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Dynamic Chiropractic – November 4, 2010, Vol. 28, Issue 23

ACA Responds to Ernst Study on Stroke Risk

By Editorial Staff

Despite the U.S. Task Force on Neck Pain and Its Associated Disorders' conclusion that the risk of suffering a stroke following a cervical manipulation is likely attributable to a vertebral artery dissection in progress prior to the adjustment - and that the association between the stroke and the office visit is no higher in patients receiving chiropractic care versus those receiving care from a medical doctor, the profession and public have been hit with "Deaths After Chiropractic: A Review of Published Cases," a review of case reports published in the International Journal of Clinical Practice.

Consider these concluding remarks by author Edzard Ernst (who, by the way, authored an article in 2006 in the same journal titled "When Natural Is Not Harmless"):

"Many chiropractors claim that because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely ... even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition."

After the article appeared on Medscape and in several of its e-newsletters, the ACA sent a stern letter to the editor of Medscape, criticizing the Ernst study and the online information resource for distributing it:

"A review of the paucity and anecdotal nature of the data on which Ernst bases his conclusions should have given Medscape pause; further examination would have revealed that Ernst omitted mention of the most credible scientific literature on the effectiveness and safety of chiropractic manipulation. This raises serious questions about not only Ernst's conclusions but also his objectivity relative to chiropractic care."

"We do understand that Medscape has partnerships with dozens of journals and that you select content with the understanding that they have vetted their content carefully; however, the Ernst paper clearly did not undergo rigorous review. For example, as your readers know, causation cannot be established by case reports alone, yet Ernst makes seriously unsupported assertions about the safety of chiropractic treatment using only case reports. This is unscientific and irresponsible at best."

"If Ernst was truly interested in examining the safety and effectiveness of spinal manipulation, he would have referenced the studies cited in this letter. If he was truly interested in public health, he would have discussed the risks of spinal manipulation, not chiropractic manipulation."

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