Statement of Purpose:
"Guidelines” and " Systematic Reviews” propagated by organizations and individuals who have neither conducted any of the original research nor have meaningfully contributed to the literature and wittingly and willfully continue to deny and limit access to medical care that is reasonably necessary, logical, rational and biologically plausible. Established interventions executed under strict epidemiological protocols and externally audited, have been castigated and denigrated by the deliberate misrepresentation of statistical data and a convoluted and somewhat deluded interpretation of what constitutes "evidence-based medicine.” Accompanying disparagement and disconformities severely erodes the Hippocratic intention.
Confusion now abounds as to what constitutes unambiguous evidence. Assiduously and pre-emptively, the ISIS Board has now directed the Standards Committee, in addition to updating the ISIS Guidelines, to reappraise the methodology upon which "evidence” is based for interventions such as injections, radiofrequency neurotomy, and surgery or intradiscal therapies; and not unlike in other surgical domains, cannot be assessed in a manner analogous to non-invasive drug trials.
Consonant with the other surgical disciplines, ISIS will be exploring other variables as measures of outcomes, rather than relying on a single domain, as currently in vogue and which may be inappropriate. To achieve commonality and uniformity within the surgical disciplines, a template is being devised evaluating inter alia, reduction in VAS, utilization of other health services, medications, vocational prospects and improved functionality.This should generate a more realistic composite outcome, the aggregate of which becomes more meaningful than the conventional "hierarchy / level of evidence.”
Though onerous, the assigned tasks are inescapable if ISIS is to retain its pre-eminence. Fruition is attainable: to this end the Committee is ably assisted by more than 20 members who have unflinchingly inherited a substantial quota of the workload. Additionally, the Committee is buoyed by the arrival of Mrs. Phillipa Powis, Research Librarian of some 25 years standing. Located at the University of Newcastle (Australia), Mrs. Powis will in the first instance vet the available literature, download topic wise the more pertinent and qualitative data, and "bundle” these off to the respective Standard Committee members.
In response by requests from our general membership, the Standards Committee will also review the literature pertaining to "emerging technologies”, such as Nucleoplasty, Vertebroplasty, Pulsed Radiofrequency, Epidural Lysis, and Spinal Cord Stimulation.
Members are encouraged to participate in our on-going reviews, which will ultimately generate material for white papers, position statements, or for presentations at scientific meetings and in peer reviewed journals.
Much of which the Standards Committee generates will ultimately form the basis for the initiatives of the Education Committee.
| Nikolai Bogduk, MD, PhD | D Scott Kreiner, MD | Devi Nampiaparampil, MD |
| Andrew Engel, MD | Milton Landers, DO, PhD | Anil Sharma, MD |
| Wade King, MMed(Pain) | John MacVicar, MD - Chair | Yakov Vorobeychik, MD |
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