Professor Edzard Ernst's study, which concluded that manipulation does not work and may be dangerous in some circumstances (report, Mar 22), was incomplete as it included a review of just 16 selected studies from the very many more high-quality studies which arrive at precisely the opposite conclusion.

That the European Commission Research Directorate-General, the health ministries of most European countries, as well as those of the US, Canada and others, do recommend spinal manipulative care would indicate an adverse degree of selection bias in the study.

At our centre, differing health professionals work alongside one another and conclude that each has a role to play in the treatment of spine and joint conditions. Manipulation, along with other medical treatments, has the potential to cause harm if inappropriately applied. There is, however, a consensus in the research community that spinal manipulation is indeed a safe treatment. Much unnecessary distress is caused by such studies to the thousands of patients relying on these professionals.

Consultant neurosurgeon

Consultant rheumatologist

Article from the Times Online