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Edzard Ernst, MD, PhD

E. Ernst is with the Department of Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, United Kingdom.

Correspondence: Requests for reprints should be sent to E. Ernst, MD, PhD, Complementary Medicine, 25 Victoria Park Road, Exeter, EX2 4NT, UK (e-mail: edzard.ernst{at}pms.ac.uk).

I’m grateful to Mr Evans for correcting the misprint and for raising several points, to which I’d like to respond as follows.

First, I did not omit the study by Meade et al.¹; it is included in several of the reviews I mentioned, but I cited only original studies that emerged after these reviews were published.

Second, Evans asks, "What is wrong with the total experience?" The answer is obviously, "Nothing at all." The effectiveness of treatment packages relates to one research question, specific therapies to another. Both are relevant, but I happened to address the latter.

Third, I agree that surgical interventions or nonsteroidal anti-inflammatory drugs (NSAIDs) are probably more risky than chiropractic treatments. My article was not intended to present a relative risk–benefit assessment of these therapies, which, methodologically, would be extremely difficult to do. Moreover, does the fact that thousands die on the roads every year justify railroad accidents? The incidence figures for serious adverse events provided by chiropractors are unreliable as long as underreporting of such complications is close to 100%.²

Finally, Eddy’s notion that only 15% of medical interventions are supported by valid scientific evidence goes back about 30 years and is therefore no longer applicable.

I do still think that a critical (not aggressive, as Evans put it) risk–benefit analysis of chiropractic is a worthwhile exercise. Pity that many chiropractors seem to take criticism so badly.

References

1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ.1990;300:1431–1437.

2. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J Roy Soc Med 2001;94:107–110.[Abstract/Free Full Text]

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