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May I reply to some comments generated by my paper on ‘whiplash injury’1? Dr Sweetman (December 2000 JRSM, p. 662) emphasizes careful examination particularly at C1 and D3, confirming the sometimes involvement of thoracic segments. Mr Morrison (February 2001 JRSM, p. 102) notes that most neck sprains heal within an expected time-span. In 1959, Martin2 suggested six weeks. It is hard to believe that minor neck sprains following minor motor vehicle impacts continue to produce significant symptoms for months or even years from purely organic factors. Careful history-taking and reading of general practitioners' regular case notes recorded before the accident may help solve the puzzle3. Morrison points out that there is always a psychosocial factor in illness or injury (as Balint4 had noted previously). He also states that experts rarely follow up the patients they prepare reports upon. They may not always well understand the natural history of these injuries.
Dr Mendelson (February 2001 JRSM, p. 102) correctly notes Crowe's earlier use of the unfortunate term ‘whiplash’ at a 1928 conference. Space limits one's ability to acknowledge all prior work. I submitted my article before publication of the paper by Cassidy et al. revealing the effect of reducing compensation in whiplash cases5. However, I did note the study by Partheni et al. on 130 Greeks with whiplash injury who improved far more rapidly than patients in countries who hear ‘frightful diagnoses’ and are overtreated6. Both Morrison and Mendelson consider litigation harmful.
Mendelson stresses the importance of recognizing a biopsychosocial paradigm in illness. I agree. When we consider biological, mechanical, psychological and social factors more equally in whiplash injury we will help our patients more7.