A study published in the June 3, 2003 issue of the Annals of Internal Medicine concludes: "There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain."

The Cochrane Back Review Group, Dutch College of General Practitioners, RAND, and Greater Los Angeles Veterans Affairs Healthcare System performed the study, which received no outside funding. The study was a meta-analysis of 39 previously published randomized controlled trials on the treatment of low back pain. It found that "[s]pinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school."

That authors note that "[f]or patients, clinicians, and policymakers, our findings that spinal manipulative therapy is substantially less effective than previously estimated should temper enthusiasm for this treatment as ‘the’ recommended therapy for patients with low back pain…. We conclude that spinal manipulative therapy is one of several options of only modest effectiveness for patients with low back pain. Truly effective therapy for such patients remains elusive."

ACOEM Releases Guidelines for Contact Lens Use in an Industrial Environment

In the newest guideline release "The Use of Contact Lenses in an Industrial Environment," the American College of Occupational and Environmental Medicine (ACOEM) stresses that contact lenses are not eye protection and do not reduce the need for eye and face protection. The guideline does recommend that workers be permitted to wear contact lenses when handling hazardous chemicals as long as safety guidelines are followed. For full details visit: www.acoem.org/guidelines/article.asp?ID=58.

DOT Amends Drug Testing Substituted Criteria

On May 28, 2003, the Department of Transportation announced that it was immediately changing the definition of a "substituted" specimen in urine drug testing so that urine specimens with a creatinine level greater than 2mg/dL but less than 5 mg/dL will no longer be reported as "substituted." This change is important because a "substituted" test is considered a refusal to take a drug test, which is a violation of DOT rules equivalent to failing a drug test.

The reason for the change is that the DOT has learned of a small number of cases in which individuals appear to have had legitimate medical explanations for producing specimens with a creatinine level of less than or equal to 5 mg/dL. In addition, the DOT concluded that there is an increasing consensus among scientific and medical experts that the 5 mg/dL standard may not be appropriate.

Under the new rules, when the Medical Review Officer (MRO) gets a report from the laboratory that the creatinine level in a specimen is less than 2 mg/dL or "not detected," the MRO will report the specimen to the employer as "substituted."

When the MRO gets a report from the laboratory that the creatinine level in a specimen is greater than or equal to 2 mg/dL but less than or equal to 5 mg/dL, the MRO will report the specimen to the employer as "dilute" and must, under the new rules, direct the employer to require the employee to undergo an immediate recollection under direct observation. The employer must then ensure that this recollection takes place.

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OSHA Will Not Require Separate Column for Musculoskeletal Disorders

The Occupational Safety & Health Administration (OSHA) issued a news release on June 30, 2003 announcing that it will not require a separate column to record musculoskeletal disorders on the form used by employers to record workplace injuries and illnesses. The injuries must still be recorded. The decision appears in the June 30th Federal Register.

Read the news release at www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= NEWS_RELEASES&p_id=10281.

JCAHO Program Announcements

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has announced the 2004 Ambulatory Care Program Standards. A pre-publication version is available at www.jcaho.org/accredited+organizations/2004+standards.htm.

JCAHO has also announced the 2004 National Patient Safety Goals. Read them at www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_npsg.htm.

Be aware that JCAHO has added a goal ("reduce the risk of healthcare-acquired infections") to its 2003 National Patient Safety Goals that become effective January 1, 2004. Read more at www.jcaho.org/accredited+organizations/patient+safety/03+npsg/npsg_03.htm.

Benchmark Information

The Workers Compensation Research Institute provides benchmark information on its web site that is of interest to occupational healthcare providers. These benchmarks include indicators on Benefits and Costs, Expenses, Timeliness, and Duration and Closure. For more info: www.wcrinet.org/benchmarks.html.

Amphetamine Use in General Workforce Increases

According to the Quest Diagnostics 2002 Drug Testing Index, the incidence of positive drug tests due to amphetamine use has increased substantially over the past five years. The Drug Testing Index summarizes the results of workplace drug tests performed by Quest Diagnostics between January and December 2002. In the general U.S. workforce, the incidence of amphetamine positivity has grown 70% over five years, from 0.20% to 0.34%. For federally-mandated, safety-sensitive worker testing, the incidence has grown to 0.28% from 0.25%. However, overall workplace drug use declined in 2002 to the lowest level since the Index was first published in 1988. In 2002 the positive drug rate for federally-mandated, safety-sensitive worker testing was 2.5% while the positivity rate for the general U.S. workforce remained steady at 4.8%. Read the full summary at www.questdiagnostics.com/brand/business/DTI_05_2003/dti_index.html.