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Robert J. Barth

occurred, but that it has also left permanent residuals manifested in the pain. General medical clinicians (those not specializing in psychological issues) are regularly asked to evaluate chronic pain in the context of a claim, but this often compounds the misattribution, given the definition of pain (Merskey & Bogduk), which states: Pain is “always a psychological state.” “Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons.” Scientific findings, examples of which are

in AMA Guides® Newsletter
Robert J. Barth
and
Christopher R. Brigham

Huber. 2 Huber's books, Galileo's Revenge: Junk Science in the Courtroom 3 and Judging Science: Scientific Knowledge and the Federal Courts, 4 are useful references. Foster and Huber's book 4 provides a thorough discussion of the US Supreme Court's insistence that expert witness work for scientific issues (eg, health science) must be based on credible methodology. The following represents the significance of Huber's work and its influence on the US Supreme Court's call for scientific credibility within legal matters 2 : In Galileo's Revenge: Junk Science

in AMA Guides® Newsletter
Robert J. Barth

warrant further discussion of these diagnoses and impairment assessment. This article reviews Guides principles and scientific considerations that should be noted by any evaluator faced with such cases. Additionally, in accordance with the overall goal of helping the Guides to be more scientifically sound as reflected in Section 1.2b, Five New Axioms of the Sixth Edition (6th ed, 2), in Axiom 2, “The Guides becomes more diagnosis based with these diagnoses being evidence-based when possible,” and internally consistent as reflected in Axiom 5, “The Guides

in AMA Guides® Newsletter
Robert J Barth

questions such as: How can an evaluator credibly determine if a claimed work-related clinical presentation is really work-related? How can an evaluator credibly determine if a claimed injury-related clinical presentation is really caused by the litigated events? This article: presents the evaluation protocol from Causation provides evaluators with self-assessment questions that can be used to scrutinize whether one's own work complies with that protocol highlights that protocol's value as a model for scientifically credible practice in general

in AMA Guides® Newsletter
David Langham
and
Marjorie Eskay-Auerbach

may require, accept, or debate the expert’s conclusions. Notably, decision-makers may also lack frequent exposure to scientific issues and analyses, making them reliant to a significant degree on experts to understand the ultimate opinions and the relevance of the expert’s process in reaching his or her conclusions. With that in mind, it is sound advice for the expert witness to ensure both report and testimony remain persuasive in the face of such challenges. It helps to avoid colloquialisms, terms of art, abbreviations, and particularly foreign languages (eg

in AMA Guides® Newsletter
Robert J. Barth

-report to influence their decision making. Claims administrators (adjustors, judges, commissioners, arbitrators, etc) also rely on such claimant-reported histories for administrative decision making. They rely on such history directly in the form of the reports from examinees, and indirectly in the form of any clinical conclusions that are based largely on the examinee-reported history. Unfortunately, the premise that examinee reports are accurate has repeatedly failed scientific testing. As is detailed below, scientific tests have demonstrated that such histories are

in AMA Guides® Newsletter
Mohammed I. Ranavaya

from traditional psychogenic causes to more exotic toxicodynamic theories, including the concept of “kindling” from various chemical exposures and immune dysregulation. 4 Research does not appear to support immunologic abnormality in MCS. In short, the scientific scrutinies of these hypotheses have failed to show any extrinsic causes of MCS. Ducatman describes an interesting biopsychosocial model of MCS: The definition of MCS could refer to the perception of exposure rather than exposure. For reasons that may relate to insurance, indemnity, and self-image, the

in AMA Guides® Newsletter
Christopher R. Brigham
,
Charles N. Brooks
, and
James B. Talmage

Causation analysis should always be based on current scientific evidence and the facts of a specific case. However, certain beliefs have evolved that lack scientific basis. One unsupportable myth is that “favoring” one lower extremity will often result in injury or illness of the opposite lower limb. This is exemplified by the case of a 40-year-old male long-shoreman who reportedly sustained an injury to left knee at work on September 1, 2009. His past history is remarkable for prior knee problems bilaterally, including high school football injuries that

in AMA Guides® Newsletter
Robert J Barth

misdirected. A century of scientific research is available on this subject. That research has reliably indicated that any such observation changes an examinee's presentation. While the finding of a change in the examinee's presentation is reliable, the nature of the change is not predictable. Subsequently, an observed evaluation can precipitate results that are different from a non-unobserved evaluation, but the nature of the difference is not identifiable for any one case. Because the history of health science on which the evaluation is based does not involve this form of

in AMA Guides® Newsletter
J. Mark Melhorn
,
LuAnn Haley
, and
Charles N. Brooks

the integrity of the workers' compensation system that the medical expert have, and base his or her causal opinions on, thorough knowledge of three sets of data. First, the expert must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation. Second, the expert must know the facts of the individual case, specific causation. Just how repetitive were the allegedly causative activities? What were the forces and postures involved? Was the worker exposed to vibration or temperature extremes

in AMA Guides® Newsletter