The current debate in New York regarding the development of medical treatment guidelines shows just how much politics is involved in medicine, and just how little science actually steers the debate.
The New York State Workers' Compensation Board (SWCB) began working on the state's first medical treatment guidelines through a 14-member Medical Advisory Committee appointed by SWCB Chairman Robert Beloten.
When he signed a series of workers' compensation reforms into law on March 13, 2007, former Gov. Eliot Spitzer directed the New York State Insurance Department to assemble a task force of doctors to come up with an initial set of guidelines and to explore what other types of injuries should be addressed.
While the Insurance Department task force was finishing work on the proposed carpal tunnel syndrome guides last May, Beloten announced his own initiative on chronic pain and created the Medical Advisory Committee to keep the guides current and on track with "evolving medical knowledge."
The panel includes three doctors nominated by the Business Council, three nominated by the AFL-CIO, three picked by Beloten, and one non-medical representative each from the union and the Business Council.
In addition, the committee is co-chaired by the board's medical director, Dr. Jaime Szeinuk of Mt. Sinai Medical Center, and SWCB Associate Medical Director Elain Sobol-Berger.
Work on the treatment rules for chronic pain and carpal tunnel syndrome has rekindled debate over which injured workers should be covered. The issue is whether the rules are to be applied prospectively only, or whether they should be applied to all injuries and illnesses – no matter when they occurred.
This is particularly an acute issue with chronic pain victims since, by definition, these are long term treatment cases.
The debate is steered by non-medical political interests.
The AFL-CIO, claimant's attorneys, the Medical Society of New York State, and the New York State Chiropractic Association argue that applying the guides to injuries and illnesses occurring before rule adoption will cut off long-term treatment for workers with chronic conditions predating the guidelines.
Both the American Insurance Association and the Business Council argue that limiting the application of the guidelines to new injuries and illnesses would create two classes of injured workers in New York.
One would think that the answer is simple - what does the science say?
Chiropractic, physical therapy, and other physical medicines have their place in the treatment regiment, but not necessarily over the long term. Chronic pain patients can be treated, and if they're on long term prescriptions for pain medication then there should be adequate guidelines to cope with the cessation of non-beneficial therapy (i.e. opioids or other long-term destructive medications) and transfer of care to other pain treatment protocol.
From my perspective, this is a no-brainer. Just because something has been does not mean it should be in the future.
The old joke of the patient telling his doctor that it "hurts when I do this", and the doctor responding, "then don't do that" seems particularly applicable in the politics of defining workers' compensation treatment guidelines.