Harold Merskey, in attacking Walter Rosser's review1 of Andrew Malleson's book,2 makes the misleading allegation that one of our studies was “denied validity” by the Norwegian Centre for Health Technology Assessment. In fact, the Centre's report,3 after praising our study design in terms of selection of material and use of control groups, concluded (as did we) that it seems impossible to document a causal relation between whiplash trauma and the development of chronic symptoms.
However, it was emphasized that for the demonstration of small differences in symptoms between collision victims and controls, a greater number of subjects would be required than we used in our study. The final statement of the report3 concluded that whiplash should be managed as “an acute self-limiting process.” Incidentally, Magne Rø, the leader of the investigative group for the assessment, has praised Malleson's book in a published review.4
Studies from Western countries indicate that 15% to 58% of people with a whiplash injury experience the late whiplash syndrome.5,6,7,8,9 Our 2 controlled studies10,11 were conducted in Lithuania, a country where whiplash injury provides little opportunity for “secondary gain” and where there is little awareness that whiplash injury is a reputed cause of chronic pain and disability. Altogether, we evaluated 412 people who had been involved in rear-end collisions, which gave an estimated minimum of 180 subjects with acute whiplash injury (i.e., acute symptoms).12 According to previous reports this number should have yielded between 27 and 104 people with late whiplash syndrome. Yet we identified no subjects with chronic symptoms related to the collision. If the late whiplash syndrome does exist, it seems to occur very infrequently in Lithuania.
Harald Schrader Professor of Neurology Gunnar Bovim Professor of Neurology Dean of Medical Faculty Trond Sand Professor of Clinical Neurophysiology Department of Neurology and Clinical Neurophysiology University Hospital in Trondheim Trondheim, Norway