International Research Foundation for RSD/CRPS

References for Special Report:
American Medical Association is Injuring Patients with RSD


1. Dr. Kirkpatrick filed complaint with AMA


June 25, 2004

Michael D. Maves, M.D., MBA
Executive Vice President

PHONE #312-464-5445

Dear Dr. Maves:

I am a member of the AMA and the Chairman of the Scientific Advisory Committee for the INTERNATIONAL RESEARCH FOUNDATION FOR RSD/CRPS. We have a website at

Over a year ago I advised the AMA that it was publishing false and misleading clinical guidelines that were causing needless pain and suffering in patients. I am writing to you to hold the AMA accountable for the damages and to request that you take action to end this attack on the health of patients.

On May 13, 2003, I contacted Barry Bowlus, AMA's Senior Acquisitions Editor. I informed Mr. Bowlus that the AMA was causing "ongoing injury" to patients by disseminating false and misleading information about the diagnosis of complex regional pain syndrome (CRPS Type I), also referred to as reflex sympathetic dystrophy (RSD). He responded with an email requesting that I put my complaint in writing so that he could "make sure that the appropriate people are notified within the AMA".

On May 14, I filed a detailed, 2-page complaint with Mr. Bowlus and called him on the phone requesting a date for a response to my complaint.

On May 17, I followed up with an email:

"At your request, I sent you an 'urgent' email message providing the AMA with substantial and credible evidence that your organization is injuring patients by disseminating false and misleading information. (Copy forwarded below) As of today, I have not received a response. Please provide me with a date when I can expect a response. Thank you".

On May 19, 2003, Mr. Bowlus sent the following reply:

"We appreciate you providing the information. As soon as I can anticipate a date to provide you with further information I will do that".

Despite numerous attempts over the past year to obtain a date for a response to my complaint, none has been forthcoming from the AMA. I will not restrain myself any longer. Patient care should be the highest priority

Here are the facts:

The 5th Edition of the AMA Guides to the Evaluation of Permanent Impairment (page 496) state that at least eight of the objective findings listed "must" be present "concurrently" to establish a diagnosis of RSD/CRPS.

The AMA has been blatantly irresponsible and has acted in a reckless manner. The evidence is two-fold:

First, I called Linda Cocchiarella, M.D., Editor of the 5th Edition. I requested published data to support the AMA's diagnostic criteria and the names of people responsible for the peer review process for AMA's published diagnostic criteria for RSD/CRPS. Dr. Cocchiarella said she was not aware of published data to support the diagnostic criteria nor was she aware of a peer review process for the diagnostic guidelines. Thus, there is no peer review process to support the AMA's clinical guides and no one at the AMA stands accountable for the clinical guides.

Second, nowhere in the scientific literature will you find such stringent criteria for the diagnosis of RSD/CRPS.

Any organization, such as the AMA, that publishes clinical practice guidelines without any accountability or peer review process, is simply acting recklessly to endanger the health and lives of innocent people. In addition, the AMA has created the appearance of being in cahoots with the insurance industry. To the delight of insurance companies, the AMA guides are being used by carriers as a basis to state patients do not have RSD/CRPS and as a basis to deny authorization and payment for care.

The false assertions by the AMA are particularly egregious because RSD/CRPS is a syndrome that must be treated in a timely manner in order to avert exacerbation of symptoms leading to irreversible impairment and suffering. I have personally witnessed patients with RSD/CRPS lose hope and commit suicide following denial of authorization for care by insurance carriers.

The recent decision by the US Supreme Court to prohibit the suing of HMO's for acts of negligence is going to make things a lot tougher for patients who have to deal with third party payers. The last thing patients need now is bogus clinical guidelines published by the AMA. Nor is this the time to tolerate foot-dragging by the AMA in correcting its long-standing mistake that has caused enormous pain and suffering for patients with a medical condition that is potentially catastrophic and life-threatening.

Accordingly, I respectfully request that the AMA publish a retraction of its diagnostic criteria for RSD/CRPS at the earliest possible date in the Journal of the American Medical Association. Two weeks should not be an unreasonable time within which to act in light of the fact that the AMA has taken no action for more than a year.

I trust that you will respond to my request in a manner consonant with the highest principles of our profession.


Anthony F. Kirkpatrick, M.D., Ph.D



Robert A. Musacchio, Ph.D
Senior Vice President, AMA Business

Catherine D. DeAngelis, M.D., M.P.H.
Editor-in-Chief, JAMA


Charles Berde, M.D., Ph.D.
Harvard Medical School
Scientific Advisory Committee

Gustavo Roman, M.D.
University of Texas Health Sciences Center
Scientific Advisory Committee

Timothy Lubenow, M.D.
Rush-Presbyterian-St. Luke's Medical Center
Scientific Advisory Committee

Srinivasa N. Raja, M.D.
Johns Hopkins University Hospital
Scientific Advisory Committee

Dr-med. Ralph-Thomas Kiefer
Eberhard-Karls University, Germany
Scientific Advisory Committee

Dr-med. Peter Rohr
Teaching Hospital of the University of Saarland, Germany
Scientific Advisory Committee

Sabine Kost-Byerly, M.D.
Johns Hopkins University Hospital
Scientific Advisory Committee

Robert Schwartzman, M.D.
MCP Hahnemann University
Scientific Advisory Committee

Adam L Seidner, M.D., M.P.H.
St. Paul Travelers Property Casualty
Scientific Advisory Committee

Wen-hsien Wu, M.D., M.S.
New Jersey Medical School
Scientific Advisory Committee

Peter Wilson, M.D.
Mayo Clinic
Scientific Advisory Committee

Stephen M. Butler, M.D.
Uppsala University, Sweden
Scientific Advisory Committee

Takashi Mashimo, M.D., D.M.Sc.
Osaka University Medical School, Japan
Scientific Advisory Committee

Edward Covington, M.D.
Cleveland Clinic
Scientific Advisory Committee

Jerry H. Trachtman, Esq
General Counsel
Board of Directors

Richard Hoffman, Ph.D.
Board of Directors

Deborah Shanley
Executive Director


Jim Broatch, M.S.W.
Executive Director


5th Edition, pp 495-97





 3. July 9, 2004: Letter from Dr. Maves to Dr. Kirkpatrick






5th Edition, pp 343-44



5. October 28, 2004: Letter from Dr. Maves to Dr. Kirkpatrick




Reflex Sympathetic Dystrophy (RSD)   |   Complex Regional Pain Syndrome (CRPS)

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