"Every profession is a conspiracy against the laity," the famous playwright George Bernard Shaw once said. His observation, though fitting for some professions, does not describe the field of interventional pain medicine. In the last issue of Pain Physician, I explored various issues related to interventional pain medicine and interventional pain physicians (1). Despite a growing number of so- called "pain clinics" in the United States, organizations representing pain physicians and practitioners, and pain management journals, interventional pain medicine con- tinues to suffer from a lack of proper recognition, as well as from misconceptions and malaise among interventional pain physicians. Of course, this is true for all specialties, as physicians are known to be reactive rather than proac- tive. Winston Churchill said, "True genius resides in the capacity for evaluation of uncertain and conflicting in- formation." Interventional pain medicine is full of con- flicting and uncertain information; however, the question remains: is there a true genius out there to sort out all these questions? This is not said with arrogance or with disrespect to pain specialists. However, pain medicine has been largely dominated and essentially taken over by physicians who believe in the biopsychosocial model, uti- lizing predominantly psychosocial approaches. While the biopsychosocial model is generally accepted and should be accepted by all interventional pain medicine special- ists, we must also realize that the psychosocial approach is not the only way of managing these patients; interven- tions are an integral part of such an approach. Further, it has been stated by rulemakers in pain management that interventional pain medicine is a procedural specialty, rather than a field of pain medicine that is primarily a non-procedural specialty, and pain is always subjective and always a psychological state (1,2). Of course, there is plenty of criticism of interventional pain medicine for excessive use and abuse of the interventions, lack of dem- onstration of medical necessity, lack of outcomes, and lack of cost effectiveness. This mostly anecdotal criticism, fair or unfair, not only stems from non-physicians, but also from physicians. More interestingly, much controversy stems from the inability of shortsighted pain specialists with differing philosophies and understanding of econom- ics and medicine to assimilate facts and from overaggres- sive attitudes. This is not to say interventionalists are always above board. Thus, practice guidelines and the practice of conservative interventional medicine will go a long way in the new era of documentation and compli- ance.