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"BMJ Clinical Evidence — an excellent organization that publishes EBM reviews (much like the World HQ for EBM, The Cochrane Collaboration) — updated their acute low back pain review recently. Here’s what they had to say about spinal manipulative therapy: One systematic review (149 people) and one subsequent RCT (101 people) added at this update. The review and RCT found no significant difference between spinal manipulation and placebo or usual care in pain. One further study added in harms which reports on adverse effects after spinal manipulation. Categorization of spinal manipulation changed from ‘Likely to be beneficial’ to ‘Unknown effectiveness’. This is nothing new to anyone who has actually been following the SMT evidence: scientific optimism about spinal manipulative therapy has been steadily eroding for a decade. There was never any evidence of serious efficacy (it always failed the “impress me” test), and larger and better experiments have conclusively shown that it is either completely ineffective, or so unreliable and trivially effective on average that it really just doesn’t deserve to be an expensive therapy with a good reputation any more. It just isn’t all it’s cracked up to be." Paul Ingraham, Skeptic North blogspot (11th July 2011)