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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).

Hurwitz, Meeker, and Smith raise further interesting points. Having published more than 50 systematic reviews, I am of course aware that such articles require a methods section. My article in the Journal was not, however, a systematic review, and nowhere do I pretend that it was. Hurwitz et al. say that another review contradicts my statement that there is no evidence to demonstrate that chiropractic spinal manipulation is more than a placebo.¹ I disagree. The crucial discrepancy is that the article by van Tulder et al.¹ was limited to back pain trials, while my systematic review² was based on trials of spinal manipulation versus sham manipulation regardless of indication. Also, I don’t think that our result of 100% underreporting of serious complications³ is in any way contradicted by the suspicion emerging from another study⁴ that an approximately 50% incidence of mild and transient adverse effects could have been owing to overreporting. The obvious discrepancy here is that we are dealing with two dramatically different types of effect.

These few lines clearly show that it is always possible to accuse people with whom one disagrees of using "deficient methods, a biased sample of reference material, selective reporting of results, and prejudicial language." The readers might decide for themselves which side is more guilty of these "crimes" than the other.

The more important point, however, seems to be missed: Many patients use chiropractic treatments, and even the most optimistic interpretation of the data must conclude that a risk–benefit evaluation is far less positive than most chiropractors make it out to be. In the interests of these many patients, it is urgent that we do the necessary research and clarify this important matter.

References

1. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions. Spine.1997;22:2128–2156.[ISI][Medline]

2. Ernst E, Harkness EF. Spinal manipulation: a systematic review of sham-controlled, double-blind, randomized clinical trials. J Pain Sympt Man.2001;24:879–889.

3. 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]

4. Leboeuf-Yde C, Rasmussen LR, Klougart N. The risk of over-reporting spinal manipulative therapy-induced injuries: a description of some cases that failed to burden the statistics. J Manipul Physiol Ther.1996;19:536–538.[Medline]

This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ernst, E. Search for Related Content PubMed Articles by Ernst, E.