Exclusive interview with Dr. Murray Katz -- Pediatricians in U.S. are targeted next
Dr. Murray Katz, of Quebec, Canada, incorporator and sole director of Orthopractic Manipulation International Inc.
Editor's note: This Katz interview, that discusses the anti-chiropractic, pediatric position statement signed by 13 Canadian pediatricians (organized by Dr. Katz), has been edited to fit the space constraints of the International Forum.
"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. 23 issue of "DC").
Dr. Katz: These pediatricians and I have seen over the last four or five years increasing involvement of chiropractors with children. We had one pediatrician treating a child for recurrent ear infections and was told by a chiropractor to stop taking antibiotics and subsequently deteriorated. 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: 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 people from the Canadian Pediatric Society; there were people who were the heads of genetic departments.
"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.
"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: Yes.* (Though answering "Yes" to the question during the interview, Dr. Katz later amended that response by sending us this written statement: "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 know from the inquiries we've had from government and insurance companies both in the U.S. and Canada, predominantly in the U.S., one of the things they seem to be looking at is identifying those scientific chiropractors. One of the criteria seems to be: "What are their claims in terms of treating children?"
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 an MD 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.
"DC": 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 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.
"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.
"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 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.
"DC": The U.S. government has just published national guidelines for the treatment of otitis media with effusion (from the Agency for Health Care Policy and Research, department of Health and Human Services). They list treatments that they recommend, ones they don't recommend, and treatments they feel that they don't have enough evidence to make a decision on. Chiropractic did not end up in the list of treatments not recommended. 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 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.
"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, 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.
"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.
"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. 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 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.
"DC": Thank you Dr. Katz.
