In reflecting on the '. . . statistically significant . . .' expression used in both the DiPALS and the RespiStimALS study, I have doubts as to whether sufficient patients were involved in these studies for the determination to be valid due to the high variance of regression rates in patients. The report of the DiPALS study group implies the patients were of middle to fast regression rates - one third suffered from bulbar onset. The report of the RespiStimALS group implies the patients were of middle to slow regression rates, with less than the expected quantity of bulbar onset cases. The RespiStimALS also reports theirs was a multicenter study but is unclear on how many surgical teams were involved . . . only one, or one for each cite . . ? The RespiStimALS group also use a web based service to decide what group to enter each patient into.