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J R Soc Med. 2007 October; 100(10): 444.
PMCID: PMC1997269

Adverse effects of spinal manipulation

I am astounded that the Journal has seen fit to publish Edzard Ernst's latest offering (JRSM 2007:100:330-338)1—especially following critical comment of his last paper published herein (JRSM 2006;99:192-196).2

Professor Ernst calls this a systematic review, yet it is not. While it is a personal review of the literature, it does not fulfill the criteria for a systematic review which principally assesses the methodological quality of previous studies according to pre-determined criteria and bases its conclusions on the level of evidence presented. This latest contribution is based on low-quality research and is riddled with misquotes and errors.

Whether Professor Ernst likes it or not, the major body of published evidence points to manipulation being a safe and effective tool in a chiropractor's armamentarium. Instead, he focuses on negligible risk elements of care and ‘puffs them up’ out of all proportion—effectively claiming causality where none exists. He even suggests that minor, common side-effects of chiropractic are sufficient to call into question the sagacity of chiropractic care being provided. This is as nonsensical as suggesting that injections should not be given because they cause localized inflammation and ‘hurt’ patients for a short period—or even more silly, to suggest that those with fractures should not have them cast as that process causes itching and muscular atrophy.

One can only conclude that Professor Ernst not only has a problem with chiropractic, but that this is sufficient to cloud his judgment and create illogical ‘findings’ from nothing.


Competing interests BJL is the President of the British Chiropractic Association.


1. Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007;100: 330-8 [PMC free article] [PubMed]
2. Ernst E, Canter P H. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 2006;99: 192-6 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press