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We are surprised by the theme and what we believe are logical fallacies in the letter from the WFCRC where strong “appeal to authority” and “authoritative” citation arguments were made. In the end, they call for retraction of our commentary, without providing proper data or critique of our position! Their letter exemplifies a form of scientific egocentrism known as “the curse of knowledge”; these WFCRC authors, find difficulty suppressing the content of their personal knowledge base when trying to reason about a less informed, but still legitimate evidence-based, alternate perspective. We point out 5 examples of invalid arguments from the WFCRC with rebuttal. First, the WFCRC states: “ . . . we know of no reputable clinical practice guideline that suggests radiological imaging is a routine requirement for effective treatment . . . ” To the contrary, there are several radiology guidelines and recommendations from reputable groups supporting our premise of “routine radiography” in clinical chiropractic practice. For instance, the American College of Radiologists (30, 000 plus radiologists) have published guidelines that support routine use of imaging in acute and chronic spine conditions. Similarly, the International Chiropractors Association (ICA), one of the largest and oldest chiropractic organizations, has developed a comprehensive spine radiography guideline for practicing chiropractors that includes routine use of spine imaging to aid in the analysis and management of a variety of patient conditions. The ICA guidelines have been adopted by several other groups representing thousands of practicing chiropractors as well as surveyed chiropractors (including all 50 states and the District of Columbia) by the National Board of Chiropractic Examiners, which identified that reviewing radiographic images to determine the presence of spine displacements or altered alignment was rated as a chiropractic professional function having “significant importance.” Second, the WFCRC states: “When imaging is performed, there is evidence that it does not improve patient outcomes, but can result in undesirable and unintended effects” and referenced 4 articles over a decade old! One of their cited articles is a magnetic resonance imaging (MRI) study that does not apply to our original manuscript (Ash et al, 2008). In contrast to the WFCRCs interpretations, the Kerry et al’s (2002) study identified patients receiving X-rays of their low backs had better psychological well-being and less depression scores at 1-year follow-up. Likewise, their third citation from Djais et al (2005) was a small trial with only 3-week follow-up that merely demonstrated that low-back pain (LBP) patients deemed to require X-ray investigation (by MDs) improved less than those patients not determined to need imaging on initial assessment, indicating they were more severe to begin with. The WFCRCs fourth citation is the Kendrick et al’s study, which ironically found that two-thirds of all patient X-rays

dose-response

Response to Letters From Anderson and Kawchuk et al: X-Ray Imaging Is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks