A recent judgement in the district Court ofAuckland1 found that upper cervical manipulation carried out by a New Zealand chiropractor in 2006, for the purpose of treating a patients arm pain, caused a carotid artery dissection and occlusion, which subsequently led to a stroke. This legal finding confirms the many reports in the medical literature of serious harm or even death resulting from this practice.2,3 Given that chiropractic manipulations of the neck involve a high velocity thrust, it is not surprising that the manoeuvre could damage important structures in the neck.4Even though these adverse events seem to be rare, given their severity, they must be considered alongside the expected benefits from the practice. Here, the medical literature shows that there is no good quality evidence that chiropractic manipulation is effective for the treatment of any indication other than possibly low back pain.5 Therefore consideration of the benefits and risks indicates that there is no place for chiropractic manipulation of the neck for any reason.Despite this, in a recent article published in the (NZ) Sunday Star Times (24 Feb 2013)6about the above judgement, the president of the New Zealand Chiropractors Association, Corrian Poelsma, is quoted as saying, [t]his case is rare....all health care carries some risks , and he cited a study which found no serious adverse events from chiropractic neck manipulations.We therefore suggest that, at the very least, the Chiropractors Association inform its members that they should obtain full informed consent before undertaking a potentially fatal procedure, something that is an ethical imperative in any area of health care.We believe that failing to obtain informed consent, would be consistent with other ethical concerns around the chiropractic profession that we have previously highlighted, including stifling free speech, unsupported claims that they can treat non-musculoskeletal diseases such as asthma, treating children for any reason, use of the title \"Doctor\" and overuse of X-rays.7Therefore we advise that anyone considering upper cervical manipulation by a chiropractor should also consider conventional treatment options offered by their GP or a physiotherapist. Anyone who does receive chiropractic manipulation and afterwards experiences pain, discomfort or illness is advised to immediately seek attention from either their GP or a hospital outpatient department. Andrew Gilbey Palmerston North, NZ Shaun Holt Tauranga, NZ Edzard Ernst Exeter, UK

A recent judgement in the district Court ofAuckland1 found that upper cervical manipulation carried out by a New Zealand chiropractor in 2006, for the purpose of treating a patients arm pain, caused a carotid artery dissection and occlusion, which subsequently led to a stroke. This legal finding confirms the many reports in the medical literature of serious harm or even death resulting from this practice.2,3 Given that chiropractic manipulations of the neck involve a high velocity thrust, it is not surprising that the manoeuvre could damage important structures in the neck.4Even though these adverse events seem to be rare, given their severity, they must be considered alongside the expected benefits from the practice. Here, the medical literature shows that there is no good quality evidence that chiropractic manipulation is effective for the treatment of any indication other than possibly low back pain.5 Therefore consideration of the benefits and risks indicates that there is no place for chiropractic manipulation of the neck for any reason.Despite this, in a recent article published in the (NZ) Sunday Star Times (24 Feb 2013)6about the above judgement, the president of the New Zealand Chiropractors Association, Corrian Poelsma, is quoted as saying, [t]his case is rare....all health care carries some risks , and he cited a study which found no serious adverse events from chiropractic neck manipulations.We therefore suggest that, at the very least, the Chiropractors Association inform its members that they should obtain full informed consent before undertaking a potentially fatal procedure, something that is an ethical imperative in any area of health care.We believe that failing to obtain informed consent, would be consistent with other ethical concerns around the chiropractic profession that we have previously highlighted, including stifling free speech, unsupported claims that they can treat non-musculoskeletal diseases such as asthma, treating children for any reason, use of the title \"Doctor\" and overuse of X-rays.7Therefore we advise that anyone considering upper cervical manipulation by a chiropractor should also consider conventional treatment options offered by their GP or a physiotherapist. Anyone who does receive chiropractic manipulation and afterwards experiences pain, discomfort or illness is advised to immediately seek attention from either their GP or a hospital outpatient department. Andrew Gilbey Palmerston North, NZ Shaun Holt Tauranga, NZ Edzard Ernst Exeter, UK