Informed Consent: A Potential Dilemma for Complementary Medicine

Professor Ernst draws attention to the need for informed consent to be obtained by complementary medicine practitioners. He makes the comment that “the United Kingdom and United States guidelines clearly want the chiropractor to explain (1) the diagnosis, (2) the benefits of the chiropractic approach for neck pain, (3) its risks, and (4) the risks/benefits of other therapeutic options.” A point to be made is that why is complementary medicine expected to go to such lengths when practitioners of orthodox medicine rarely, if ever, seek informed consent for the prescription of the medications which they order? For instance, the prescription of penicillin is so commonplace so as not to apparently require informed consent when it is recommended, yet the mortality rate of such a prescription from anaphylaxis could be 50 times greater than from an outpatient spinal manipulation treatment.1 The same statistics would apply to most other drug treatments.

Meta-analysis of studies concerning a treatment is a valuable assessment tool, providing that the initial search encompasses the key issues of the therapy. This is not the case here: Ernst's research ignores the neurological benefits of spinal manipulation therapy. For example, Ernst remarks “other treatments that have shown promise in the treatment of neck pain include exercise therapy, which is virtually free of serious adverse events or complications.” Before recommending this type of therapy to chiropractors, Ernst should recognize that chiropractic does much more than relieve neck pain. The recovery of vision is an acknowledged effect of spinal manipulation, so in dealing with informed consent for spinal manipulation therapy, the risk/benefit ratio has to be considered. It is of little value to recommend exercise therapy, compared with spinal manipulation, if there is no evidence available to validate its effectivity in regularly improving vision, in appropriate patients, which spinal manipulation clearly does.

The chiropractic profession has only itself to blame for the fact that Professor Ernst has been able to denigrate spinal manipulation therapy by reference to clinical trials, which question its efficacy. It is now 3 decades since it was shown that vision improved with spinal manipulation treatment, and this entrée to a discussion on the risk/benefit ratio of spinal manipulation has never been exploited by the chiropractic profession2; nor has it been researched to provide independent confirmation.