More on The Lancet Whiplash study

In the June issue, we reported on the whiplash study conducted in Lithuania that concluded that chronic whiplash was not real. Finally, the Letters to the Editor have been published, and other criticisms have been raised.

One Norwegian professor dismisses the patient selection methods as invalid, and lack of use of safety belts (which have been found to increase the probability of whiplash injuries). He concludes that the Lithuanian study, “...is interesting as a research idea, but it should also be methodologically valid. The conclusions drawn from this study can hardly be justified by the data. They remain personal, unproven beliefs.”

Two Dutch scientists also dismiss the selection methodology as flawed. They also questioned why there was no data on traffic density, number of accidents, and the severity of the injuries. They state that the Lithuania study researchers, “...justify the selection of Lithuania as a study location by using the popular prejudice that the legal system has in fact created this disability. In our opinion, unsafe traffic is to blame, and sociocultural and legal circumstances encourage the submission of insurance claims...”

Finally, Dr. Michael Freeman and Dr. Arthur Croft wrote that, “Schrader and colleagues do not seem to have studied late-whiplash syndrome. They investigated 202 Lithuanian individuals who were involved in car accidents in which the police were summoned.” They make the excellent point that the study should have studied people who had suffered a whiplash injury, not just people who had been in an accident.

“When the accident exposed cohort was examined for those who had been exposed to acute whiplash, we found that only 15% (31 of 202) gave any indication of neck pain after their accident.” Freeman and Croft then go on to reject all but two of the original group of patients as invalid. “As a result, none of Schrader’s conclusions about this cohort relating to the natural progression of late whiplash are valid because of severe and fatal selection bias.”

Letters. The Lancet 1996;348:124-126.

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