As was announced earlier this month, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) has posted the evidence synthesis on “CHIROPRACTIC MANAGEMENT OF PREVENTION AND HEALTH PROMOTION; NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS OF THE ELDERLY, CHILDREN AND PREGNANT WOMEN—DRAFT” for review and commentary at www.ccgpp.org. The CHIROPRACTIC MANAGEMENT OF PREVENTIONAND HEALTH PROMOTION; NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS OF THE ELDERLY, CHILDREN AND PREGNANT WOMEN chapter addresses issues of achieving and maintaining wellness through care by chiropractic doctors. It was written by the CCGPP Commission Chair, Cheryl Hawk, DC, PhD, CHES and her team. The chapter covers the special populations most commonly treated by doctors of chiropractic. It is the second chapter to be released in the ongoing best practices initiative of the CCGPP, as commissioned by its founding organizations. This latest chapter utilizes an improved format developed to make the information more user-friendly for the profession; however, it should be noted that this chapter represents only the literature synthesis. Future projects are planned to translate this evidence into useful information for the DC practice to be published in its final form as the Clinical Chiropractic Compass. The 60-day comment period on this “Wellness” chapter draft begins September1, 2007. Comments should be submitted in an electronic format to [email protected] and include a discussion of the conclusions, submission of additional literature for review, and editorial suggestions. The CCGPP anticipates releasing the "Upper Extremity" evidence synthesis on October 1 2007, for its 60-day review and comment period. Additional chapters will follow thereafter. The "Low Back" evidence synthesis was the first chapter released in May 2006. That chapter is currently being revised based on the feedback received during its commentary period, and it will be re-released for review later this year. Thank you for your participation in the comment period, as well is your continued support of the CCGPP's iterative best practices process.

Abstract Little is known about how people with pain seek relief. To estimate the proportion of the population reporting recent pain, to identify ways people seek pain relief, and to report the perceived effectiveness of pain relief methods, we conducted a secondary analysis of results from a nationwide survey of the general U.S. population. Of the 1204 respondents, 31% had experienced moderate to very severe pain within the past 2 weeks and 75% of these had sought medical attention. Only 56% of those who sought medical attention got significant pain relief. Although seeking medical attention was the primary pain relief strategy, almost all of those with pain had tried multiple alternative methods for pain control, with 92% of pain sufferers having tried 3 or more alternative strategies. People who did not seek medical attention were more likely to report pain relief from prayer and going to a chiropractor than were those who sought medical attention. Factors leading to inadequate pain relief included difficulty communicating with a health professional and lack of health insurance. People who perceive that their pain is not understood by medical providers and those without health care insurance coverage are at greater risk for poor pain control. Perspective This article presents an analysis of data from a national survey on pain and the effectiveness of ways people seek pain relief. Difficulty communicating with health professionals and lack of health insurance contributed to inadequate pain relief. Almost all people with pain used multiple methods to control their pain. Volume 8, Issue 8, Pages 624-636 (August 2007)

Summary Background Whether calcium supplementation can reduce osteoporotic fractures is uncertain. We did a meta-analysis to include all the randomised trials in which calcium, or calcium in combination with vitamin D, was used to prevent fracture and osteoporotic bone loss. Methods We identified 29 randomised trials (n=63 897) using electronic databases, supplemented by a hand-search of reference lists, review articles, and conference abstracts. All randomised trials that recruited people aged 50 years or older were eligible. The main outcomes were fractures of all types and percentage change of bone-mineral density from baseline. Data were pooled by use of a random-effect model. Findings In trials that reported fracture as an outcome (17 trials, n=52 625), treatment was associated with a 12% risk reduction in fractures of all types (risk ratio 0•88, 95% CI 0•83–0•95; p=0•0004). In trials that reported bone-mineral density as an outcome (23 trials, n=41 419), the treatment was associated with a reduced rate of bone loss of 0•54% (0•35–0•73; p<0•0001) at the hip and 1•19% (0•76–1•61%; p<0•0001) in the spine. The fracture risk reduction was significantly greater (24%) in trials in which the compliance rate was high (p<0•0001). The treatment effect was better with calcium doses of 1200 mg or more than with doses less than 1200 mg (0•80 vs 0•94; p=0•006), and with vitamin D doses of 800 IU or more than with doses less than 800 IU (0•84 vs 0•87; p=0•03). Interpretation Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation). Affiliations: Dr Benjamin MP Tang MD a b, Guy D Eslick PhD b, Prof Caryl Nowson PhD c, Caroline Smith PhD a and Prof Alan Bensoussan PhD a a. Centre for Complementary Medicine Research, University of Western Sydney, New South Wales, Australia b. University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia c. School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia

Abstract: Study Design. An economic evaluation alongside a randomized clinical trial in primary care. A total of 135 patients were randomly allocated to physical therapy added to general practitioners' care (n = 67) or to general practitioners' care alone (n = 68). Objective. To evaluate the cost-effectiveness of physical therapy and general practitioner care for patients with an acute lumbosacral radicular syndrome (LRS, also called sciatica) compared with general practitioner care only. Summary of Background Data. There is a lack of knowledge concerning the cost-effectiveness of physical therapy in patients with sciatica. Methods. The clinical outcomes were global perceived effect and quality of life. The direct and indirect costs were measured by means of questionnaires. The follow-up period was 1 year. The Incremental Cost-effectiveness Ratio (ICER) between both study arms was constructed. Confidence intervals for the ICER were calculated using Fieller's method and using bootstrapping. Results. There was a significant difference on perceived recovery at 1-year follow-up in favor of the physical therapy group. The additional physical therapy did not have an incremental effect on quality of life. At 1-year follow-up, the ICER for the total costs was [Euro sign]6224 (95% confidence interval, -10419, 27551) per improved patient gained. For direct costs only, the ICER was [Euro sign]837 (95% confidence interval, -731, 3186). Conclusion. The treatment of patients with LRS with physical therapy and general practitioners'care is not more cost-effective than general practitioners'care alone. Spine. 32(18):1942-1948, August 15, 2007. (C) 2007 Lippincott Williams & Wilkins, Inc.

The Foundation for Chiropractic Progress is pleased to unveil three new ads to communicate to the chiropractic profession and the general public. These advertisements present both the purpose and successes of the Foundation over the last twelve months. With a focus on the range of methods used to reach the consumer public on the benefits of chiropractic, these ads are another key to help unlock the best kept secret in health care - chiropractic. ”We encourage every state association and chiropractic publication to utilize these ads on a rotating basis,” stated Kent S. Greenawalt, Foundation Chairman. “In doing this, the chiropractic profession can see what is being achieved and more importantly what can be achieved if the entire profession supports the public relations campaign.” Mr. Thomas Collins, known as one of the best copywriters in the world, prepared the ads for the Foundation. Co-founder and creative director of Rapp & Collins, an advertising agency specializing in direct marketing and fundraising appeals, Mr. Collins writes The Makeover Maven, a monthly column in Direct Magazine. In addition, he has compiled 40 advertising makeovers into a book, How I Would Have Done These Ads. The number of positive messages generated by the Foundations’ public relations efforts has exceeded thirty million and continues to grow. The combination of a prominent public relations agency, generating monthly press releases and public service announcements, along with positive ads in national publications is having an enormous impact on this effort. The Foundation for Chiropractic’s public relations campaign is the longest, continuous public relations campaign in the history of the profession. Every dollar received from vendors and doctors will go directly to the advertising/public relations campaign. We invite you to join the Foundation and build on the positive press of this campaign. Contributions can be mailed to P.O. Box 560, Carmichael, California 95609-0560 or please visit: www.foundation4cp.com.

Fifteen months after the release of the first draft of the low back evidence stratification for public comment, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is poised to release additional components of the Chiropractic Clinical Compass beginning immediately with the Preface, a revised Introduction, and a newly created chapter on Methodology. Each of these three sections will be available for review on the CCGPP website next week at www.ccgpp.org. The next draft of evidence stratification scheduled for release for public comment is Wellness, Non-musculoskeletal and Special Populations, which will be posted at www.ccgpp.org on September 1. CCGPP anticipates the release of one additional draft approximately every 30 days beginning with "Upper Extremity Conditions" on October 1 followed by Low Back Part A, Cervical Spine, Soft Tissue, Thoracic Spine, and Lower Extremities. As was done previously, drafts will be posted on the CCGPP website (www.ccgpp.org) for 60 days of comment. Notification of each release and instructions for submitting comments will be distributed to stakeholders prior to posting via traditional communication outlets. Interested constituent members are urged to organize review efforts now. A previous draft of the low back evidence stratification released for public comment a year ago was the subject of a significant amount of very helpful feedback, much of which was discussed and worked through in a constructive session with stakeholders at the Congress of Chiropractic State Associations annual meeting in Baltimore last November. Based on suggestions received, the low back team has elected to perform a more comprehensive review of the literature pertaining to diagnostic issues, which will further delay re-release of portions of the low back chapter. Over 600 comments have been received, reviewed and addressed, using methodology similar to that used to address public comments to statutory or workers' compensation regulations in states like Texas. Similar comments were collapsed and addressed with one of three possible responses: 1. agreement with the criticism and appropriate revision of the document 2. no response, when no supporting evidence was provided for the critique 3. disagreement with the criticism, with rationale for the disagreement A large number of urgent requests have been voiced by the profession for high quality evidence of efficacy to support care, particularly in addressing third party payor denials and to assist with regulatory hearings. The literature review to date demonstrates excellent quality of literature support for the primary chiropractic treatment approaches to low back pain, which are unlikely to be changed by review of additional literature at this time; therefore the commission has elected to re-release the low back chapter in two parts. Part A will consist of treatment approaches and other aspects which generated little or no comment. Part B, which will consist of diagnostics and related issues, will be deferred pending additional literature review and synthesis. A new chapter concerning the vertebral subluxation has been commissioned by the Association of Chiropractic Colleges. A committee, headed by Drs. Carl Cleveland III and Meridel Gatterman and comprised of content experts from the various colleges, has been charged with developing the chapter following CCGPP methodology, which is outlined in the introduction. In keeping with the agreements reached with COCSA members in Baltimore last year, the recommendations of constituents have been revisited and addressed. Among other suggestions was the need to improve formatting, and to that end professional assistance has been retained to make the document more readable and user friendly. The Council is quick to point out, however, that editing is for the purpose of clarity and readability and not for any content or conclusion edits. The Council is pleased to announce the appointment of Cheryl Hawk, DC, PhD, of Cleveland Chiropractic College, as new Chair of the CCGPP Research Commission. Dr. Hawk is currently Vice President of Research and Scholarship at Cleveland Chiropractic College. She is a 1976 graduate of National College of Chiropractic and practiced full-time for 12 years. In 1991, she earned a PhD in Preventive Medicine from the University of Iowa and also became a Certified Health Education Specialist (CHES). She has been the primary writer of successful grant and contract proposals totaling over $5 million. She is also an author on over 60 peer-reviewed articles and book chapters. Currently Dr. Hawk serves on the ACA Wellness Campaign Committee and as the CCGPP Team Leader for "Wellness, Non-musculoskeletal Conditions and Special Populations." From 2003-2006, she served as the appointed chiropractic representative on the National Advisory Committee for Interdisciplinary, Community-Based Linkages of the U.S. Health Resources and Services Administration Bureau of Health Professions. In 2005, she was named "Researcher of the Year" by the Foundation for Chiropractic Education and Research. "We are very fortunate to have someone of Dr Hawk's caliber take over the reins. Dr Hawk brings a fresh perspective, as well as years of clinical experience and research expertise. We're very excited to have her on board," noted Dr. Whalen. Dr Hawk replaces outgoing Chair Jay Triano, DC, PhD, who stepped down on the heels of his appointment as professor and Interim Dean of Graduate Education and Research for the Canadian Memorial Chiropractic College. He has also been appointed as Associate Professor in the School of Rehabilitative Science at McMaster University. Dr. Triano, a biomechanist and formerly a clinician and researcher at the Texas Back Institute, served as CCGPP Research Commission Chair since 2003 and was instrumental in orchestrating the broad and diverse pool of researchers from across the country and internationally who collaborated to review and rate the literature on the various conditions. Simply finding doctors with the special skills necessary for the task, much less convincing them to volunteer hundreds of hours of their time was a Herculean task. Organizing the massive effort among dozens of clinicians and academic topic volunteer experts was a major undertaking, and now that framework has been established, Dr Triano felt comfortable in turning over the reins. "While this project has required the collective efforts and sacrifice of dozens of the profession's best and brightest, no one involved would dispute that without the persistence and vision of Dr Triano, the project would ever have made it this far. We all owe Dr Triano a debt of gratitude," noted CCGPP Chairman Dr Wayne Whalen. Dr. Triano now joins the ranks of prior Research Commission chairs Charles Lantz, D.C., Ph.D., Dana Lawrence, D.C. and William Meeker, D.C., M.P.H., who have all served CCGPP with distinction. Dr Alan Adams, an expert on literature evaluation, continues to serve as Commission Vice Chair in a primarily advisory role. Further information, as well as the draft chapters when released, is available at the CCGPP web site below:

As part of its ongoing effort to provide a diversity of clinical education experiences for its students, New York Chiropractic College (NYCC) recently signed an internship agreement with Stony Brook University, New York’s second largest university. The agreement will enable NYCC’s chiropractic students to experience hands-on clinical training at the Stony Brook University student health centers as Stony Brook’s students get to discover chiropractic’s many benefits. NYCC currently affiliates with SUNY Farmingdale, and with New York’s largest university, the University of Buffalo. Stony Brook University is a member of the prestigious Association of American Universities, the invitation-only organization of the best research universities in the country, and Kiplinger’s Personal Finance magazine lists it as one of the “100 Best Values in Higher Education” among public universities. NYCC continues to pursue similar arrangements with private colleges and universities throughout the United States.

Seneca Falls: On July 28 and 29, New York Chiropractic College held commencement exercises, conferring upon candidates the Doctor of Chiropractic, and Master of Science in Acupuncture, or Master of Science in Acupuncture and Oriental Medicine degree. On Saturday, July 28, at 10 AM, 27 candidates for the degree of Doctor of Chiropractic were awarded their diplomas in a ceremony held in the campus’s Delavan Theater. The commencement address was delivered by Serge Nerli, D.C., a 1983 NYCC alumnus. Nerli earned a Master of Science in Nutrition from the University of Bridgeport in 1999, has a private practice in Fresh Meadows, N.Y., and currently serves on the NYCC Board of Trustees. Valedictorian Rachel A. Streit had the honor of addressing her classmates and the assembled audience. Christa Marie Whiteman was named Salutatorian for the Spring 2007 graduating class. On Sunday, July 29, at 10 AM, the NYCC School of Acupuncture and Oriental Medicine (AOM) graduated 31 master’s candidates. The commencement address was delivered by Dainel Seitz, chair of the Accreditation Commission for Acupuncture and Oriental Medicine and executive director of the Council on Naturopathic Medical Education. Former president of New England School of AOM and former chief of the Acupuncture Unit for the Massachusetts Board of Registration in Medicine, Seitz earned his Bachelor of Arts and Master of Arts for Teachers from the University of Chicago and holds a law degree from Boston University Law School. He served as founding dean of the AOM master’s degree programs at NYCC and currently serves on NYCC’s Oriental Medicine Advisory Committee. For further information about New York Chiropractic College’s degree programs in chiropractic, acupuncture and Oriental medicine, and applied clinical nutrition, please visit our Web site at:

In a letter dated July 27, 2007, Dr. Frank J. Nicchi, President of New York Chiropractic College (NYCC), received official notification from the Commission on Accreditation of the Council on Chiropractic Education (CCE) reaffirming accreditation for the College’s doctor of chiropractic program. The reaffirmation marks the beginning of the next eight (8) year accreditation cycle for the college’s chiropractic program. Expressing delight at the good news, President Nicchi remarked, “I’m thrilled with the report and extremely proud of the valuable contributions by faculty, staff and students to this significant achievement.”

Company refused fair reimbursement for covered services, Department alleges TRENTON – On Monday the Department of Banking and Insurance (DOBI) filed an administrative order levying $9,475,000 in fines against Aetna Health Inc. for refusing to appropriately cover certain services provided by out-of-network health care providers – including emergency treatment – in violation of New Jersey rules and regulations. In June, DOBI received numerous complaints after Aetna issued a letter to health care providers stating that the company had determined what was “fair payment” for services rendered by non-participating physicians and health care facilities and that “additional reimbursement would not be considered.” This included services by non-participating providers that were required under New Jersey law, such as emergency care, services provided by non-participating providers during an admission to a network hospital, and services rendered as the result of a referral or authorization by Aetna. The letter stated that Aetna determined that 125 percent of the Medicare allowable amount was fair payment, and 75 percent for lab fees and durable medical equipment. As a result, many patients were subject to receiving bills for the amount Aetna would not pay, creating significant financial exposure. Under such circumstances, New Jersey regulations state that members of a health maintenance organization (HMO) have the right to “be free from balance billing by providers for medically necessary services…” DOBI Commissioner Steven M. Goldman signed the order requiring Aetna to cease its limited reimbursement practice, to reprocess all claims for services rendered by non-participating providers adversely affected by Aetna’s unfair practices, and make payment to those providers based on the billed amount plus 12 percent interest from the date the claim was initially paid, in addition to the monetary penalty. Aetna has 30 days to request an administrative hearing objecting to the order. If no hearing is requested, the order will then become final.

New York Attorney General sent a letter to the insurer’s UnitedHealthcare unit to cease the implementation of a program design to rank doctors according to quality and cost effectiveness. The attorney general is prepared to seek an injunction if UnitedHealthcare fails to comply with the request TO READ ATTORNEY GENERAL CUOMO'S LETTER TO UNITEDHEALTHCARE CLICK ON THE LINK BELOW

Any paper claims received by Medicare after June 29, 2007, must be submitted on the new version of the CMS 1500 form (08-05 version). If the old CMS form (version 12-90) is received by Medicare after June 29, 2007, the paper claim will be returned to the provider for resubmission on the new form. Medicare also requires the use of the National Provider Identifier (NPI) on paper claims as well as electronic claims. Be sure to denote your NPI on the new CMS 1500 forms on both electronic and paper claims.

New York Chiropractic College was presented with the “Gold” award during a ceremony held Friday, June 8, 2007. “Today we give quality its due,” said Nicchi, “as we join a small handful of institutions of higher education to receive Empire State Advantage’s ‘Excellence at Work Program’ Gold level of recognition.” NYCC is the only college of chiropractic or school of acupuncture and Oriental medicine ever to be so honored. Nicchi thanked all those who work at NYCC for their hard work and dedication: “This award belongs to all of you.” The Gold Level of recognition is reserved for those educational institutions who have demonstrated outstanding leadership and offer highly effective teaching and work practices. An onsite review team visited the NYCC campus to evaluate, among other qualities, the college’s management systems, work processes, employee satisfaction and customer service. Empire State Advantage (ESA) Executive Director George Hansen, in awarding the honor, said “This is the best kind of day that we have …when we can come out to present and award and celebrate!” ESA Board Chairman Ronald Knight said “We need to have more celebrations of this kind – celebrating our work.” He congratulated NYCC on its achievement and challenged those present to be proud of your accomplishment, continue the “improvement journey” aggressively and to reach out to other area organizations to share what has been learned and to ask for help. “This is how communities of excellence grow,” he said. New York State Senator Michael F. Nozzolio, who was on hand to share in the celebration, remarked “Congratulations on a job well done…this recognition is certainly well deserved.” ESA Executive Director George Hansen and Chairman of the ESA Board of Directors Ronald Knight presented NYCC President Frank J. Nicchi, D.C., M.S. and Chairman of the NYCC Board of Trustees, Lewis J. Bazakos, D.C., M.S. with the ESA “Excellence at Work” Program Gold level of recognition, thus making NYCC one of only eight organizations in New York State to be so honored. To learn more about ESA please visit their Web site at

The Sherman College of Straight Chiropractic Board of Trustees recently announced the appointment of Jon C. Schwartzbauer, D.C., as the college’s fourth president, effective August 13. A Sherman alumnus, Schwartzbauer brings a breadth of academic, leadership and administrative experience, as well as a passionate commitment to vertebral subluxation-centered chiropractic. Most recently he has served the college as vice president for academic affairs and director of the Leadership and Practice Management Institute. Schwartzbauer and his wife, Mitzi, a clinical sciences faculty member at Sherman, ran Schwartzbauer Straight Chiropractic Center in Mahtomedi, MN, for five years before he joined the Sherman College faculty in 2002. The couple also served as team chiropractors for the St. Paul Saints, a minor league baseball team in their home state of Minnesota. Schwartzbauer was selected in early 2006 to lead the launch and development of Sherman College’s Leadership and Practice Management Institute (LPMI). As LPMI director, he worked to create a culture of ever-improving leadership within the chiropractic profession. He instituted Sherman College’s Success Colloquia, a series of seminars designed to enhance leadership and practice management skills for members of the chiropractic profession as well as Sherman students and faculty. He also laid the groundwork for a student leadership program on campus. He was named vice president for academic affairs in December 2006. In addition to the doctor of chiropractic degree he earned in 1997, Schwartzbauer holds a B.S. from Excelsior College. His appointment as president follows a nationwide search and comprehensive selection process that provided the college with a broad array of talented candidates. “I am committed to being a faithful steward to the college’s history and working with the college community as we address the opportunities in chiropractic education today,” Schwartzbauer says. “I look forward to working with our talented and dedicated board, faculty, staff, students, alumni and supporters to strengthen Sherman College and the chiropractic profession.” Schwartzbauer says his priorities include increasing enrollment and fund-raising at the college. “I am grateful for the trust the Board has placed in me,” he says. "I intend to put my heart and soul into Sherman College.” Sherman Board Chair Cindy Pekofsky, D.C., says the trustees look forward to working with Schwartzbauer as he continues to lead and advance the college’s mission of being the leader in bringing straight chiropractic to the world. “We are excited to welcome Dr. Schwartzbauer as Sherman College’s fourth president, and we look forward to the great things we will accomplish for Sherman College and for the chiropractic profession under his leadership and guidance,” she says. Pekofsky adds that the continued service of Sherman College’s Interim President and founder, Thomas A. Gelardi, D.C., will be invaluable in the coming months as he helps provide a seamless transition to Dr. Schwartzbauer’s dynamic leadership. “The board is extremely grateful for Dr. Gelardi’s dedicated service to the college and for his many contributions to the college’s successes during his tenure as interim president for the past two years,” she says.

ABSTRACT Background Widely used models for teaching and assessing communication skills highlight the importance of greeting patients appropriately, but there is little evidence regarding what constitutes an appropriate greeting. Methods To obtain data on patient expectations for greetings, we asked closed-ended questions about preferences for shaking hands, use of patient names, and use of physician names in a computer-assisted telephone survey of adults in the 48 contiguous United States. We also analyzed an existing sample of 123 videotaped new patient visits to characterize patterns of greeting behavior in everyday clinical practice. Results Most (78.1%) of the 415 survey respondents reported that they want the physician to shake their hand, 50.4% want their first name to be used when physicians greet them, and 56.4% want physicians to introduce themselves using their first and last names; these expectations vary somewhat with patient sex, age, and race. Videotapes revealed that physicians and patients shook hands in 82.9% of visits. In 50.4% of the initial encounters, physicians did not mention the patient's name at all. Physicians tended to use their first and last names when introducing themselves. Conclusions Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names. Arch Intern Med. 2007;167:1172-1176 Gregory Makoul, PhD; Amanda Zick, MA; Marianne Green, MD Author Affiliations: Center for Communication and Medicine (Dr Makoul and Ms Zick) and Division of General Internal Medicine (Drs Makoul and Green and Ms Zick), Northwestern University Feinberg School of Medicine, Chicago, Ill.

New York State Insurance Superintendent Eric Dinallo today issued a plan to reform the resolution of disputed workers’ compensation claims. The plan substantially speeds the resolution of disputed claims from over 6-months to 90-days and was submitted in a letter sent on June 1, the deadline set by the Governor. The Superintendent outlined the reforms and their benefits in the letter and submitted an accompanying set of regulations. Resolving disputes faster is one part of the historic agreement between business, labor and government to reduce system costs to employers while increasing benefits to injured workers and getting employees back to work faster. "We are delivering on our promise to reform workers’ compensation in ways that both reduce costs to employers and increase benefits. This reform is an essential part of reviving the State’s economy and encouraging businesses to create more jobs here," Governor Eliot Spitzer said. "These reforms will significantly increase the efficiency and fairness of the system and accelerate the time it takes to get benefits to injured workers. Workers will be able to return to work earlier, system costs will fall and premiums will become more affordable for business owners. This is truly a win-win for employees and employers," Insurance Superintendent Dinallo said. "I would like to thank my staff and our advisors for their excellent and speedy work. We trust that we will be able to continue to find ways to improve the workers’ comp system thanks to the highly collegial and productive dialogue and process that we have with our advisors." On March 13, Governor Spitzer announced legislation to reduce the State’s high workers’ compensation costs for business, while increasing the State’s weekly payments to injured workers. By 2010 maximum benefits will rise to nearly $700 per week from only $400 today. The Governor asked Superintendent Dinallo to lead several reform efforts that further the legislative goals. The first task was reforming the adjudication process with a goal of reducing the time it takes to resolve disputed claims to 90 days. Currently, it takes more than 200 days. During this period, the injured worker may be receiving no cash payments or medical benefits. Delays in cash payments can cause serious financial hardship. Delays in receiving medical benefits and treatment can affect workers’ long-term medical prognosis and the ability to return to work. Under the current system, it is often not until the pre-hearing conference – an average of 75 days from the start of the claim – that the parties have sufficient information to evaluate their claims and defenses. It takes almost three more hearings for a typical claimant to establish a disputed claim and start the flow of benefits. In the 20 percent of cases that take more than three hearings, the average number of hearings is five. It can take up to 90 days to schedule each additional hearing. The newly proposed process will significantly accelerate resolution of disputed cases to within 90 days or less of the dispute. This will cut the time by more than half for the resolution of disputed claims. The reformed process was developed by the Workers’ Compensation Task Force led by Executive Director Bruce Topman after consultation with advisors designated by the Governor drawn from business labor, the legislature and executive departments. It sets specific time benchmarks for each stage of the proceedings, accelerates the time when evidence must be submitted and testimony taken, and requires professional representatives and medical providers to meet their responsibilities in a timely fashion, with consequences for not doing so. A major improvement will require employers, claimants and doctors to submit complete information up front. Early information substantially increases the opportunities for settling cases at an accelerated mediation session and at the pre-hearing conference. It also makes the trial-ready claim quicker and the initial evidentiary hearing follows within minutes of the pre-hearing conference. The proposed regulations accelerate claim resolution through earlier factual disclosure and assist injured workers in filing claims with all necessary information.

The American Chiropractic Association is urging doctors of chiropractic nationwide to take immediate action to provide documentation pertaining to the discriminatory practices of chiropractic networks. The investigation of these matters is becoming of national interest and we want to be ready to supply regulatory authorities with the information they need. Your assistance is needed by June 15, 2007. "Doctors across the country have the information that regulatory authorities need to address the serious problems posed by managed care organizations," announced ACA President Dr. Richard Brassard. "Many doctors have assisted us over the past two years in this long battle, but now more than ever, it is time for all doctors of chiropractic to take a stand to protect our patients and our profession. We have a real opportunity, one that we may not have again, to address the problems of these networks – and we cannot do it without help." ACA has been in communication with several state Departments of Insurance and Attorneys General regarding tactics by managed care networks that, in ACA’s view, limit reasonable and necessary treatment, placing effective patient care at risk. Our preliminary evidence gathered was used to petition these state regulatory agencies to investigate these practices. Recent indications received by ACA lead us to believe that state agencies are prepared to take a closer look in connection with these managed care networks. "The only way that state authorities will act is if they have the ‘ammunition’ to take on the powerful and wealthy managed care companies," added Dr. Brassard. "That ammunition is your patients’ records, which contain hard evidence on how managed care decisions have limited access to medically necessary chiropractic care that is provided for under plan descriptions and/or state law." To do your part and assist ACA and regulatory authorities with this historic investigation, we request that you take the following steps by June 15. (Documentation will continue to be collected after that date, but will be most useful before the deadline.) Read and sign the Business Associate Agreement (found here) creating an arrangement between you and the ACA, so that you do not need to sanitize records for this project or in the future. The purpose will always be for the Insurance Relations Department to investigate issues that impede patients obtaining the care they need. Note that all unsanitized patient records will be kept in a locked room in locked cabinets. Identify patients whose care or benefits have been compromised by coverage decisions made by managed care networks and speak with them to ascertain if they are interested in allowing their medical file to be shared with the ACA and regulatory authorities. A patient information sheet is provided (here) for your convenience. Only the ACA, State Departments of Insurance and State Attorneys General offices will be privy to the information in the patient records. No information regarding patients or their doctors will be shared with managed care companies. Obtain HIPAA Authorization: Explain HIPAA rights to the patient – (a brochure can be found (here) just in case you are unsure if your office documentation is up to date.) Once you are sure the patient clearly understands the reason for this initiative, and they indicate they would like to participate, have them sign the HIPAA Authorization (found here) which has been pre-completed for your convenience. Mail the following to the ACA: copies of your five complete unsanitized patient files with the associated HIPAA Authorization and your signed Business Associate Agreement to the following address: American Chiropractic Association Attention: Insurance Relations/Records 1701 Clarendon Blvd Arlington, VA 22209 If you are having trouble accessing the links above, all the referenced documents can be found on the ACA Web site at www.acatoday.org/datacollection For questions about this initiative, please e-mail [email protected] or call (703)276-8800 and ask to speak with someone in the Insurance Relations Department. Your assistance with this unprecedented data collection is appreciated. Together we can bring managed care abuses to light and with one voice share this information with those who have the power to bring change.

Prof Xiaobin Wang, Xianhui Qin, Hakan Demirtas PhD, Jianping Li MD, Guangyun Mao MD, Prof Yong Huo MD, Prof Ningling Sun MD, Prof Lisheng Liu MD and Prof Xiping Xu MD ABSTRACT Background The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Our aim was to do a meta-analysis of relevant randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke. Methods We collected data from eight randomised trials of folic acid that had stroke reported as one of the endpoints. Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risk of stroke with a random effect model. The analysis was further stratified by factors that could affect the treatment effects. Findings Folic acid supplementation significantly reduced the risk of stroke by 18% (RR 0•82, 95% CI 0•68–1•00; p=0•045). In the stratified analyses, a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months (0•71, 0•57–0•87; p=0•001), a decrease in the concentration of homocysteine of more than 20% (0•77, 0•63–0•94; p=0•012), no fortification or partly fortified grain (0•75, 0•62–0•91; p=0•003), and no history of stroke (0•75, 0•62–0•90; p=0•002). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant. Interpretation Our findings indicate that folic acid supplementation can effectively reduce the risk of stroke in primary prevention. The Lancet 2007; 369:1876-1882

ABSTRACT Objective To test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery. Methods We analyzed data from a cohort study of 1,693 Saskatchewan adults who sustained whiplash injuries between July 1, 1994 and December 31, 1994. We investigated 8 initial patterns of care that integrated type of provider (general practitioners, chiropractors, and specialists) and number of visits (low versus high utilization). Cox models were used to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders. Results Patients in the low-utilization general practitioner group and those in the general medical group had the fastest recovery even after controlling for important prognostic factors. Compared with the low-utilization general practitioner group, the 1-year rate of recovery in the high-utilization chiropractic group was 25% slower (adjusted hazard rate ratio [HRR] 0.75, 95% confidence interval [95% CI] 0.54-1.04), in the low-utilization general practitioner plus chiropractic group the rate was 26% slower (HRR 0.74, 95% CI 0.60-0.93), and in the high-utilization general practitioner plus chiropractic combined group the rate was 36% slower (HRR 0.64, 95% CI 0.50-0.83). Conclusion The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery. Pierre Côté 1, Sheilah Hogg-Johnson 2, J. David Cassidy 3, Linda Carroll 4, John W. Frank 5, Claire Bombardier 6 1Institute for Work & Health, the University of Toronto, and the Toronto Western Research Institute and Rehabilitations Solutions, Toronto, Ontario, Canada 2Institute for Work & Health, the University of Toronto, and Mt. Sinai Hospital, Toronto, Ontario, Canada 3University of Toronto, and the Toronto Western Research Institute and Rehabilitations Solutions, Toronto, Ontario, Canada 4Alberta Centre for Injury Control and Research, Edmonton, Canada 5Institute for Work & Health, the University of Toronto, and the Institute of Population and Public Health, Toronto, Ontario, Canada 6Institute for Work & Health, the University of Toronto, the Toronto General Hospital Research Institute, and Mt. Sinai Hospital, Toronto, Ontario, Canada Arthritis Care & Research Volume 57, Issue 5, Pages 861 - 868

America’s veterans are one step closer to gaining expanded access to chiropractic services after the U.S. House of Representatives passed legislation on May 23 that includes a provision to expedite expansion of the chiropractic benefit through the Department of Veterans Affairs (VA) health care system. The bill was approved 421:1. The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) lobbied successfully for passage of the bill, HR 1470, which requires the VA to have a chiropractor on staff at no fewer than 75 major VA medical centers before the end of 2009 and for all major VA medical centers to have a chiropractor on staff before the end of 2011. “I am proud that ACA and ACC spearheaded the advocacy efforts in support of HR 1470,” said ACA President Dr. Richard Brassard. “The health and well-being of our nation’s veterans is one of America's most important obligations. This legislation builds and expands on ACA’s previous work with Congress and will greatly improve the availability of chiropractic care to veterans young and old.” Congressman Bob Filner (D-Calif.), a strong supporter of extending chiropractic care benefits to military retirees as well as active-duty personnel, worked closely with the ACA in securing support for the legislation. As Chairman of the House Veterans Affairs Committee, Rep. Filner’s leadership was essential to securing House passage of the bill. According to remarks contained in the March 12, 2007, Congressional Record, Rep. Filner said that when writing the legislation he worked closely with “chiropractic patients, particularly our veterans, who know the benefits of chiropractic care and bear witness to the positive outcomes and preventative health benefits of chiropractic.” “I also was pleased to work with the American Chiropractic Association (ACA), the nation’s largest chiropractic organization and the national voice of doctors of chiropractic and their patients,” Rep. Filner said. Through previous congressional action, chiropractic care is now available at 30 VA facilities across the country; however, in the more than 120 facilities without a chiropractor on staff, the chiropractic care benefit that Congress authorized for America’s veterans remains virtually non-existent. Detroit, Denver, and Chicago are a few examples of major metropolitan areas without a doctor of chiropractic available at the local VA facility. ACA leaders believe that integrating chiropractic treatment into the VA health care system would not only be cost-effective, it would also speed the recovery of many of the veterans returning from current operations in Iraq and Afghanistan. A 2006 report from the Veterans Health Administration indicates that nearly 42 percent of veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top malady of those tracked for the report. HR 1470 is now headed to the Senate for consideration.