| Abstract/Notes |
A 2026 case report in Child's Nervous System attributed a pediatric vertebral artery dissection and ischemic stroke to chiropractic manipulation on the basis of an unverified exposure history, a vague chronology, and a medically complex clinical picture that included a hypoplastic vertebral artery and concurrent viral infection. Two letters were submitted to the journal in response. One, prepared on behalf of the chiropractic profession, challenged the report's causal framing, its unverified exposure, its overstated diagnostic certainty, its selective literature, and its categorical claims about pediatric chiropractic evidence and guidelines. The other, authored by chiropractic researchers, criticized the inference while conceding several of the reports's contested presmises, including the assertion tha the profession lacks standardized clinical guidelines, a concession contradicted by the very consensus document that letter cited. This commentary compares the two letters point by point, analyzes the concessions as a malpractice and regulatory risk, documents the additional steps the profession has taken to hold the underlying research to account, and argues that the episode illustrates why the profession needs researchers and advocates who approach pediatric chiropractic from a vitalistic, salutogenic, and subluxation-centered perspective rather than from a posture of accommodation to a medicalized evidence hierarchy.
Author Keywords: chiropractic, pediatrics, vertebral artery dissection, risk management, vertebral subluxation, research ethics, scope of practice
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