesystem/Pages/default.aspx

National Network for Immunization Information, "How Vaccines Work",  http://www.immunizationinfo.org/parents/why-immunize/how-vaccines-work

Palmer E, Bryant A,  Top 5 Vaccine Companies by Revenue, FierceVaccines 2012 (March 14, 2013) http://www.fiercevaccines.com/special-reports/top-5-vaccine-companies-revenue-2012

Tarzwell R MD, One Minute Medical School, Overview of the Immune System http://oneminutemedicalschool.com/2013/02/13/immuneoverview/

Your Logical Fallacy Is (website) https://yourlogicalfallacyis.com/ (note: I have chosen to use this website, as informal as it is, because it is accessible to people without formal training in logic, argumentation,  or the scientific method. There are other excellent sites such as http://www.nizkor.org/features/fallacies/)

Video Resources

Broad Institute Midsummer Nights' Science series An Immune System Primer: Vaccines, allergies, and immune-related disease https://www.youtube.com/watch?v=AqgU5KdZT8M

University of California Television (UCTV) University of California Television (UCTV)· Your Immune System 101: Basic Immunology: Nuts and Bolts of the Immune System, https://www.youtube.com/watch?v=mFNxXfwlP3A&list=PLD44D26A1C7FDE43F&index=4 and Introduction to Clinical Immunology https://www.youtube.com/watch?v=_oI0jVN4TTI&list=PLD44D26A1C7FDE43F&index=6 

The Great Courses | Understanding the Human Body: An Introduction to Anatomy and Physiology, https://www.youtube.com/watch?v=fDr8rEORVo0

Doctors of Chiropractic Receive Extensive, Demanding Professional Education on Par with MDs and DOs

Chiropractors like to claim that their education is equivalent to the MD curriculum, with statements such as this:

source: http://www.healthandchiropractic.com/chiropractic/chiropractic-facts

The chiropractor and marketer Ron Grisanti has published a widely-reproduced article, Educational Requirements for Admission to Medical and Chiropractic College, and for the MD Degree (Doctor of Medicine) and DC degree (Doctor of Chiropractic) in which he claims

The educational requirements for the MD degree (doctor of medicine) are often exaggerated, and that of the DC degree (doctor of chiropractic) underestimated. Here, actual requirements for each degree are compared....

...clearly shows that compared to medical colleges, chiropractic colleges require more courses for admission and more classroom hours for graduation. 

Grisanti then lists comparative admissions requirements:

Clearly the chart alleges that aspiring chiropractic students are better-educated that aspiring medical students, even for prestigious programs such as the medical schools of Harvard and Stanford.  This is a footling claim, both Harvard and Stanford medical schools require an undergraduate degree from an accredited four-year university.   For example, to graduate with a BS in chemistry from Stanford University a student is required to complete a least a competency in a non-English language, take courses in rhetoric and writing, and satisfy other general education distribution requirements. In any case, according to Wyatt (2005), only "seven states currently require a baccalaureate degree before granting a chiropractic license".

Further, a 1997 study found that chiropractic students were the least academically qualified of all the medical professions surveyed.

(Aside: it would be interesting to repeat the study in the current educational climate.)

Grisanti then lists classroom hours for chiropractic students and medical students, drawn from a "Parker College study".  (I have not been able to find a proper citation for this study.)

Grisanti concluded, "It should be apparent.... that in general, the chiropractic student has a more extensive classroom education and practical training in these areas, particularly in diagnosis, than the medical student."

There are two small problems.  First is that those hours cannot be verified, as the "Palmer College study" cannot be found.  Another small problem:  chiropractic students lack both clinical training while in school, and post-doctoral training. As Ralph E. Gay MD, DC wrote, "The weakest part of chiropractic education is the clinical post-doctoral period...there is no requirement for an internship or residency prior to licensure as there is in medicine and osteopathy."

In 2005, Wyatt et al. wrote (emphasis added)

In general, the first four to five academic terms are spent studying basic sciences while also learning the basics of spinal examination and treatment. Terms five through eight are spent in clinical classes such a diagnostic imaging, clinical neurology, physical examination, geriatrics, pediatrics, case management and the like. In addition, it is during these terms that students refine their diagnostic and treatment skills for the management of joint diseases, primarily of the spine. 

Currently, internship (more correctly externship) in the chiropractic profession is a one-year undergraduate endeavor, while it is a three to five year post-graduate program in medical and osteopathic training, including residency training.... In addition, clerkships are routine in medical training, while they are not in chiropractic schools, although some chiropractic schools have had clerkship programs for students in lower terms.... Our cumulative observations suggest that the obvious contrast in numbers of patient encounters in a chiropractic externship, when compared to a medical/osteopathic internship, are sadly disconcerting from the perspective of the volume and variety of patient exposures. Post-graduate residencies are available to chiropractors, but residency-based training is not currently a requirement, or even commonplace, the exception being diagnostic radiology training leading to diplomate status.

In  "Chiropractic Education for Primary Care", Harriet Hall at the Science Based Medicine Blog expands on how much medical education and training happens in the post-doctoral setting of internship and residency:

Traditional Education of MDs The 4 years of medical school are very different from those of a chiropractic school. When I was a student, the first two years were spent in classrooms and labs studying gross anatomy, physiology, pharmacology, pathology, biochemistry, histology, neuroanatomy, microbiology, immunology, embryology, and other meaty science subjects. In the 3rd year, students moved into the hospital wards, rotating through internal medicine, surgery, pediatrics, OB/GYN, psychiatry, neurology, radiology, emergency medicine, etc. 4th year clinical rotations involve a higher level of responsibility and include electives. Most of the clinical experience is with seriously ill hospitalized patients, but students also get some outpatient clinic experience.

The real training begins after graduation, when students get to put their learning into practice. They assume primary responsibility for patients, under supervision. I did what was called a “Rotating 0” internship, designed to provide a broad foundation before entering a specialty. I rotated through internal medicine, surgery, OB/GYN, pediatrics, and electives (neurology and ENT). Most of my time was spent on the hospital wards, but I also worked in outpatient clinics and in the ER. The experience was intensive, with call every 3rd night. This meant working all day, all night, and the following day for a total of 32+ hours straight, followed by a day when we worked 9-10 hours and got to go home in the evening. In my case, my training was interrupted by an Air Force assignment as a General Medical Officer, and after that I spent 2 years in a 3-year residency in Family Practice (my internship counted for year 1). Residencies are where doctors get their training in a specialty, with graduated responsibilities as the program proceeds. At 3 years, the family practice residency is one of the shortest; a surgery residency typically lasts 5 years, a neurosurgery residency 7 years. In some cases, a residency is followed by a fellowship in a subspecialty, such as gastroenterology or child psychiatry. Rigorous exams are required at various stages of training and for board certification in a specialty.
....
Chiropractic education
Chiropractic education is much less rigorous. Class time is taken up by many hours of training in manipulation technique like “toggle,” and “cervical technique,” palpation, and “subluxation” analysis; and for subjects like financial management and practice management. They don’t get any experience caring for seriously ill hospitalized patients. There is no internship or residency. 

Summary:
I think it is clear: chiropractic education is in no way as rigorous or as extensive as that required of MDs and US-trained DOs. In other words, chiropractors are not equipped by their education to opine on any medical matters other than the management of low back discomfort.

Sources 

Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M. (1998) A comparative study of chiropractic and medical education. Altern Ther Health Med. 1998 Sep;4(5):64-75. http://www.ncbi.nlm.nih.gov/pubmed/9046456

Deardorff J August 4 2009, A Medical Doctor's view of Chiropractic Health Care (Interview with Ralph E. Gay, MD, DC) http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/08/a-medical-doctors-take-on-chiropractic-care.html

Doxey TT, Phillips RB. Comparison of entrance requirements for health care professions. J Manipulative Physiol Ther. 1997 Feb;20(2):86-91, http://www.ncbi.nlm.nih.gov/pubmed/9046456 

Hall H October 13, 2013 Chiropractic Education for Primary Care  http://www.sciencebasedmedicine.org/chiropractic-education-for-primary-care/

Hodges BR, Cambron JA, Klein RM, and Madigan DM,(2013) Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic. Journal of Chiropractic Education: Fall 2013, Vol. 27, No. 2, pp. 123-127. doi: http://dx.doi.org/10.7899/JCE-13-101

Grisanti R >Educational Requirements for Admission to Medical and Chiropractic College, and for the MD Degree (Doctor of Medicine) and DC degree (Doctor of Chiropractic) (no date)http://www.yourmedicaldetective.com/drgrisanti/mddc.htm

Wyatt LH, Perle SM, Murphy DR, Hyde TE The necessary future of chiropractic education: a North American perspective Chiropr Osteopat. 2005; 13: 10. Published online 2005 July 7. doi:10.1186/1746-1340-13-10

Introduction, Including Conflict of Interest

The chiropractic profession (and sometimes, individual chiropractors) write or say things that aren't aligned with objective reality. While there are a number of sources of critiques of the chiropractic profession (such as http://www.chirobase.org/ and http://chirotalk.proboards.com/) there's not a one-stop-shop for analysis of claims from the chiropractic profession or individual chiropractors.  That's what this blog is meant to do.

One of my revered ancestors used to say of criticism, "don't break the rice bowl".  In other words, don't cause someone to lose their job or their means of earning money. I will try to structure the posts here in such a way that individuals aren't criticized, but the profession is, where justified.

I identify as a skeptic, in the sense of Tim Farley's elevator pitch:

“Skepticism is the intersection of science education and consumer protection. We help people learn from science to avoid spending their money on products and services that do not work.”

For those of you who like visuals:

Conflict of Interest: I am not a chiropractor.  I have never attended a chiropractic school.  I do not receive any income (that I know of, I do have some mutual funds) from any health-care related sources. In the past, I received chiropractic care from time to time, but now if I have musculoskeletal issues, I patronize a physical therapist or a massage provider.

You will notice that my visage is not of a contemporary person.  The image is of John Adams, I believe painted by John Trumbull.  James True Adams is an homage to some of my ancestors. This use of a nom de net is based on previous experiences of retaliation.  See for example the saga of René Najera or the British Chiropractic Assocation's suit against Simon Singh.