Editor,

I read with interest the paper by Pierre Boucher, Cervical Spine Manipulation Therapy, Arterial Dissection, and the Law: Informed Consent and Causation in Goldie C. Arsenault.

While I applaud the effort of his causation analysis, the author could have evaluated causation of the dissection and the stroke simply by applying the 3-step causal analysis proposed by Freeman et al. Courts have endorsed the 3-step causal methodology as the generally accepted approach for injury causation.