Volume 28, Issue 1 , Page 78, January 2005
In Response: to Cashley
Article Outline
In Response:
This comment, I fear, is largely based on a misunderstanding of my article. I do not agree that Peloso et al have invalidated my systematic review with their critique. The commentator omits to mention the fact that the publication of their critique was directly followed by a rebuttal1 which set the record straight. In any case, I did say (as the commentator mentions) that others came to different conclusions. Most importantly, I do not quite see how this impacts on the intention of my article, that is, to stimulate a discussion on informed consent. The commentator seems to misread my article as a review of the efficacy and safety of spinal manipulation.
The author also believes that I should address the issue of “informed consent for the use of nonsteroidal anti-inflammatory drugs in the care of neck pain”. Yet, I am professor of complementary medicine, not of pharmacology. I would be happy to “suggest that allopathic physicians should tell patients with neck pain that chiropractic is safer treatment than using nonsteroidal anti-inflammatory drugs,” but there are 2 problems with this. First, this is not quite as clear as the commentator thinks—the lack of a formal reporting scheme and the significant level of underreporting of adverse effects invalidate all estimates of adverse effects of spinal manipulation.2 Second, the absolute risks are almost irrelevant compared with the risk-benefit profiles of each therapy.
References
PII: S0161-4754(04)00287-8
doi:10.1016/j.jmpt.2004.12.019
© 2004 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Volume 28, Issue 1 , Page 78, January 2005
