Editing Chiropractic (section)

=== Risk-benefit ===

A 2012 systematic review concluded that no accurate assessment of risk-benefit exists for cervical manipulation.<ref name="Haynes" /> A 2010 systematic review stated that there is no good evidence to assume that neck manipulation is an effective treatment for any medical condition and suggested a [[precautionary principle]] in healthcare for chiropractic intervention even if a causality with [[vertebral artery dissection]] after neck manipulation were merely a remote possibility.<ref name=Ernst-death/> The same review concluded that the risk of death from manipulations to the neck outweighs the benefits.<ref name=Ernst-death /> Chiropractors have criticized this conclusion, claiming that the author did not evaluate the potential benefits of spinal manipulation.<ref name=Ernst-response /> [[Edzard Ernst]] stated "This detail was not the subject of my review. I do, however, refer to such evaluations and should add that a report recently commissioned by the General Chiropractic Council did not support many of the outlandish claims made by many chiropractors across the world."<ref name=Ernst-response>{{cite journal | author = E Ernst | title = Response to critiques of deaths after chiropractic | journal = International Journal of Clinical Practice| volume = 65 | issue = 1 | page = 106 | year = 2011 | doi = 10.1111/j.1742-1241.2010.02568.x | s2cid = 72845939 | doi-access = free }}</ref> A 1999 review of 177 previously reported cases published between 1925 and 1997 in which injuries were attributed to manipulation of the cervical spine (MCS) concluded that "The literature does not demonstrate that the benefits of MCS outweigh the risks." The professions associated with each injury were assessed. Physical therapists (PT) were involved in less than 2% of all cases, with no deaths caused by PTs. Chiropractors were involved in a little more than 60% of all cases, including 32 deaths.<ref name="Di_Fabio_1/1/1999">{{cite web | last=Di Fabio | first=Richard P | date=January 1, 1999 | title=Manipulation of the Cervical Spine: Risks and Benefits | website=[[Physical Therapy (journal)|Physical Therapy]] | url=https://academic.oup.com/ptj/article/79/1/50/2857770 | access-date=November 1, 2021 | quote=Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed. }}</ref>

A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.<ref name="ErnstMaintenance2009">{{cite journal | author = Ernst E | title = Chiropractic maintenance treatment, a useful preventative approach? | journal = Preventive Medicine| volume = 49 | issue = 2–3 | pages = 99–100 | year = 2009 | pmid = 19465044 | doi = 10.1016/j.ypmed.2009.05.004 }}</ref>