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"Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery. Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit. Edzard Ernst, Int. Journal of Clinical Practice, Vol. 64 Issue 8, Pages 1162-1165 (16th June 2010) [pdf]
Deaths after chiropractic spinal manipulations: a reply [Prof. E. Ernst Int J Clin Pract. July 2011]
To the Editor: "This response (1) confirms that many chiropractors find it impossible to accept the key messages regarding spinal manipulation therapy (SMT), namely that this therapy lacks a plausible rationale (2) and its risks outweigh its benefits (3). The risks are, of course, far greater than the relatively few deaths seem to imply. Several hundred cases of severe but non-fatal adverse events are on record (e.g. 4,5). The benefits of SMT have, so far, not been demonstrated; even the many chiropractors who criticised my review (6–12), have not produced convincing evidence for such benefit. Why? The answer is simple: there is none! In the most recent Cochrane review of SMT for chronic low back pain, the main indication for chiropractors, concluded that ‘there is no clinically relevant difference between SMT and other interventions for reducing pain’ (13). For all other conditions, the evidence is even more squarely negative (14). If we focus on the bigger picture, we are confronted with balancing little benefit with considerable risks. The result of such an evaluation can never be positive – no matter how we turn and twist the complex details of this debate.”
References: (1 ) Haynes MJ. Deaths after chiropractic: a comment. Int J Clin Pract; 65: 817. (2) Homola S. Real orthopaedic subluxations versus imaginary chiropractic subluxations. FACT 2010;15(4): 284–7. (3) Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35(5): 544–62. (4) Shin BC, Lee MS, Park T-Y, Ernst E. Serious adverse events after spinal manipulation: a systematic review of the Korean literature. FACT 2010; 15(3): 198–201. (5) Terrett AGJ. Current Concepts in Verebrobasilar Complications Following Spinal Manipulation. Iowa, IA: NCMIC Chiropractic Solutions, 2001. (6) Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract 2010; 64: 1162–5. (7) Wenban AB, Bennet M. Critique of review of deaths after chiropractic, 1. Int J Clin Pract 2011; 65: 102. (8) Poelsma C, Owen D. Critique of review of deaths after chiropractic, 2. Int J Clin Pract 2011; 65: 103. (9) Dokos C, Tragiannidis A. Critique of review of deaths after chiropractic, 3. Int J Clin Pract 2011; 65: 103–4. (10) Perle SM, French S, Haas M. Critique of review of deaths after chiropractic, 4. Int J Clin Pract 2011;65: 104–5. (11) Whedon JM, Bove GM, Davis MA. Critique of review of deaths after chiropractic, 5. Int J Clin Pract 2011; 65: 105. (12) Ernst E. Response to critiques of review of deaths after chiropractic. Int J Clin Pract 2011; 65: 106. (13) Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev 2011; 2: CD008112. (14) Ernst E, Canter PH. A systematic review of systematic reviews of spinal manipulation. J R Soc Med 2006; 99: 192–6.