Adverse effects of spinal manipulation

If one is to draw any conclusions from the recent article by Ernst (JRSM 2007;100:330-338),¹ two assumptions must be made:

1. That Ernst's reviews are not without their limitations;

2. That correlation and causal effect are the same thing with respect to serious adverse effects.

Having done this, we learn that spinal manipulation may or may not help and that the incidence of serious adverse effects is unknown because not enough have been reported. This is clearly a case for more research to be done to define the extent to which under-reporting, bias and even conspiracy theories contribute to their real incidence—but to continue to ignore evidence of the effectiveness of spinal manipulation, as outlined in previous letters to the Journal (JRSM 2006;99:277-278),^2-4 in order to repeat the mantra that ‘it doesn't work and it'll probably harm you’ is bad science that does no-one any good. Might I suggest that a way ahead, in the UK at least, is for Ernst and/or the JRSM to speak to regulatory bodies such as the General Chiropractic Council⁴ or the General Osteopathic Council⁵ before publication? This is an efficient way to learn about current research in the professions, to realize that that systems are in place for adverse event reporting and to recognize that some popular generalizations about the activities of chiropractors and osteopaths are inaccurate. Lighting the touch-paper of ‘an eclectic and combustible mix’, to quote the Editor (JRSM 2007;100:299), may attract attention to the Journal, but one wonders at what price?