July 17, 2016
TO: Vincent Jackson, Editor
“World of Knowledge” magazine
Nicola Conti, Brand Manager
FROM: JC Smith, MA, DC
RE: Edzard Ernst
The July, 2016, publication of the World of Knowledge included a salacious article that was anything but knowledgeable; in fact, it was obviously an affront to the current science and international guidelines.
I was dumbfounded by the article, “Are Chiropractic Treatments Ineffective.” Similar misinformation by Edzard Ernst, an infamous self-appointed medical propagandist, has been thoroughly discredited in the past by many scientists and the current article supports the notion that he remains untrustworthy.
Professor Robert Hahn, a Swedish physician, scientist and professor at Linkoping University, stated: “I’ve never seen a science writer who was so obviously biased as Edzard Ernst.”
Dr. Avery Jenkins, a chiropractor and writer in Australia, also accused Ernst of misrepresenting the actual safety of spinal manipulation:
“What is interesting here is that Edzard Ernst is no rookie in academic publishing. In fact, he is a retired professor and founder of two medical journals. What are the odds that a man with this level of experience could overlook so many errors in his own data?
“The likelihood of Ernst accidentally allowing so many errors into his article is extremely small. It is far more likely that Ernst selected, prepared, and presented the data to make it fit a predetermined conclusion.
“So, Ernst’s article is either extremely poor science, or witheringly inept fraud. I’ll let the reader draw their own conclusion.”
Not only have credible health professionals discarded Ernst as a rational voice on alternative healthcare, his biased reports also cost him his job at the University of Exeter when he attacked homeopathy arousing the wrath of Prince Charles, the Prince of Wales, and a patron of the homeopathic profession.
A complaint made by Charles’s former private secretary, Sir Michael Peat, forced Ernst to retire in 2011 and his department was closed. The trouble started in 2005 when Ernst publicly attacked a report by economist Christopher Smallwood that had been personally commissioned by Charles. The report claimed complementary and alternative medicine (CAM) was cost effective and should be available on the NHS.
Ernst described this report as “complete misleading rubbish.” Ernst continued his attack by slapping Charles in the face:
“Prince Charles has continued to promote alternative medicine indefatigably, often showing himself unwilling or unable to distinguish between real health care and blatant quackery, between medicine and snake oil, or between the truth and some half-baked obsessions of his own.”
I find it odd that Ernst with his outlandish comments was stunned Prince Charles might be annoyed by his remarks. Indeed, Ernst shows himself as an irrational critic who ignores the current research on cost and clinical effectiveness of alternative treatments.
Ernst described the episode as “the most unpleasant period of my entire professional life.” Perhaps Ernst now understands how CAM practitioners must feel when their professions are attacked by biased critics like him.
As a practicing chiropractor myself for the last 35 years and author of “The Medical War Against Chiropractors,” I have chronicled the propaganda emanating from so-called medical watchdogs like Ernst who are inherently contemptuous of any non-medical practices.
Medical chauvinism is an accurate label for people like Ernst who ignore the facts, misconstrue the science and purport to be the source of truth when, in fact, he is nothing more than a medical bigot with “half-baked obsessions of his own.”
Medical curmudgeons like Ernst are quick to criticize with specious science but completely ignore any legitimate criticism of medical treatments. For example, just two month before your July, 2016, publication of World of Knowledge, an article in the British Medical Journal revealed the overall danger of medical care: “Medical error—the third leading cause of death in the U.S.”
Another example from the editors of the British Medical Journal, was the commentary in 2013, “Nuts, Bolts, and Tiny Little Screws: How Clinical Evidence Works,” that insists two-thirds of medicine is ineffective, unproven or too dangerous to use.
Yet we heard nothing from Ernst about these shocking reports from the most prestigious medical journal in the western world.
Ernst commented in your magazine about chiropractic care being unsafe, “There is now a lot of evidence showing that more than half of all patients suffer mild to moderate adverse effects after seeing a chiropractor,” but he offered no references for his unfounded accusation nor did he compare it to medical mistakes.
Indeed, chiropractic treatments are now shown to be more effective and safer for the majority of spine related disorders and the pandemic of back pain than anything the medical world has to offer.
Scott Haldeman MD, DC, PhD, confirms that every credible guideline on spine care now recommends conservative care first:
“The paradigm shift has already taken place. Non-surgical, non-invasive care is the first choice for treatment for spinal disorders in the absence of red flags for serious pathology in virtually all guidelines.”
This is not the first time Ernst has made unsupported comments about the alleged danger of spinal manipulation.
In 2010, he attacked chiropractic care in his report, “Deaths after Chiropractic: A Review of Published Cases,” noting, “Twenty-six fatalities were published since 1934 in 23 articles.”
Considering 26 deaths over 76 years equates to 0.34 deaths per year (one-third of a person!), instead of sounding an alarm to scare people, Ernst should have praised chiropractic care for its obvious safety since this is an extremely low rate in comparison with equivalent medical methods for the same diagnostic conditions.
Ernst’s paper drew quick criticism from The Dartmouth Institute for Health Policy and Clinical Practice:
“Three deaths were reported during the last 10 years of the study, so for that most recent time period, the absolute risk could be estimated to be 3/10 per 100 million, or three deaths for every billion chiropractic encounters…This rate is so low that it cannot possibly be considered significant…An interesting flip side to the research question might be: by undergoing a course of chiropractic spinal manipulation, how many patients were able to avoid death by avoiding complications of surgical intervention?”
However, upon closer examination on the issue of iatrogenic problems within healthcare as a whole, if Ernst wanted to be fair and balanced, he should have compared chiropractic accidents with the many obvious medical iatrogenic issues to give the public a more accurate appraisal of relative safety.
An analysis by Anthony Rosner, PhD, compared medical procedures to chiropractic care and concluded that, in fact, patients should be warned of the dangers of medical procedures rather than chiropractic care.
Dr. Rosner discovered, “The statistics really begin to spin one’s head.” Using a baseline figure of one stroke incidence per 1 million cervical manipulations as an estimate, Dr. Rosner found a:
- Two times greater risk of dying from transfusing one unit of blood
- 100 times greater risk of dying from general anesthesia
- 160-400 times greater risk of dying from use of NSAIDs
- 700 times greater risk of dying from lumbar spinal surgery
- 1000-10,000 times greater risk of dying from traditional gall bladder surgery
- 10,000 times greater risk of serious harm from medical mistakes in hospitals
Nor did Ernst make mention of medical mistakes that cause more harm to many more people than chiropractic care. According to the Journal of Patient Safety, as many as 440,000 patients a year die from hospital errors as reported in 2013. In all, some claim this figure is now over 1.5 million deaths due to medical mistakes.
On August 26, 2014, another article appeared warning of the dangers of medical care: “Doctor Errors Kill 500,000 Americans a Year.” Compared to 26 deaths over 76 years caused by chiropractic care, the likelihood of death from medical care is overwhelming. Yet Ernst made no mention of the greater danger of medical care.
Another important issue ignored by Edzard Ernst is the fact chiropractic care today is highly regarded by many comparative studies, evidence-based guidelines and patient surveys:
- In 1994, the U.S. Public Health Service’s Agency for Health Care Policy and Research (AHCPR) report entitled “Acute Low Back Pain in Adults” touted spinal manipulation as a “proven treatment.”
- In 2007, the American College of Physicians/American Back Pain Society “Guidelines on the Diagnosis and Treatment of Back Pain” also endorsed acupuncture, spinal manipulation, massage therapy, and other CAM treatments for low back pain.
- In 2010, the North American Spine Society recommended spinal manipulation should be considered before surgery or narcotics.
- In 2013, the Optum Health internal analysis of low back pain treatments determined the best track to take for cost efficiency begins with a patient consulting a chiropractor first. When a chiropractor was the first provider, treatments were “well-aligned with clinical evidence; the least fragmentation of care; low rates of imaging, injections, and prescription medications; and low total episode cost when manipulation is introduced within the first 10-days of the episode.”
- In 2013, Consumer Reports surveyed more than 14,000 subscribers who ranked chiropractic care the #1 preferred treatment for low back pain.
Silence of the Lame
However, none of this important information was mentioned by this medical curmudgeon who obviously has an agenda to deceive the public rather than offer a “fair and balanced” report.
For example, Ernst ignored the plethora of new research criticizing medical spine care such as the recent article in the Medical Journal of Australia: “Perspectives: Surgical management of low back pain.”
The authors stated, “Spinal surgery for chronic low back pain is controversial, and the disproportionate number of fusions in private hospitals is unexplained.” Obviously this is quite a damning indictment from the leading medical journal that will go unmentioned by journalists like Ernst.
A related online article published by the MJA InSight newsletter on April 26, 2016, Spinal Fusion Surgeries Questioned, also was painfully clear the urgent need to stop the tsunami of back surgeries:
“Spinal fusion surgeries for chronic low back pain are on the rise, despite the lack of research to back their efficacy, and experts are now calling for tighter guidelines, including a waiting period.”
Dr. Richard Williams, orthopaedic surgeon and spokesperson for the Royal Australasian College of Surgeons, told MJA InSight that a key regulation should be that patients must wait a period of 12 months before a spinal fusion surgery was performed, noting “Most patients will recover after these 12 months” without any surgery.
Imagine the impact this policy would have on the lives of thousands of Aussies, the money that would be saved by avoiding the high cost of surgery, hospitalization, disability and the inevitable chronic pain and the risky use of opioid (heroin) painkillers that follow failed back surgery.
In fact, the back pain epidemic has been so mismanaged by the medical profession with opioids and fusion surgery and patients are so ill-informed by the biased media that Mark Schoene, associate editor of The BackLetter, an international spine research journal, clearly warns, “such an important area of medicine has fallen to this level of dysfunction should be a national scandal. In fact, this situation is bringing the United States disrespect internationally.”
I could continue about this medical misinformation, but I think I’ve made my point that Edzard Ernst is an unreliable source of information on any CAM profession of truth when, in fact, he is nothing more than a medical bigot with “half-baked obsessions of his own.”
As Prince Charles, Robert Hahn, Anthony Rosner, Mark Schoene, the Dartmouth Institute for Health Policy and Clinical Practice, the editors of the BMJ and the many researchers who know the facts would attest, Ernst is a fraud when he purports to be a medical scientist and watchdog for public safety.
Perhaps Edzard Ernst would be better suited to warn the public about medical mistakes and deaths at the hands of his own medical profession than to throw stones at safer alternative practitioners.
If your magazine believes in “fair and balanced” reporting, it behooves you to print my response to counter the serious misinformation your article presented to the public.
 BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2139 (Published 03 May 2016) Cite this as: BMJ 2016;353:i2139
 Private communication with JC Smith, 7/10/2013
 E Ernst “Deaths After Chiropractic: A Review Of Published Cases,” Int J Clin Pract, 64/8 (July 2010):1162–1165
 JM Whedon, GM Bove, MA Davis, “Critique of review of deaths after chiropractic, 5” Letter to editor, The International Journal of Clinical Practice, 65/1 (January 2011):102-106.
 A Rosner, “Evidence or Eminence-Based Medicine? Leveling the Playing Field Instead of the Patient,” Dynamic Chiropractic 20/25 (November 30, 2002)
 J Paling www.healthcare speaker.com, 2000.
 Paling, ibid.
 V Dabbs, W Lauretti. “A Risk Assessment Of Cervical Manipulation Vs NSAIDs For The Treatment Of Neck Pain,” Journal of Manipulative and Physiological Therapeutics 18/8 (1995):530-536.
 RA Deyo, DC Cherkin, JD Loesser, SJ Bigos, MA Ciol, “Morbidity and Mortality In Association With Operations On The Lumbar Spine: The Influence Of Age, Diagnosis, And Procedure,” Journal of Bone and Joint Surgery Am 74/4 (1992):536-543.
 J Paling www.healthcare speaker.com, 2000.
 Paling, ibid.
 A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, James, John T. PhD, Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128
 Bigos et al. U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)
 Chou et al., Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Med., 2007, vol. 147 no.7
 Thomas M. Kosloff, DC, David Elton, DC, Stephanie A. Shulman, DVM, MPH, Janice L. Clarke, RN, Alexis Skoufalos, EdD, and Amanda Solis, MS, Conservative Spine Care: Opportunities to Improve the Quality and Value of Care, Popul Health Manag. Dec 1, 2013; 16(6): 390–396.
 Charlotte Mitchell, Spinal fusion surgeries questioned, MJA InSight, 26 April, 2016
 U.S. Spine Care System in a State of Continuing Decline?, The BACKLetter, vol. 28, #10, 2012, pp.1