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"….one must consider underreporting: if a patient suffers a serious complication after spinal manipulation, her chiropractor is unlikely to see her again, and the physicians who do might not think of a link between manipulation and the adverse effect. And even if they consider an association, are they likely to publish this as a case report? Moreover, none of the prospective studies available to date have enough power to detect events that occur less frequently than 1 in approximately 500 patients." E. Ernst, Stroke (2001)