JAMA. 1963;186(3):254. doi:10.1001/jama.1963.03710030094015.
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When orthopedists at Baylor University1 examined the results of therapy in 509 cases of low back pain, they discovered that only one of two compensable patients improved. Yet, when no compensation was involved, nearly 90% responded to treatment. How can such a difference be explained medically.

Further, the perceptive physician must find several therapeutic questions in these figures: Why do some of the compensable patients get well? Or, why do some of the noncompensable patients fail to respond? Is there an identifiable motivational factor which is affected by insurance or compensation? In some cases? In all cases? Finally, does this factor operate in daily medical practice?

These conundrums motivated a study by Hirschfeld and Behan. Their findings are reported in part in this issue of The Journal (p 193) and will be continued in the next issue. The authors examined approximately 300 chronic syndromes of all kinds and identified


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