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Data-Driven Daubert-Defensible Care Code (D4C2)  
The term Data-Driven Daubert-Defensible Care Code (D4C2)  is a combination attributed to Dale Sharp in 2000. He first uttered it during a discussion about a Data Drive Code in the best interest of patient's health needs that would be Defendable Care according to the US Supreme Court's Daubert v Merril Dow 1993 decision.  
The Daubert Decision led to new rules of evidence requiring data rather than just unsubstantiated experience based opinion or what Cindy Doktor commonly describes in Medicine as the "Think so, hope so." approach.  The goal of D4C2 is to comply with the Federal Rules of Evidence which parallels high quality Evidence based Medicine in making relable distinctions about musculoskeletal care. 
I certainly hope you enjoy the process.  Science is never set in stone but a living growth of knowledge with new cells of information that continue to support or replace those that served before much like the turnover of cells of in the human body.  The difference is that it continues to grow and mature - unlimited by any concept of adulthood. 
Thanks for your time and consideration and enjoy a firmer foundation for expressing your views
Stanley J. Bigos, MD 
Prof. Emeritus Orthopedic Surgery and Environmental Health 
Why D4C2
Data-Driven Daubert-Defensible Care Code (D4C2) links Medicine and Law to Reliable Science.  Do you know how to define "Reliable Science?"  Do you know that since the AHCPR Low Back Guidelines were published in 1994 that subsequent scientific efforts have so supported the original findings the finding of the systematic review continue to be used world wide?  Do you know that of the 17 systematic review based back guidelines by 2004. All but one guideline (attempted prior to The AHCPR Back Guideline) use the AHCPR Guide #14 literature review findings in their efforts? These are two reasons why The US Dept Health and Human Service's AHCPR Guideline $14 has become a benchmark for the medical and legal definition of "Reliable Science."  Data-Driven Daubert-Defensible Care Code (D4C2) by following the AHCPR Guideline #14 setting of the bar at a reliable level now used by multiple disciplines.  Reliable science for which medicine and law has long searched is possible by not over estimating less reliable retrospective studies that by their nature can only provide associations and hypotheses.  Prospective studies, that cannot as easily hide bias, actually test hypotheses to determine whether or not the hypothesis is true.  Concentration on prospective studies has proven over time time to provide the reliable scientific data needed to make difficult decisions when risks of complications need to be weighed against hopes of improved outcomes. 
The goal of Data-Driven Daubert-Defensible Care Code (D4C2)  is to help professionals, whether nurses, physicians, chiropractors, therapists, administrators, attorneys or judges, who want to improve the care for individuals with musculoskeletal problems.  Back problems are the educational lodestar possessing more reliable science than other musculoskeletal issues.  A soon again to be available course and related materials are intended as a foundation in Evidence Based Medicine since the US Supreme Court Federal Rules of Evidence Daubert v. Merrill Dow decision '93
Spine Resource Consultants provides this Website for your perusal.  A separate site and demo introduces the basis for prior educational courses and the Basic D4C2 Educational CD.  The Advanced D4C2 Quick Reliable Science Reference is aimed at increasing access of well informed professionals to reliable information. 
These educational tools are based upon the research, teachings and clinical investagory experience of Prof. Stanley J. Bigos, whose career is dedicated to reliable science for back problems especially at work.  The tools are a source for professionals seeking Continuing Education Course work in reliable science about musculoskeletal problems.  This web-site provides an overview of the basic course information and the D4C2 Quick Reference CDs for your preview. 
Dr. Stanley J. Bigos, MD, is Professor Emeritus of the University of Washington. His professional focus helped to define and promote reliable science for back problems in patient care,  teaching and research. Over 100 scientific publications on musculoskeletal problems, evince his collaboration with world wide experts and scientific presentations to national and international audiences and governing agencies. A career of more than a 25 years includes numerous awards honoring his teaching, practice, research and over 400 guest lectureships.  Dr. Bigos won the most prestigious award in Orthopedics, the Kappa Delta Award, as leader of the Boeing Study on Industrial Back Problems funded by NIH, NIOSH and other prestigious foundations. He also chaired of the US Dept. Health & Human Services Federal Back Guidelines (AHCPR Guide #14) and authored the Spine Injury Model adopted by the AMA Impairment Guide Editions 4 and 5.  He has testified about the state of musculoskeletal science before the US Senate, twice before the US Congress, 4 times before US Department of Labor Hearings in response to requests for information about reliable science.  As a member of multiple professional societies he has hosted the International Society of the Lumbar Spine and relentlessly fosters the use of Reliable Science as defined in Medicine and Law.  As founder and director of the University of Washington Spine Resource Clinic, researcher and educator he is considered a major influence on numerous disciplines through clinical teaching and his research has been termed "sentinel work."  
The generated information has been used to successfully to train employers and consultants, insurance personnel and supervisors. Beyond the tired old pain paradigm, the US Dept of Health and Social Service AHCPR Finding and Recommendation Statements were applied to improve activity tolerance at work as described by Malmivaara et al., Indahl et al., and Burton et al., with messages later verified by Hagen et al., Buchbinder et al., McGuirk et al., and others.  In recent years, more solid information about diagnostic and surgical interventions has surfaced from reliable science upon which to guide recommendations for patients considering themselves ready to take risks. Most need care rather than low yield procedures with high complication rates. You can help care for patients by helping patients who become too frustrated to allow symptoms run there normal course.  Help all patients cope by giving them the reliable evidence concerning what is at stake and what difference they can expect from risky procedures.   
The reference is available from the D4C2 course and Advanced D4C2 Quick Reliable Science Reference CD.  Both are the product of world wide searches for Reliable Science. The course material provides understanding through discussions about specific issues (early x-rays, MRIs, surgery, fusion, discograms, opinion logic, with quick links to explain activity paradigm, pain behavior, impairment, lifting issues, making critical decisions about surgery, MRIs or evaluating EMGs).  The Basic and Advanced reference CDs are built around the validated US Dept. Health and Human Services AHCPR Guide # 14 for Back Problems.  The Advanced Quick Reference CD includes updates for important issues with electronic links from the numbered endnotes to references, on to their abstracts. 
 Other electronic links provide direct access to reliable science and guidelines in other musculoskeletal areas.  The systematic review for the US Department of Health and Human Service AHCPR Back Guideline ( #14) "Finding and Recommendation Statements" are accepted as a standard worldwide and their basis as a reliable science was validated in 2001 when researchers found subsequent publications to support rather than conflict with the original systemic review findings. The scientific information based upon scientific review as demanded by the AHCPR Guide #14, Cochrane Collaboration and others disciplined in systematic reviews of the literature are now the standard in both medicine and law. 
Please feel free to peruse the demo previewing both the Basic D4C2 Educational CD and the Advanced D4C2 Quick Reliable Science Reference CD centered around Back Problems at Work and at Home.  
If you are interested in:  1. Ordering a Basic Educational CD, or 2. Access to D4C2 course on line, 3. D4C2 Certification or  4. Ordering an Advanced D4C2 Quick Reference CD needed for Professional Certification, please review the Ed.Option (Educational Options) - last button in window to the left.   
 If you have further questions please email   
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