ICBC Committee Report — Dr. Brian Arthur
The BCCA is once again vindicated in its Position Statement on the Quebec Task Force (QTF) regarding Whiplash-Associated Disorders (1). This time, support comes in the form of an article written by Canadian medical researchers, R. Teasell and H. Merskey, from the London Health Sciences Centre of the University of Western Ontario. The article, published last autumn in the Canadian Pain Society's journal Pain Research and Management, reviews the QTF's cohort study, consensus recommendations, best evidence synthesis on interventions and the BC Whiplash Initiative. As pointed out in the review, both the QTF and the BCWI were generated by insurance companies Societe d'Assurance Automobile du Quebec (SAAQ) and ICBC respectively (2).
With regard to the cohort study, the researchers state: "It is impossible to draw valid conclusions about the natural history of whiplash injuries from this study because it did not study recovery from whiplash symptoms and excluded the majority of patients who were classified as recurrences from the final study analysis."
In addition, the authors assert that the QTF consensus recommendations were "of concern", because there was limited evidence to support the consensus; the classification and recommendations were entirely arbitrary; the cohort data that the consensus panel relied upon to identify a natural history was seriously flawed; funding for the study was partisan; there was potential for abuse of guidelines; and there was a failure to deal with chronic whiplash injuries.
In relation to best evidence synthesis on treatment interventions, the authors state that the paucity of research "limited the number of conclusions that could be drawn". However, ICBC has either mistakenly or deliberately concluded that the paucity of good research on treatment interventions means a lack of efficacy or effectiveness of all interventions.
Even more interesting is the researcher's review of the British Columbia Whiplash Initiative (BCWI) (3). According to the authors, the BCWI not only propagates the errors made in the QTF document, but it magnifies them. This is important because ICBC uses the BCWI to trivialize whiplash injuries (even more than the QTF) and to promote its insurance model for the management of these injuries. The insurance model inappropriately gives medical practitioners complete control over whiplash injuries for which they have little training (4). This would come at the expense of the public's well being.
Of course, ICBC is making it of economic interest to the medical profession to cooperate with their insurance model. The economic reward is illustrated in the recent joint ICBC/BCMA agreement with the medical profession. Under this agreement, medical doctors will be paid handsome fees to compel them to fill out an ICBC form that is derived directly from the QTF/BCWI.
In summary, the authors state "Both the QTF and the BCWI draw attention to the potential dangers of insurance industry initiatives designed to persuade medical and allied health professionals to accept viewpoints that appear overoptimistic and potentially self-serving."
The BCCA will be calling on all consumers and the government to consider whether it is appropriate for ICBC to engage in social engineering by adopting an insurance model where none previously existed. This model seeks to limit access to chiropractors, which are primary care practitioners and are trained and licensed to diagnose, treat and manage whiplash-associated disorders. It was recently stated in the November issue of Recovery magazine that "choice is the cornerstone of democracy" in relation to severely disabled injured motorists. The BCCA submits that this truism should apply equally to all less severely injured motorists (5).
The Liaison Committee hopes to meet soon with ICBC or the Minister to discuss this issue, as well as the Corporations proposed revision of the Regulations.
1. Quebec Task Force on Whiplash-Associated Disorders (WAD). Redefining Whiplash" and Its Management. Societe de l'assurance automobile du Quebec. Quebec City, 1995.
2. Teasell RW, Merskey H. The Quebec Task Force on whiplash-associated disorders and the British Columbia Whiplash Initiative: A study of insurance industry initiatives. Pain Res Manage 1999;4:141-149.
3. BC Whiplash Initiative. Whiplash-Associated Disorders: A Comprehensive Syllabus. Vancouver, Physical Medicine Research Foundation, 1997.
4. Craton N, Matheson, G. Training and clinical competency in musculoskeletal medicine: Identifying the problem. Sports Medicine 1993: 15(5):328-327.
5. Weeks C, Young J. Regaining Autonomy. Recovery 1999;10(4):20-21.
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