INTRODUCTION

In the past few decades, society as a whole and individuals in the community have been repeatedly confronted with health-related dilemmas that are difficult to resolve. Individuals, on the one hand, seek cures or control for fatal and chronic diseases that science cannot provide. Meanwhile, policy makers and those who pay for health services question whether investments should go to aggressive preventive intervention, or to high technology for treatment, or a mix of both. The intensity of these dilemmas has been driven by recent international recession and virtually universal cost containment strategies in developed countries.

Since World War II, there has been pressure to depend more on sophisticated technology. Such technology often goes through a trendy "fad phase" and is not always subjected to rigorous scientific evaluation before its use becomes widespread. The price paid by society for such shortcomings is aggravated by procedure-oriented fee-for-service reimbursement schemes that reward "doing" much more than "thinking." Once such procedures become part of the mainstream of clinical practice, it becomes very difficult to evaluate them, due to legitimate ethical concerns about withholding accepted interventions from patients whom might need them.

Since 1976, the Department of Epidemiology and Biostatistics at McGill University and its hospital-based Divisions of Clinical Epidemiology have been addressing controversial social and medical issues for governments and public agencies. Task Forces have been formed to address such problems as the value of the periodic medical examination, the disproportionate disability and associated expense of occupational back injury, the congestion in Montreal area emergency rooms, and possible causal associations between exposure to pesticides and Reye's Syndrome in children and exposure to sour gas emissions and respiratory disease and cancer.

This Task Force addresses the problem of whiplash and its associated disorders. Neck pain is to the automobile what low back pain is to the workplace. Whiplash-Associated Disorders (WAD) are becoming increasingly worrisome in the Western world. In Quebec alone, approximately 5,000 whiplash cases annually account for 20% of all traffic injury insurance claims 34, 35 and the average period for compensation has increased from 72 days in 1987 to 108 days in 1989. In British Columbia and Saskatchewan, two other Canadian Provinces with single-payer motor-vehicle insurance programs, claims for whiplash injury represent 68% and 85% of the automobile injury claims respectively. 35, 98 In addition, whiplash injury presents a substantial financial burden to society.