Chiropractic: Not All That It's Cracked Up to Be

I am a chiropractor who is very interested in improving the chiropractic profession (by improving research, ending unscientific claims, and ending adherence to outdated vitalistic concepts, etc.). I decided to purchase this book because Edzard Ernst is one of the profession’s more prominent detractors. Much of the information contained in this book is can be summarized as “fair criticism” of a profession that has many issues. I would be happy to address and eliminate these problems from the profession. However, the tone of the book is that of a smug keyboard-warrior chuckling to himself as he virtue signals his “big brain” in the comments section of a YouTube video. The power of the arguments is lost as they oscillate from fair and factual to pejorative, repetitive, and pedantic.Ernst is obviously biased in this topic, and that is fine, being biased does not necessarily make you wrong, it merely makes you intellectually weak. His term “so-called alternative medicine” (abbreviated SCAM), is a childish pun transparently aimed at getting a rise out of alternative medical practitioners and stroking the egos of alternative medicine detractors. The existence of alternative medicine detractors is not a bad thing, critical examination is important, but their being condescending ideologues possessed by their own perceived intelligence is probably unnecessary.Of the many examples of the smugness and self-referential virtue signaling of his own intelligence in the text, I think that the rhetorical question, “who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?” (page 10) is most hilarious because Ernst is actually neither of these. He is an author who is *selling books in an attempt to discredit the chiropractic profession* (unless I am misinterpreting the title of this book). He therefore cannot present himself as “impartial” because he stands to make a financial gain from people purchasing a book (*his* book) arguing against chiropractic. A little self-awareness would go a long way, much of the tone of Ernst’s writing is a mix of individual, comparative, and antagonistic arrogance.He spends a large portion of the book discussing serious adverse outcomes of cervical spine manipulation (CMT). He spends a full chapter listing case report after case report of serious adverse events (strokes, a few cases of paralysis, one case of visual issues, etc.) caused by CMT. He also lists many systematic reviews and retrospective studies of case reports from around the world, leading to a grand total of about 700 serious adverse events (page 192) from the literature. The line of reasoning in this chapter is funny when considered alongside Ernst’s later statement, “the plural of anecdote is anecdotes, not evidence!” (page 272), which he uses to justify his idea that one cannot make scientific conclusions of causality based on case reports and reviews of clinical success/failure. This statement is true, but it apparently does not apply to his own analysis of causal relationship between serious adverse side effects and CMT (lest we forget that case reports and retrospective analyses are both classified as anecdotal data).Since the overall number of serious adverse events in the literature across CMT history is pretty low (proportionately low compared to millions of CMT treatments per year), he repeatedly states that “most adverse events remain unpublished” and “under-reporting is therefore huge” in the absence of any evidence to corroborate this claim. Absence of additional reports of serious adverse events does not have any causal link to the their existence. The idea that “most” *serious* adverse consequences of CMT are somehow below the radar of the entire medical community seems spurious. Are we supposed to believe that many chiropractic patients around the world are having strokes and telling no one? There is no evidence to support such an unverifiable claim (it is impossible to verify that “most” of an uncounted phenomena is uncounted).The underlying premise of Ernst’s above statement is that not reporting adverse events in scientific papers is unethical and unscientific (one of his stated reasons for chiropractic research being unethical), which is true. This critique is fair and should be considered. Limiting underreporting of adverse events is a reasonable goal for the chiropractic profession, but it does not logically follow that the absence of a system to report these events necessitates the existence of “many” serious adverse complications (which is Ernst’s argument, so far as I can tell).Overall, this book presents a series of issues within the chiropractic profession that must be addressed for the profession to improve its standing within the scientific medical community. However, sorting through Ernst’s pejorative, condescending material to get to the fair, unbiased, and unpretentious material is quite a task.

This was a really thoughtful expose of an industry that somehow continues to get a pass on its complete lack of scientific basis. Thanks to clever marketing and deceptive practices, the public still believes that they are doctors and that they must use evidence to guide their practices. This book takes great care to stick to objective facts and is fairly well-written. IT's both sad and fascinating that people are allowed to continue to trick vulnerable people with "subluxations" that their services are good for anything other than the most minor back and neck soreness. Recommend this book to all of your friends.

Overly simplified, unfounded, ignorant speculation

As a former practicing chiropractor, chiropractic college professor and chiropractic researcher (Palmer West in San Jose, CA), I recommend this book for an accurate view of the chiropractic profession. Thank you Dr. Ernst.

This author claims to be evidence based and that chiropractic is not. No mention of Church et al. 2016) which shows no more risk of VAD versus going to the beauty salon. The 3 Randomized Controlled Trials also seem to be missing. I mean, they were only conducted about 20 years ago.This is not a book. Its a glorified internet message board post with a plethora of cherry picking "evidence" to propagandize their hate under the guise of "science" from their perspective. Things like this is why we cant have nice things.DOI: 10.7759/cureus.498Cite this article as: Church E W, Sieg E P, Zalatimo O, et al. (February 16, 2016) Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 8(2): e498. doi:10.7759/cureus.498

This book is written about old times and not the newer times. Chiropractic injuries happen 1 in 2 million adjustments. This book is disheartening.

The fact that you have dedicated enough time and energy to write a book on how much you hate something says all I need to know. Save your opinions for Reddit and keep this trash off of Amazon.

As a chiropractor, the vast majority of negative information propagated by books like this, or various websites are so inaccurate it is hard to believe. Some people are so engrossed in their personal beliefs they cannot see anything outside there mental paradigm. If you want to read about quackery see allopathic treatment for chronic health conditions..if it hurts numb it, if your fire alarm is going off don’t put out the fire, take the batteries outIt’s sad to know people consume information like this and will never get to experience true health care. If you want to take a pill for all your ills, keep following the people like Edzard

This heavily discounted spineless book reminds me i am on the right track in suspecting1. Academic bias2. Failure of EBM3. Chiropractic is more relevant today than ever4. Edzard should tell us what he really thinks5. Professors are people too6. You cant give a product 0 stars here