To the Editor: The study of Rothwell et al, recently published in Stroke ,1 attempts to add some light to the considerable heat generated by a long series of case studies,2–6 some of which have implied that spinal manipulation is exceedingly dangerous, suggesting that “patients, chiropractors, and physicians should be aware of the potential adverse neurologic outcomes following chiropractic adjustment”2 or (even worse) “since possible complications cannot be predicted and may be very severe, it seems of utmost importance to carefully evaluate the benefit-risk ratio of each cervical manipulation.”3 By adding a control patient population that did not report a vertebrobasilar accident (VBA) stroke but saw a chiropractor nevertheless, Rothwell and colleagues have attempted to clarify whether a visit to a chiropractor constitutes a significant risk factor leading to a …