Representative Henry Bonilla, a San Antonio Congressman in his second term, was home for a visit early this year when he received a small stream of visitors who wanted to complain about a federal agency. The visitors were local back surgeons and some physical therapists angry over a study by the agency that said most back surgery and much physical therapy used by Americans for back pain was unnecessary.

As a Republican member of the Appropriations subcommittee that deals with the agency's budget, Mr Bonilla was a good choice for the surgeons' complaints that the Agency for Health Care Policy and Research was a waste of money.

As far as battles in the current multibillion-dollar budget war go, the fight over the agency is only a tiny skirmish, because its budget is $165 million dollars.... The agency, which is supposed to evaluate the effectiveness of medical treatments, issued a set of guidelines for the public last December that said, in effect, that most of the back surgery performed in the country is unnecessary ... The agency's director, Dr Clifton Gaus, has gone on the offensive, depicting the situation as one in which back surgeons were trying to undercut his agency simply to maintain their substantial incomes... The agency was created by a law signed in 1989 by President George Bush and is supposed to study the effectiveness of medical treatments.... Dr Robert B. Keller said that the guidelines were the result of the best science available. "Those who have attacked the study," he said, "are simply trying to protect their livelihoods."

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