Observations on Medscape, IDET, Jusrisprudence

Saturday, January 14, 2006 | 0

by "Jake" Jacobsmeyer

There are a couple of items of interest that I wish to bring to your attention.

Medscape Article on IDET Procedure:

The most recent copy of Medscape, which is an electronic update from the American Medical Association, contains a fascinating report on a study of the IDET procedure. The study was conducted in Australia and appears to be as far as the undersigned is aware, the first true double blind study for valuation of the efficacy of the IDET procedure in treatment of low back pain. There have been prior studies which essentially rely upon anecdotal information and which had reported varying degrees of benefit from the IDET procedure. However none of the studies met the criteria for being truly objective in having a control group and a subject group both of whom believed that they received the same medical treatment and then measuring the results.

In this study slightly less than 60 individuals were identified for inclusion utilizing strict criteria for potential benefit for the procedure. Two-thirds of the patients were identified as the subject group and one-third were identified as a control group. Each individual underwent exactly the same procedure with the exception that the control group while undergoing the procedure did not have the electrodes connected to the machine that would provide the thermocoagulation procedure. The only person who was aware of whether the patient received the IDET procedure or a placebo was a technician who was given a sealed envelope that provided instructions at the time of surgery as to which category the patient was assigned. Neither the patient nor the physicians and their operating personnel had any idea which individuals received the IDET procedure and which did not.

The results showed an almost identical result regardless of which category the patient belonged. In neither group was there any significant improvement of overall back pain based upon the criteria identified in the study. There were also very few side effects and the conclusions drawn included that while the IDET procedure is safe with a low incidence of side effects and potential detrimental impact, there was no demonstrated value over the placebo treatment. The resulting scores for function, pain and other criteria utilized to measure whether the procedure provided any benefit showed almost no change before and after the procedure with follow-ups at three months and six months. This study therefore did not even demonstrate a placebo effect as the procedure appeared to have neither detrimental nor positive effect on the overall pain pattern in either category.

The authors also reviewed some of the other studies that have been performed noting that none appeared to have a truly objective basis for arriving at conclusions. Prior studies were flawed primarily for lack of a true control group to compare the overall impact of the treatment. The overall conclusion of these authors was the IDET procedure does not offer any benefit over other traditional treatments for low back pain.

Registration to Medscape's newsletter is free and can be accomplished by going to their registration cite at www.medscape.com/home.

Legal Overload (?):

The editors of the California Compensation Cases have recently added to the CCC publication, as well as the Lexis website, reports of "Noteworthy WCAB Panel" decisions. These are reports of cases after Reconsideration has been granted or denied by the WCAB. The editors are selecting decisions which they believe have some specific merit for inclusion in a publication for the workers' compensation community. On their current website are some 47 of these reported decisions collected over the past several months.

The cautions that I expressed regarding citation of writ denied cases as legal authority are exponentially magnified with these cases. Keep in mind that the WCAB will issue between 3000 and 5500 decisions after Reconsideration in a typical year (based on past history). Lexis may publish a few hundred, selected cases a year in this category, probably less than 5% to 10% of the total.. Given the small number of cases that will be included in this grouping, selection of cases that will be considered for publication will be critical if the cases are to have any meaning.

The decisions are collected by being submitted to Mathew Bender/Lexis for inclusion by one of the parties or other interested individuals. It is further important to keep in mind that these decisions have no specific precedential value and technically are not citable as authority for any of the holdings in the individual cases. To the extent these decisions are considered persuasive, they should be less persuasive than other citable authorities such as writ denied cases, citations in the California Workers' Compensation Reporter, etc. Interestingly these cases could end up being citable (with very low level of actual authority) when unpublished decisions of the Courts of Appeal (where an actual decision has been written by an Appellate Court) are not citable authority.

Such is the wacky world of workers' compensation juris prudence.

By attorney Richard "Jake" Jacobsmeyer, managing partner of the Concorde office of Adelson, Testan, Brundo & Popolardo. Jake can be reached at richardjacobsmeyer@atblaw.net.

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