Screening for the detection of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes in welfare homes residents from south-eastern region of Poland.
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. Prof. E. Ernst Director, Complementary Medicine, Peninsula Medical School, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UK Email: edzard.ernst@pms.ac.uk