For a conference of the Workers' Compensation Educational Conference's size and magnitude, the process of renovating the annual program "house" is not an easy one. On one hand, the conference has existed successfully for 63 years based on the strength of its foundation: a program that addresses the problems and issues workers' comp professionals face year after year. On the other hand, the conference could end up rickety and dilapidated without a fresh coat of paint on the walls every now and then to keep matters fresh.

It's with this metaphor in mind that WCEC Program Chairman Steve Rissman and Program Moderator Dr. Robert Barth venture out on a home improvement of sorts by introducing a new breakout to this year's schedule, "Using Health Science to Resolve Workers' Compensation Claims: Why Evidence-Based Medicine Is Important." While the topic itself isn't new, the approach is.

"In our opinion, it's the first breakout in the country that was an evidence-based medicine program directed at adjusters, employers, and lawyers -- not doctors," said Rissman, who in addition to his chairman duties is an attorney at Rissman, Barrett, Hurt, Donahue, and McLain, P.A. "Evidence-based medicine is taught in a lot of seminars, but it's not directed to this type of audience. It's been our goal to nationalize and devise a program that adjusters, employers, and lawyers can attend and understand what evidence-based medicine is so they can use it in their cases and practices."

Evidence-based medicine is just that -- using objective evidence to decide on a course of treatment. While it sounds simple, there is a lot of room for interpretation.

"In workers' compensation, doctors decide the treatments that are used, which in turn decides what disability benefits are paid," said Rissman. "Some doctors -- in fact, too many doctors -- don't use objective standards in determining what is wrong with a patient and how much disability they should get. So evidence-based medicine, whatever the state in which the doctor is located, is a statutory requirement that they follow and requires certain standards."

Rissman cited Daubert v. Merrell Dow Pharmaceuticals as a landmark case for establishing set criteria, but noted that it was just the beginning of the movement, not the final word.

"Daubert essentially says that doctors can't use what's called 'junk science' in determining diagnoses and treatments," said Rissman. "There are a lot of different state statutes around the country that either codified Daubert or have different objective medical evidence-based medicine standards. So Daubert might have been the start, but it has gotten very sophisticated. But there are no programs around the country that are teaching it to lawyers, adjusters, and employers."

After convening for lunch, attendees returned in the afternoon to a program that continued to answer questions by bringing in three highly respected doctors. For instance, the theme of credible science was revisited.

"The adversarial nastiness that takes place in workers' compensation could be done away with if the medical side would restrict itself to scientifically credible health care," said Barth. "Many people say that you can't turn to medical science because for every study that says one thing, another says something completely different. This is a false statement."

Barth supported this assertion by highlighting the accomplishments of Dr. Stan Bigos, who presented on back problems. Bigos was appointed by the federal government in the 1990s to put together guidelines for health care when it came to back complaints. He organized a panel to review the scientific credibility of every individual research study, and then he sorted the studies into what was essentially a group of scientifically credible studies and a group of design-flawed studies. Once sorted, there were no longer disagreements with the science.

"Everything that ended up in the credible 'pile' gave us the same results and complete consistency in the science," said Barth. "For example, the idea that the best option for back pain was surgery went out the window because there was no science to support it. The credible science supported what's called the activity paradigm, which calls for a patient with back pain to become more active rather than withdrawing from it."

Special Reports /

WCEC Wrap-Up: Evidence-Based Medicine Goes Mainstream

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