MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

On 29 August, I published a post discussing a case report of a patient who had suffered multiple unilateral pre-retinal haemorrhages immediately following chiropractic neck manipulation suggesting that chiropractic spinal adjustments can not only affect the carotid artery, but also could lead to pre-retinal haemorrhages. Two days ago (over one month after my blog-post), the story was reported in the Daily Mail. They (originally) quoted me both in their on-line and print version as follows: “Edzard Ernst, an expert in alternative medicine, said chiropractic treatments were too dangerous and not sufficiently effective to be recommended for any condition.”

I think this is a statement that does not really relate well to the story. Crucially, it is a sentence that I do not identify with.

So, why did I say it?

The answer is simple: I didn’t!

What happened is this:

The ‘science correspondent’ of the Mail emailed me asking whether she could speak to me. I replied that I am currently in Brittany and that it would be better to send me questions which I promised to answer swiftly. She then send a press-release about the above-mentioned case report and asked for a quote. The paragraph I swiftly sent her read as follows:

“Chiropractors frequently manipulate patients’ neck in such a way that the joints are taken beyond their physiological range of motion. This can lead to all sorts of problems, sometimes even death. This new report suggests that chiropractic neck manipulations can also damage the eyes. As the ensuing problems tend to be temporary, it is likely that such eye-damage occurs often after chiropractic treatments. Chiropractic neck manipulations are not convincingly effective for any condition; as they can cause a lot of harm, their risk/benefit balance is clearly negative. In other words, we should not use or recommend them.”

The science correspondent thanked me and replied that my quote was too long and had to be shortened; would I be happy, she asked, with the following text:

“Edzard Ernst, an expert in the study of alternative medicine and former professor at the University of Exeter, said: ‘Chiropractors frequently manipulate patients’ neck in such a way that the joints are taken beyond their physiological range of motion.
‘The ensuing problems tend to be temporary but it is likely that this kind of eye damage occurs often after chiropractic treatments.
‘Chiropractic neck manipulations are not convincingly effective for any condition as they can cause a lot of harm. Therefore we should not use or recommend them.’ ”

I made a slight alteration (exchanging ‘the ensuing problems’ for ‘the ensuing eye-problems’) and replied that this was fine by me.

When I saw what was eventually published (the nonsense printed in bold above), I was baffled and irritated. Therefore I instantly complained to the science correspondent. She apologised saying that my quote had been “paraphrased from [my] full quote, probably for reasons of space during the production process”. She also changed the quote in the on-line version to what it says currently.

I replied: “of course, I accept your apology personal, as I knew it was not your doing. nevertheless, I find it totally unacceptable that someone at the DM can just go ahead and change direct quotes. you say he/she paraphrased me; I disagree! the published sentence has an entirely different meaning. this is not journalism! I want an apology from the person who is responsible.”

The science correspondent then promised to take care of it; but, so far, nothing has happened.

One could easily view this episode as trivial. However, I believe that decent journalism should stick to the rules. And one of the most fundamental one is that journalists cannot put words into people’s mouths just because it fits their story-line (Boris Johnson did this when he was a journalist, and look what a formidable mess he is now creating!). If we let journalists get away with such behaviour, we cannot have trust in journalism. And if we cannot trust journalism, it has lost its purpose.

So, should I continue insisting on an adequate apology from the person responsible or not?

What do you think?

47 Responses to “Chiropractic treatments are too dangerous…” A TALE OF POOR JOURNALISM (by the Daily Mail)

  • The fact that they have put this sentence in quotes clearly implies to their readers that those were your exact words. This could lead them to form ideas about your own beliefs that are untrue, and also perhaps about your character (suggesting that your approach might be less measured than in fact it is). I don’t know the legality of this, but in some circumstances maybe this sort of thing could be considered libellous.

    Having said that, The Daily Mail is well-known for its particular approach to journalism, and the saying “It must be true, because I read it in the Mail” is well-known.

    Years ago, a friend of mine was a sub-editor on The Telegraph. One of her jobs was to comb the other newpapers to ensure that they hadn’t missed important stories. She would regularly find reports in The Daily Mail that weren’t in the other papers, and on investigation many of these proved to be completely fabricated.

    On the other hand, when my patients brought be press cuttings they were usually from The Daily Mail, so clearly it had some influence on them.

  • Excuse me Doctor,
    I live in Canada not the UK but I was under the impression that the Mail and “decent journalism” were diametrically opposed.

    OTOH, if anyone is quoted, it should be accurately; otherwise it should not be called a quote. Otherwise it is deliberate misrepresentation.

  • Dear Dr. Ernst,

    Reading your blog of today, I think “I replied that I am currently in Brittany” should read “I replied that I am currently NOT in Brittany”. Some other minor comments I have, I’ll kep to myself.

    Best wishes,

    Jeroen Staring

  • ‘Poor journalism y the Daily Mail’, you say? Whatever next? It’s t be hoped that standards at the Telegraph at least are upheld

  • Just had an email from the DM science correspondence:
    “I’m afraid asking for it to be changed online (which it has been) is all I can do at my level.
    But I’ll pass this straight on to the complaints department in our office and they will come back to you.
    If they do not by next week, please email me again and I will chase them.”

  • Welcome to DM, world-famous home to Complementary and Alternative Journalism. Warning: May Both Cure AND Cause Cancer.

  • I wouldn’t worry so much about the apology as about some sort of retraction. I think it’s important for someone who specializes in evidence based CAM to not have this statement distorted.

  • Dear Mr Edzard,

    I, first off would like to say, that I appreciate you attempting to correct this absolutely horrendous act of so called journalism. Obviously the media is only interested in shocking the public and not reporting the facts. Bravo for you.

    Secondly, I have been a chiropractor for 20 years and have probably have delivered over 100,000 cervical adjustments. It that time I have only experienced an occasional muscle spasm, headache or slight dizziness as an adverse reaction to a properly delivered adjustment. That is not to say that on rare occasion can something more drastic not occur but when compared to the statistics, which I am sure you are aware, there are for more dangerous complications related to main stream medicine than chiropractic adjustments.

    You are by all rights entitled to your opinions but if you polled actual patients under chiropractic care, I’m sure you would see that your statement regarding benefits versus risks to be inaccurate. Yes I know that double blind studies, as touted as the gold standard, are lacking for proof as to the benefits of chiropractic; however, I personally can give you a multitude of patients whom would more than gladly explain to you how chiropractic care has completely changed their lives for the better.

    I’m just a lowly chiropractor with a small practice but everyday I strive to do my part to help my community live a healthier more productive life. Unfortunately, it’s articles like yours that makes my job more difficult and not once have you given proof yourself that the retinal problem actually occurred due to the adjustment and just wasn’t a mere coincidence. Therefore, I believe in a court of law that would be considered hearsay.

    To your health!!

    • thanks
      a few points, if I may:
      1) my last name is Ernst, my first name is Edzard
      2) “double blind studies, as touted as the gold standard, are lacking for proof as to the benefits of chiropractic”; double blind RCTs do hardly exist. there are many single blind studies and those that are positive might be positive because of the lack of double blinding.
      3) “You are by all rights entitled to your opinions…”; thank you, very kind, but I try to report evidence rather than opinion here.
      4) “I personally can give you a multitude of patients…”; anecdote-based medicine has been shown to be seriously misleading.
      5) ” it’s articles like yours that makes my job more difficult…”; the DM article was not mine and the case-report neither. I merely discussed a published paper.
      6) “I believe in a court of law that would be considered hearsay.” have you read the original case-report? I recommend you do so before you post utter nonsense again.

    • Schwartz said:

      I have been a chiropractor for 20 years and have probably have delivered over 100,000 cervical adjustments. It that time I have only experienced an occasional muscle spasm, headache or slight dizziness as an adverse reaction to a properly delivered adjustment.

      Glad performing your manipulations didn’t cause you any serious harm, but what about your customers?

      A flippant remark, but you simply raise questions about how you know you have not seriously harmed anyone and why you felt it necessary to endanger your customers in the first place?

      • “To a “properly delivered” adjustment…”. Hardly a gold-standard here since there are likely dozens of “Techniques”….and like religious zealots ALL believe theirs is “delivered” properly…them “others”, not so much. 20 years in quackery is 20 years of infiltration and verification of quackery.
        When you quackopractors try to impress us that a “long career” doing quackery is somehow proof of “its” stable foundations, or verisimilitude I always fondly recall how long homeopathy, Scientology and Islam have been with us. And they are all “properly delivered” by their adherents also. So they tell us.

      • I had an adjustment once that made me woozy and frightened the chiropractor.

        Last visit I ever made to a chiropractor.

      • Did Francis D Schwartz do a follow-up on his clients so he knows that no one died in their sleep after coming home or was admitted with locked-in syndrome and could not tell about his recent cervical manipulation?
        I am afraid this claim of over 100.000 manipulations without a vascular adverse event is invalid due to incomplete follow up of those who did not report back for more.

        • How do you know who reported back, followed up, and who didn’t?
          I myself have been going to chiropractors for over 30 years and the worst thing that has happened to me is I had a headache for a while after a couple of adjustments. So unless you have been to a chiropractor yourself, keep your comments to yourself.

          • @Dean

            How do you know who reported back, followed up, and who didn’t?

            To whom are you posing this question? You seem to be replying to my comment but this makes no sense. What I was pointing out is that Mr. Schwartz has no way of knowing if someone died in their bed the night after his neck-manipulation unless he followed properly up on his customers, especially those who did not return for more. He needs to answer that for himself.

            I myself have been going to chiropractors for over 30 years and the worst thing that has happened to me is I had a headache for a while after a couple of adjustments.

            Good for you. I am sure you contributed well to his (her?) children’s college fund.
            A headache after chiropractic manipulation is an interesting sign. One wonders what mechanism may lie behind it.
            One quite credible possibility is stretching effect or even injury to the vertebral arteries after neck manipulation. In that case you were lucky it so rarely develops into a vertebro-basilar stroke – Obviously it didn’t inyour case as then you would not be here, commenting on this blog. 😉

            So unless you have been to a chiropractor yourself, keep your comments to yourself.

            Guess what, I have! 🙂
            And not just once. I went to one for an extended period and gave it a very fair and extended chance to help me. The only detectable improvement was in his bank-balance. That experience helped light my interest in fake medicine after reading up properly on what chiropractic is and what it is not.

          • Whatever, believe what you want.

          • Belief is your gambit, dear “Dean”, and those that use it to justify their doctor-playing.
            Belief has no role in the assessment of medical technology and practice.

  • I am a 46 year old female and I have been under chiropractic care on and off for 20 years. I have had wonderful experiences with the care except for one who adjusted my neck the wrong way for me, causing me to have a stroke. I am back at getting myself healthy again with a wonderful family physician and the coolest chiropractor I know. I have been to other professionals and turned away saying nothing is wrong with me.
    When I read the story I was furious… I wanted to make a phone call. I am so happy to wake up and know the accusations were fake.

  • When is the last time open heart surgery had a double blind study done on it. That’s performed everyday wirh numerous adverse effects. Hundreds of thousands of people in USA are killed every year because of iotrogenic death and no one questions it? You article is bogus. Chiropractic is a natural drugless way to help restore someone’s health by assisting to create optimal neurology. In turn getting people well so they don’t need opiods and harmful addictive medications. I get it your an MD, why not fail people through medicine and scare them out of trying natural ways of healing.

  • Buddy I have cronic lyme disease and have had it for 20+ years. The little worm like creatures that are eating me alive have eroded my bones too. Because of it my lower back is shot and my sacrum gets stuck at least once a month to the point Its literally a 9 on the pain scale and I cant walk. I get an adjustment for 40 bucks and I’m back up and running.

    • I bet it was the chiropractor who made that diagnosis, right? Why can´t she fix it? Perhaps because that would mean a $40 cut in her monthly budget 😉

      Scientists have been looking for chronic lyme´s disease for years without finding any evidence of chronic disease coupled with Borellia Burgdorferi, giving a whole range of commonplace symptoms. Oher than, of course, what those who sell long term worthless and riskful antibiotic courses for the “chronic lyme´s disease” they diagnose themselves from commonplace symptoms of other disorders, mainly the mild signs of aging in the worried well, that respond well albeit always temporarily from theatrical performances like chiro-manipulations or acupuncture. Try going for brisk walks in the wilderness instead of the $40 theatrical thumping invented by a charlatan magnetic healer. You´ll be surprised 😉

  • Shame on you for publishing this trash. Scaring people out of chiropractic offices is something the medical profession has been doing for a century. Rarely is there ever been a recorded death from a chiropractic adjustment. However according to The World Health Organization Medical Care is the THIRD leading cause of death. 106,000 deaths per year from reaction to prescription medicines. 12,000 per yr from botched surgery and 90,000 per year from HOSPITAL ACQUIRED INFECTIONS!! MD’s are the Dr Deaths NOT Chiropractors.

    • oh dear!
      I recommend you calm down, read up about risk/benefit and evidence, re-read the article and come back with something a little more rational.

      • Medical doctors are the problem here not chiropractors. I have been going to chiropractors for 30 plus years and have never had a bad reaction from an adjustment, nor do I know of anyone who has. But I know of several people who have had issues with doctors and/or hospital stays.

    • @Kell. You will never elevate one profession by trying to rip another profession down.

      Rather, a profession should provide credible evidence to see if their approach has a better risk/benefit/cost analysis.

  • @dean: I read your post with interest. I happen to have a personal relationship with the president of a medical college in the city I live. I will forward your email and make the strongest suggest I can that the college be closed immediately. And while I’m at it I’ll start a petition to close the local hospital.
    Let it not be said I don’t act on real, compelling evidence such as you have presented when I hear it.
    Thank you for your insights.

  • Can any chiropractor help me here?

    Why did they elect to study and qualify in chiropractic in the first place rather than medicine or physical therapy?
    What was their motivation, rationale for that choice?

    Why did they not qualify in medicine (MD/MB BS) and then take up chiropractic methods as a post graduate – much as I took up orthopaedic surgey training?

  • Edzard

    You may wish to complain to the Independent Press Standards Organisation

    https://www.ipso.co.uk/complain/#WhatWeHandleComplaintsAbout

  • today I have received this email and accepted the DM’s offer

    Dear Prof Ernst

    I am writing regarding your complaint about the use of your comments in Victoria Allen’s October 2 article, which has been brought to my attention. Please accept my apologies for the unintentional delay in contacting you.

    I am sorry that you were disappointed by the article. That was certainly not the intention and I would like to try to resolve your complaint if possible.

    Victoria has explained that although she included your full comments in her filed copy (set out below for reference), they were paraphrased during the subbing process.

    “Chiropractors frequently manipulate patients’ necks in such a way that the joints are taken beyond their physiological range of motion. The ensuing eye problems tend to be temporary but it is likely that this kind of eye damage occurs often after chiropractic treatments. Chiropractic neck manipulations are not convincingly effective for any condition as they can cause a lot of harm. Therefore we should not use or recommend them.”

    While I believe that our readers would have understood that you were commenting specifically on chiropractic neck treatments given that this was the focus of the article, I understand that you feel the published comments – which refer to “chiropractic treatments” rather than “chiropractic neck manipulations” – do not fairly represent your views.

    Following your complaint, Victoria arranged for your full comments to be added to the online version of the article on October 2. In addition, we would be willing to publish the following wording in our page 2 Clarifications and corrections box, subject to the Editor’s approval, if this would resolve your complaint:

    An article on October 2 reported that Edzard Ernst, an expert in alternative medicine, said that chiropractic treatments were too dangerous and not sufficiently effective to be recommended for any condition. In fact, Mr Ernst was referring specifically to chiropractic neck manipulations. We are happy to set the record straight.

    We will also mark our library with a note of your concerns for our journalists’ future reference.

    I would be grateful if you could confirm that the above steps would be acceptable to resolve your complaint. If you have any further comments, please do let me know.

  • In the age of the age of the cult of “managerialism” you only get a sincere and heartfelt apology from the press, police or any corporate gimpery organisation after they have lost the lawsuit they nearly ruined you to take on. Why? Because honestly and decency is an admission of culpability.

  • Dear Edzard and visitors to this site,

    As a journalist and a (conscientious) member of the NUJ for many years, and as someone who has been closely involved in legal issues around freelance journalism, I think you have clearly been libelled, although it remains to be seen whether you have suffered any professional or personal losses as a result of this situation at this time. This, I believe, you would have to prove to bring a case in court and that can be harder than you think.

    If you can find out the name of the writer concerned, and whether they are a member of the NUJ, you can broach the subject via them by making a formal complaint to the Chapter, to which they belong. The NUJ may not put her/his info out to you, but entering their name on the internet may yield something. Members can be ejected from the NUJ if they behave sufficiently badly. I have seen such a challenge myself at a Chapter many years ago. One member put another properly on the spot. It was very uncomfortable for that person, and I myself made sure that one (mysoginist) man that I knew and who wanted to join the NUJ would find his membership attempt being blocked by Yours Truly unless he changed his way, much to his shock. It is written in the terms of the NUJ, to which every member must agree, that they must behave in an ethical and non-prejudiced fashion. Clearly this has not been the case.

    As for your own side of things, you need to be aware that the primary goal of this paper (D Mail) is to sell space, and any quote will do. A classic newswriting intro consists of three paras and the third normally contains a quote. They will doctor whenever and however they feel like it and oftentimes feeling impervious because the onus is on the misquoted party to sue – which of course most don’t do.

    Being libelled is a serious issue, so do not let this ride: in one famous case a woman wrote a story that she sold to a paper. Her story was syndicated and the editor of one of those papers in the syndicated group, changed a quote from a quoted source to the extent that it became a complete distortion of what the person had said. The original writer was unaware of this, but her byline was published against the story. She subsequently found herself being sued successfully for libel by the misquoted party – and lost her house. Ignorance is not a defence in a court of law.

    You could take the view that your contract was with the writer concerned and not the paper she writes for. If you threaten her directly, this may bring her boss out of the woodwork. I take a dim view of what happened here and how the writer has not taken responsibility. Her response to your criticism and concerns also tells me that she has been poorly instructed. It is precisely because space can be an issue, a well-trained writer will have learned to write in such a way that the least important material is at the end, and can be deleted with impunity, para by para, without the content suffering at all. She herself should have taken a stronger role in how long the quote needed to be. A writer can do that on a paper. And I know – I started out as a lowly advertisement features writer, before going higher up the ladder and being trusted with fully blown commercial features, and I made it clear that my work stood on my word. I saved the paper from libel cases several times by paying attention to wrong facts that had been quoted and they treated me with respect accordingly, even when I was in my very first junior role.

    I recommend a direct and swift approach. A bi-lateral approach may work better: fire a legal shot across the writer’s bows, and write to the NUJ about her to make a formal complaint. Prior to that you can ask for a copy of the terms, saying you are thinking of joining. This will allow you to quote from it.

    If it were me, I would write a formal complaint or cease and desist letter, via a lawyer, spelling out the facts of the matter, and how your quote was changed to say something you never said. Make it clear that this could have reverberations for you, and that even an apology will not impress or redress the matter as it was wilfully, rather than thoughtlessly done (as they quoted space as the reason, they clearly made the conscious choice to misquote you), and that they will therefore be legally responsible for any damage that you suffer as a result. Mention that presumably they wish experts to trust them, and that this is hardly the way to do so, but that you will in any event think twice before collaborating with them again, and secondly that you will inform your professional network not to do so, giving full information about what has happened to you. Then warn your colleagues about this paper and the disempowered position their writers have submitted to.

    In terms of handling journalists, these are my recommendations:

    1-Don’t ever give interviews over lunch. The journalist will either eat or take notes, never both and if they are not taking notes, how good is their article going to be? If they don’t eat, and end up taking notes while you eat, they will resent you. Instead, do you interviews in your office and take them to lunch AFTERWARDS, and avoid answering any questions over lunch. Make that clear before you go out to eat. Set boundaries and STICK TO THEM.

    2-Do the interview in your office and mention in advance that you are recording the interview and will send the journalist a transcript of it that afternoon, so both they and you have a copy. Mention that you will check their quotes and that you expect them to be maintained accurately in their original wording and that paraphrases will not be accepted. This conveys to them the message that you will be holding them to the accuracy of your quotes. It helps to write up your best quotes in long, medium and ultra-short form and hand it to them so they can use any of them and know they have been approved. Keep sentences to less than 25 words and write for a 12-year old. This is the golden rule for dailies.

    3-Send them the transcript. If doing the interview in your office, you can record the interview and send them the MP4 track and a transcript. If they wish to do their own recording, let them, but do do your own. Do NOT put yourself at their mercy. Take up a stronger position to this.

    4-If they want info about the earnings or profits from your business, decide whether you want the article to appear or not. If you do, meet them half way, so they are not writing an article that lacks hard facts. It is not necessary for you to quote actual ££ or $$ to meet the writer’s needs: you can say your earnings are X% up over the previous year or over X years (have the figures ready for the interview) and refuse to be moved on that.

    5-Ask to see the quotes after the first draft, but don’t expect to see them after the article has been sub-edited. You will be hated for this – and ditched forever more. It causes massive issues in a paper if you ask to see something after it has been subbed as this means it has been committed to space and every change at that stage affects the entire page or pages. As printing goes on during the night, even though it is unlikely to stop a print run, it can and it is not unknown.

    6-If you like what has been written, write in and say so to the writer (and their boss) about it. THIS will be remembered and they may cover your topics over those suggested by your competitors. And bingo, you are a preferred source.

    Ends
    6-

    • in view of their latest response, I don’t think I will pursue any further action. but thanks anyway

      • It’s you choice of course, but they should not have paraphrased to start with! They do NOT have the right to change your words on your behalf and without your permission, only those words appearing before and after your words. And to say ‘we are sorry you were disappointed by the article’ is horribly patronising. Your emotions and views are not regrettable – they should take responsibility and say ‘we are sorry that we upset you’. But the decision to let it lie is your choice. I hope what I sent you will be helpful in future, however.

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