On January 9, 1995, Eric J. Muehlbauer, executive director for the North American Spine Society (NASS), whose members are mostly surgeons, sent out a memorandum regarding the release of the clinical practice guideline from the Agency for Health Care Policy and Research (AHCPR), Acute Low Back Problems in Adults.
Included in the memorandum was a "detailed analysis of the low back pain guidelines." The analysis was actually in the form of a "Response Letter on AHCPR Methodology," which began with the comment that "selection bias has been guaranteed to such a high degree that this has become a political, and not a scientific document."
The response letter criticized:
NASS concluded:
"We, the North American Spine Society, feel that this document should not be published in its present form. Instead, a new consensus should be sought, with appointed input from all relevant medical specialties dealing with LBP (low back pain) issues, and with AHCPR staff that is responsive to the criticisms of the methodology raised in this letter."It should be noted that the AHCPR panel members were selected from nominees of all medical and chiropractic societies. NASS does not appear to want to have chiropractic represented.
The front page of the 1995 summer edition of the NASS News proclaimed, "AHCPR Guidelines Disputed." The article said that patients should not have treatment selected or denied based on the guidelines; that the guidelines relied upon limited scientific information; that the consensus method does not necessarily identify the best forms of treatment or diagnosis; and that clinical judgments made by the AHCPR panel should be balanced with those of relevant medical societies.
With all of this opposition so clearly and adamantly stated, NASS just released four consensus statements of their own (see Spine, 1995; 20(16):1829-1833).
Looking at the events of the past year in context only leaves many wondering about NASS' original reaction to the guidelines. Perhaps the NASS experience typifies the evolution most groups undergo as they wrestle with practice guidelines. Could it be that rage, denial, review and grudging acceptance are all part of the guidelines experience for most health care providers?
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
