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They make a number of reasonable points. There is no doubt that pharmaceutical agents like nonsteroidal anti-inflammatory drugs and opioids have risks of adverse events (and dependency issues for the latter). The adverse event profile for spinal manipulation therapy (SMT) is not well described or easily determined from the literature but is likely far less than many pharmaceutical agents, particularly in the long term. While the cost-effectiveness of SMT remains unclear, it does not appear to be considerably more costly than any other therapy.
However, these arguments alone do not advocate for SMT. For this, we need unbiased interpretation of high-quality research of effectiveness for pain, function, and other outcomes. As outlined in our article,2 this is where our primary concern lies. Here are just some of the issues.
We provided the best available evidence without filtered interpretation. It is unfortunate that despite decades of research and practice, the usefulness of SMT remains unclear.