Remember the United States Agency for Health Care Policy and Research (AHCPR)? That's the agency within Health and Human Services that unveiled its Clinical Guideline Number 14: Acute Low Back Problems in Adults back in December 1994 at a press con-ference attended by all of the major media. There were rumors at the time of a surgical company threatening a lawsuit if the guidelines were released.
The guidelines were released nonetheless. The multidisciplinary panel found that "manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms." The panel, however, was highly critical of back surgery.
Edward Seljestos,MD, of the American Association of Neurological Surgeons, said the panel had "overstepped (its bounds) regarding surgical treatment." A group of Texas spine surgeons then began an effort to chop the AHCPR off at the knees. The AHCPR, meanwhile, announced a headache evidence report with Duke University inviting, among other disciplines, four representatives from chiropractic to be peer reviewers on reports developed on migraine and tension headaches. The chiropractic profession announced its candidates.
Then came the axe. The Republican-controlled Congress, responding to pressure from medical groups, cut the agency's budget in half. The headache guidelines never got off the ground. In April of 1996, six months after the release of the acute back pain guidelines, the AHCPR announced it was no longer in the business of developing health care guidelines. AHCPR administrator Clifton Gaus,Sc.D., said the agency's staff had "consulted extensively with public- and private-sector guideline users" (e.g., surgeons) and said that "their message is clear: they are seeking the scientific foundation from which they can develop their own high-quality, evidence-based guidelines." So much for multidisciplinary panels. In March of 1997, HHS Secretary Donna Shalala announced the appointment of John Eisenberg,MD,MBA, as the administrator of the AHCPR.
Now that it has learned its lesson, AHCPR may be given new life. A bill being discussed in the House of Representatives (HR 2506) will revise the Agency for Health Care Policy and Research. It is sponsored by Rep. Michael Bilirakis (R-FL), chairman of the Health and Environment Subcommittee, and Rep. Sherrod Brown (D-OH). The bill specifies that the AHCPR be renamed the Agency for Health Research and Quality (AHRQ; the acronym is pronounced "ark") and funded $250 million for fiscal year 2000 and "such sums as necessary" through 2004. The ACHPR budget for 1999 was $171 million.
Although the agency will have greater funding and new priorities, don't expect any new written guidelines from them soon. According to Rep. Bilirakis, "The bill specifically prohibits the agency from mandating 'national standards of clinical practice or quality health care standards.' Instead, it emphasizes the agency's nonregulatory role in building the science of health care quality."
The bill gained unanimous approval from the House Commerce Subcommittee on July 27. The Senate has already acted on a similar measure which was included in the Republican-backed "Patients' Bill of Rights."
One suspects the "ark" will stay afloat as long as it doesn't ruffle the medical establishment.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
