Dr. Frank Nicchi, President of New York Chiropractic College received the Achievement Award for Chiropractic Education during the annual Parker Seminars international event in Las Vegas, Nevada, February 9th. The sixth annual Foot Levelers’ achievement awards were presented to a group of the chiropractic profession’s most distinguished leaders. Foot Levelers’ President and CEO, Kent S. Greenawalt, presented the awards in recognition of their outstanding accomplishments. Dr. Nicchi, a 1978 alumnus and long-time faculty member, was appointed President of NYCC in 2000. Since that time, he has led new initiatives to develop clinical education programs that have solidified the College’s vision and its emphasis on academic excellence and successful integration of chiropractic into diverse healthcare settings. Dr. Nicchi was recognized for his leadership in NYCC’s creation of educational and clinical programs (internships and chiropractic services in the Veteran’s Administration (VA) health systems, private and military hospitals and at state university health centers) that advance and benefit the chiropractic profession. Three additional honors were awarded at the event. Dr. Fabrizio Mancini, President of Parker College of Chiropractic and the Parker Seminars received the Dr. Monte Greenawalt Chiropractic Excellence Award. David Chapman-Smith, Secretary-General for the World Federation of Chiropractic was awarded the Achievement Award for Chiropractic Leadership. The Achievement Award for Chiropractic Philosophy went to Dr. Bob Hoffman, President and CEO of The Masters Circle. “We are privileged to have this opportunity to recognize their achievements and thank them for all they have done,” Kent Greenawalt said of the award recipients. “These four individuals have made a tremendous impact on the profession.”

Buffalo – D’Youville College will open a chiropractic clinic in Buffalo to serve the general public as part of its chiropractic education program. The grand opening of the clinic will be Thursday, February 8, 2007 at 2:00 p.m. at 2900 Main Street (Across from Bennett High School) and will be open to treat patients. (Local officials have been invited to the opening ceremony.) It will serve as one of the college’s clinical training sites for chiropractic interns and also provide a variety of clinical health services to the public, according to college officials. “It is the only such chiropractic health center in the City and features full handicap accessibility,” said Dr. Stephen J. Zajac, associate professor and coordinator of clinical services for the chiropractic program at D’Youville. The 6600 square foot clinic houses examination and treatment rooms, a rehabilitation suite, conference room, patient waiting area, x-ray suite, and faculty and administrative offices. There is a lighted parking lot for 35 cars. “ Our certified chiropractic interns will provide services under the direct supervision of our chiropractic faculty who are licensed doctors of chiropractic,” Zajac said. “We will provide consultation, evaluation, diagnosis and digital imaging x-rays, EKG, lab diagnosis, and spirometry along with chiropractic manipulation, physiotherapy, treatment, rehabilitation services and wellness counseling,” he said. “The fees will be affordable and in some cases there will be no cost.” “Office hours will be by appointment and we plan to be open five days a week and eventually on Saturdays,” Zajac said. The clinic has state-of-the-art diagnostic and treatment equipment including direct digital radiography that allows a patient’s x-rays to be recorded on a CD for the patient to take to their primary physician or specialist if needed. The college is one of the first standard accredited multi-disciplinary colleges in the State to “mainstream” chiropractic education by offering the Doctor of Chiropractic degree as a part of its curriculum. Introduced in 2004, the seven-year chiropractic program currently enrolls 80 students. D’Youville, a private college based on Buffalo’s West Side, was chartered in 1908 and today has approximately 3000 students.

Recent guidelines issued by the American Heart Association that recommend medication as a last resort for chronic pain patients at risk for heart disease should encourage doctors and patients to first consider non-drug treatments such as chiropractic care, according to the American Chiropractic Association (ACA). “For years, the American Chiropractic Association has advocated restraint against the use of excessive drugs and unnecessary surgeries, because safer and more effective options exist,” said ACA President Richard Brassard, DC. “With recent studies linking many nonsteroidal anti-inflammatory drugs with an increased risk of heart attack and stroke, it is more important than ever for patients to have access to conservative treatments such as chiropractic care. Not only is chiropractic care safer than many medical treatments and procedures, it is also more cost effective.” The scientific statement, released by the heart association on Feb. 26, urged doctors to initially focus on “nonpharmacological approaches” to pain management in patients at risk for heart disease in an effort to avoid the possible cardiovascular complications of nonsteroidal anti-inflammatory drugs – or NSAIDs. Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. In addition, a significant amount of evidence shows that the use of chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes: • A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. • A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients' first year of symptoms. • A study published in the July 15, 2003, edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than does a variety of medications. The American Chiropractic Association is the nation's leading chiropractic organization representing more than 16,000 doctors of chiropractic and their patients. For more information, visit the ACA’s Web site at:

(Arlington, Va.) The American Chiropractic Association (ACA) has expressed its outrage to Congress regarding the lack of chiropractic care available to veterans and active-duty military personnel as stories continue to surface about neglect and substandard care at Walter Reed Army Medical Center and other military health facilities nationwide.

Seneca Falls, NY - New York Chiropractic College was awarded a federal grant of over one million dollars from the Department of Health and Human Services. The funding comes under the auspices of the department’s Health Resources and Services Administration’s Chiropractic Demonstration Project Grant Program. The research project, entirely funded by the federal government, will provide $1,124,244.00 over the next three years to perform this multi-site randomized clinical trial. The research will be conducted in conjunction with the Canandaigua Veterans Affairs (VA) Medical Center and private practices in the Rochester area. Dr. Frank J. Nicchi, president of NYCC, said, “The award will generate important data benefiting the millions of Americans who experience debilitating back pain. We are honored to have been selected to work with the Canandaigua VA to carry out this important project.” The study will compare two different treatment modalities for patients suffering from chronic lower back pain. The treatment modalities which will be utilized are spinal manipulative therapy and active exercise therapy. Dr. Paul Dougherty, NYCC Associate Professor and principal research grant investigator, will be utilizing a “prediction rule” to attempt to identify those patients who best respond to particular treatment modalities. ”The research will help doctors predict patient responsiveness to treatment and help determine who should be referred for spinal manipulation or for active exercise therapy.” The project will be carried out within VA clinics and in several private chiropractic and physical therapy outpatient facilities throughout Rochester. One of the strengths of this project has been the interdisciplinary cooperation with all professions represented in the study design and implementation of the project including chiropractors, physical therapists and medical physicians. Patients for the study will be recruited beginning March 2007. If you are interested in more information regarding this study, please contact Maureen Kuhlman at New York Chiropractic College’s research center at 315-568-3868.

To increase the public’s awareness of the benefits of chiropractic care through positive press – this is the mission of the Foundation for Chiropractic Progress. Since July 2006, the Foundation has advertised in major publications such as Newsweek, Health Magazine, Business Week, New York Times Magazine, U.S. News and World Report, and Sports Illustrated. More than 18 million positive impressions regarding chiropractic have been communicated to the general public through this medium. In addition, a TV commercial produced by the Foundation was recently aired to over 150 million viewers. During the 2007 campaign, we will continue to advertise in national publications with circulations of over 1 million. Realizing that advertising alone will not significantly change public opinion, the Foundation retained a prominent public relations agency, CPR Communications. With more than twenty-five years working with the media, this firm is responsible for generating positive press to complement the advertising campaign for the profession. Their efforts have already shown positive results as they generated cover stories on Sarah Harding in New Living Magazine and Total Health Magazine. In cooperation with the Foundation the agency has developed a comprehensive public relations campaign for 2007. Monthly press release to the general media on topics related to the profession, monthly Public Service Announcements to the print and electronic media, and a quarterly adversarial on topics promoting the profession are just a few positive press highlights for 2007. Also exciting is the addition of a “Health Seekers Calendar” - developed to provide appropriate health tips to consumers who visit the Foundation’s web site (www.foundation4cp.org). Additionally, a Foundation blog will be established for consumers. With this feature, we will also have the ability to monitor the health blogs of prominent publications like the New York Times and The Washington Post for positive stories about chiropractic. The reality is that chiropractic is considered the best-kept secret in health care. The Foundation for Chiropractic Progress is working for you to increase the positive press about chiropractic and change that reality. 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. If you wish to make a pledge and/or contribution to the Foundation, please visit (www.foundation4cp.org). Contributions are also received at P.O. Box 560, Carmichael, California 95609-0560.

ACN/Aetna Workers’ Compensation Access, LLC Program Last month, NYSCA sent out a notice concerning ACN’s mid-December mailing announcing a “new network access program” – the “Aetna Workers’ Compensation Access, LLC Program,” a Workers’ Compensation (WC) Preferred Provider Organization (PPO). Unfortunately, the NYSCA has learned, an ACN staffer gave out the wrong fax number participating providers to use if they were interested in opting-out of the ACN/Aetna program. Since the error was ACN’s, the NYSCA feels that ACN should honor opt-out requests sent and received already albeit to the wrong ACN facsimile number. Nonetheless, to be doubly sure that opt-out information has been properly received, the NYSCA recommends that providers re-fax their opt-out letters again to (763)595-3333, even if you sent an opt-out letter once already. It is the Association’s understanding the correct facsimile number for opting out of this program is (763)595-3333. Remember, this offer on the part of ACN and Aetna is not magnanimous. Everyone, but you and patients injured on the job, may benefit from this program. In theory PPO providers offer their services at a discounted rates with the hope of gaining a larger volume of covered patients attracted by the lower fees which more than offsets the discounts being offered. Although the theory works fine for payers, providers rarely see the boost in practice volume necessary to offset the loss in income from discounting their fees. Keep in mind too, that if you agree to join this Aetna/ACN WC PPO network your fees will be discounted off of the already low NYS WC fee schedule. As NYSCA noted before, one of the most frequent complaints the NYSCA receives questions why the chiropractic WC fees are so low and why they have not increased in more than ten (10) years. Furthermore, it is the NYSCA’s understanding that subsequent to the original ACN/Aetna mailing, ACN/Aetna sent out a revised fee schedule, one that more closely reflects the few services chiropractors can bill for under the NYS WC fee schedule. If you sign onto this program, in effect, you are directing Aetna/ACN to discount your already low WC fees. Caveat Scriptor. Remember too, to beware of fine print with hidden liabilities. By joining the Aetna WC PPO not only will signers discount their fees but they will be subject to other provisions of NYS Law embedded in the WC law. For example, the “Compliance” portion of the Appendix accompanying the ACN/Aetna solicitation references NYS WC Article 10A directing WC PPOs like the ACN/Aetna program to comply with other portions of NYS law, including Article Art 49 of the Public Health Law. Under Art. 49 Aetna/ACN WC PPO are “utilization review agents” required to “determine whether health care services that have been provided, are being provided or are proposed to be provided to a patient . . . are medically necessary.” By signing this agreement you will not only be agreeing to discount your fees but you will be agreeing to whatever treatment parameters Aetna/ACN decide are medically necessary for your injured WC patients. Caveat Scriptor. And as the NYSCA pointed out before, Aetna and ACN are not creating any new lines of business in New York. WC law already requires every employer to cover employee injuries received on-the-job either by self-insuring or through the purchase of WC insurance. Aetna and ACN are not adding any volume of new, untapped patients that you do not have access to already. To the contrary, Aetna and ACN are only creating new lines of business for themselves at your expense. They are offering your services at discounted fee$ to employers with the added prospect that utilization will be controlled as well. This inures to the benefit of Aetna/ACN and employers who contract with their WC PPO.its contracted employers. If you think you deserve le$ or that Aetna/ACN needs more profit at your expense, then . . . Caveat Scriptor. ACN Group has not been telling participating providers that they can opt-out of this program. In order to do so, it is the NYSCA’s understanding that participating providers must affirmatively opt-out by faxing a letter to the ACN Group at (763)595-3333 advising ACN/Aetna them that you “formally withdraw your participation in and from the Aetna Workers’ Compensation Access, LLC Program.” It is also recommended that you make clear your intent to remain in network with any other ACN Group products in which you are currently enrolled, if you choose to do so. Even if you sent an opt-out fax once already to the previous number ACN communicated in error, to be doubly sure your opt-out letter is properly received, the NYSCA recommends that you re-send your opt-out letter to the following number: (763)595-3333. For definitive opt-out information contact ACN Provider Services at 888-676-7768.

With the departure of Dr. Clay McDonald, Dr Michael Mestan has been named New York Chiropractic College’s Interim Executive Vice President of Academic Affairs. McDonald now serves as Palmer College of Chiropractic’s new Assistant to the Chief Executive Officer. Mestan arrived in upstate New York in 2002 having previously worked at Parker Chiropractic College chairing the college’s Department of Radiology and directing its Diagnostic Imaging Residency program. Bearing impressive credentials, Mestan came with a Bachelor Degree in Human Anatomy and has earned Diplomate status with the American Chiropractic Board of Radiology and eight years administrative experience. Dr. Mestan says of his work at NYCC, “It is exciting to be able to work at a College with such a rich history as NYCC and serve as part of an administration that provides such a clear and progressive vision.” A national search is being conducted for the Dean of Chiropractic position to oversee academic planning, curriculum development, faculty hiring and associated budgets as they relate to the chiropractic program.

American Chiropractic Association (ACA) member Michael Minardo, DC, was recently featured in a video clip on the popular news Web site MSNBC.com. The story – which was arranged by ACA communications staff – offered advice on how women can avoid back, neck and shoulder pain when carrying a heavy or oversized handbag. The segment, which appeared prominently on the MSNBC.com homepage, was also broadcast on WNBC- 4 of New York City and NBC-5 Dallas, Texas. MSNBC.com is a leader in breaking news and original journalism on the Internet. Serving 4 to 5 million site visitors daily, the news site typically handles 50,000 simultaneous users, with as many as 400,000 site visitors during major breaking news events. This latest television segment is just one of the many media relations efforts conducted by the ACA on behalf of its members. ACA’s public relations team works to increase demand for chiropractic care and ensure that chiropractic receives accurate and favorable exposure in the media. Through proactive news releases, letters to the editor, and other vehicles, the ACA has reached millions of consumers with pro-chiropractic messages. Click here to watch the video. To view additional excerpts of media stories that mention doctors of chiropractic and/or chiropractic care, click below to visit the ACA web site.

Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD ABSTRACT Context: Proton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps. Objective: To determine the association between PPI therapy and risk of hip fracture. Design, Setting, and Patients: A nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed. Main Outcome Measure: The risk of hip fractures associated with PPI use. Results: There were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; PConclusion: Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture. JAMA. 2006;296:2947-2953. Author Affiliations: Division of Gastroenterology (Drs Yang, Lewis, and Metz), Center for Clinical Epidemiology and Biostatistics (Drs Yang and Lewis), Department of Biostatistics and Epidemiology (Drs Yang and Lewis), and Division of Endocrinology (Dr Epstein), University of Pennsylvania School of Medicine, Philadelphia; and Department of Medicine, Doylestown Hospital Research Center, Doylestown, Pa (Dr Epstein).

Since Aug. 1, Palmer College of Chiropractic added three experienced administrators from outside the institution to its administrative team. These administrators are filling key roles as dean of Clinics, assistant to the chief executive officer and executive director of the Palmer Center for Chiropractic Research (PCCR). Dean of Clinics, Davenport Campus In August, Kurt Wood, D.C., was hired as dean of Clinics at Palmer College of Chiropractic’s Davenport Campus in Davenport, Iowa. Dr. Wood comes to Palmer after a 20-year career at Northwestern Health Sciences University in Bloomington, Minn. During his tenure at Northwestern, he was a professor in the College of Chiropractic, and served as department chair, program chair, associate dean of academics, associate dean of clinical services, and as Northwestern’s compliance, privacy and security officer. In 2000, he was voted Teacher of the Year by the chiropractic program students. He has presented multiple times at professional conferences and has been published in the Journal of Manipulative and Physiological Therapeutics and other professional journals. Prior to graduating from Palmer College of Chiropractic’s Davenport Campus in 1979, Dr. Wood completed Bachelor of Science degrees in biology and chemistry at Upper Iowa University. He is credentialed as a Diplomate of the American Academy of Pain Management, a senior analyst and Diplomate of the American Board of Disability Analysts, and also is certified in healthcare compliance by the Health Care Compliance Board. Dr. Wood has maintained a private practice since 1979, for many years in a multi-doctor, family chiropractic practice in Wisconsin, and more recently in a consulting, forensic practice. A member of the Upper Iowa University board of trustees for 15 years, he currently serves as chair of that board’s residential university committee. In announcing Dr. Wood’s appointment, Palmer’s Vice President for Academic Affairs Dennis Marchiori, D.C., Ph.D., remarked: “We welcome Dr. Wood to this leadership role and look forward to his contribution to our educational program. As dean, Dr. Wood will lead an experienced faculty that is dedicated to the Palmer Clinics’ dual mission of quality patient care and clinical education, and in cooperation with Clinic Department coordinators and directors, will manage, plan, develop and continually improve Palmer’s academic health centers.” Assistant to the Chief Executive Officer In early November, Palmer College of Chiropractic Chief Executive Officer Larry Patten announced that Clay McDonald, D.C., would join Palmer College on Jan. 3, 2007, as assistant to the chief executive officer. In this newly created role, he will work directly with Mr. Patten and the College administrative team to develop and implement operational systems and a program of continual improvement. He also will assist with lobbying for chiropractic education issues at various government levels. “I’ve known Dr. McDonald for many years and I greatly value his perspective and approach to chiropractic education,” said Mr. Patten. “With his diverse and successful background as an administrator, clinician and practitioner, Dr. McDonald’s return to Palmer will continue to strengthen the College leadership team and our commitment to chiropractic education.” Dr. McDonald earned his Doctor of Chiropractic degree from Logan College of Chiropractic in 1982. He also earned a Master of Business Administration degree from St. Ambrose University in 1997, and a Juris Doctorate from Valparaiso University School of Law in 2001. He maintained a private practice in Eureka, Mont., from the time of his graduation until 1990. That year, Dr. McDonald joined Palmer College faculty and spent nearly a decade in service to the College. During that time, he served as an associate professor, faculty clinician and director of Ancillary Procedures. He went on to serve as dean of Clinics before being named special advisor to the president under Dr. Guy Riekeman. Since 2002, he has served New York College of Chiropractic, as dean of Academic Affairs and most recently as executive vice president of Academic Affairs. He currently serves on the Board of Trustees and as secretary/treasurer for the Council on Chiropractic Education. Executive Director for the Palmer Center for Chiropractic Research In late November, Mr. Patten announced that William Meeker, D.C., M.P.H., who had been serving as vice president for Research and executive director of the Palmer Center for Chiropractic Research (PCCR), had been named president of Palmer College of Chiropractic’s West Campus in San Jose, Calif. Concurrently, with Dr. Meeker assuming his role on the West Campus, the College announced the hiring of Christine Goertz Choate, D.C., Ph.D., to succeed Dr. Meeker as executive director for the Palmer Center for Chiropractic Research. Beginning January 3, 2007, she will oversee the College’s research efforts from a new office that Palmer will establish in Washington, D.C. Through this office, Dr. Goertz Choate also will monitor and coordinate government relations activities. “Dr. Goertz Choate has research and administrative experience of tremendous breadth and depth,” Mr. Patten noted. “I look forward to having her on board to lead our research efforts, as well as work through Palmer’s new Washington, D.C., office with federal sources of research funding and on governmental relations efforts.” Dr. Goertz Choate comes to Palmer College from the Samueli Institute for Information Biology in Alexandria, Va., where she served as director of clinical research from 2003 to 2005, until being named deputy director in 2005. Prior to joining the Samueli Institute, Dr. Goertz Choate was the first chiropractor hired by the National Institutes of Health as a health sciences administrator at the National Center for Complementary and Alternative Medicine in Bethesda, Maryland. Dr. Goertz Choate earned her Ph.D. from the University of Minnesota School of Public Health in 1999. In 1991, she earned her Doctor of Chiropractic degree from Northwestern College of Chiropractic in Bloomington, Minn. Among her many honors and accomplishments, Dr. Goertz Choate was named George B. McClelland Researcher of the Year in 2006 by the American Chiropractic Association.

The Food and Drug Administration (FDA) today proposed to amend the labeling regulations on over-the-counter (OTC) Internal Analgesic, Antipyretic, and Antirheumatic (IAAA) drug products to include important safety information regarding the potential for stomach bleeding and liver damage and when to consult a doctor. OTC IAAA drug products, commonly known as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen and ketoprofen, are used to treat pain, fever, headaches, and muscle aches. To help ensure safe use of OTC products, and to provide consumers with the labeling necessary for them to make more informed medical decisions, FDA is proposing the following label changes: For Products Containing Acetaminophen • To require new warnings which would highlight the potential for liver toxicity, particularly when using acetaminophen in high doses, when taking more than one product with acetaminophen, and when taken with moderate amounts of alcohol; • To require that the ingredient acetaminophen be prominently identified on the product's principal display panel (PDP) of the immediate container, and the outer carton (if applicable). For Products Containing NSAIDs • To require new warnings for products that contain an NSAID which would highlight the potential for stomach bleeding in persons over age 60, in persons who have had prior ulcers or bleeding, in persons who take a blood thinner, when taking more than one product containing an NSAID, when taken with moderate amounts of alcohol, and when taking for longer time than directed; and • To require that the name of the NSAID ingredient and the term "NSAID" be prominently identified on the product's PDP of the immediate container and the outer carton (if applicable). The new labeling would be required for all OTC drug products that contain only an IAAA ingredient, as well as for products that contain an IAAA ingredient with other ingredients, such as cold symptom relievers. Consumers may also be taking IAAA ingredients in their prescription medications, which makes it important to alert them of the contents of their OTC medications, so they do not take too much of an IAAA ingredient. FDA based its proposal for labeling changes on previous Advisory Committee discussions, recommendations, and public comments (see http://www.fda.gov/ohrms/dockets/ac/cder02.htm#NonprescriptionDrugs) and a review of the scientific literature. A number of manufacturers of OTC internal analgesic drug products already have voluntarily implemented labeling changes to identify these potential safety concerns.

Arlington, Va. – Congress, in one of the final acts of the session, passed legislation that halts a 5 percent cut in Medicare physician fees. The reduction would have gone into effect on Jan. 1, 2007, in addition to the 8 percent cut doctors of chiropractic will incur in February 2007. Instead, the Tax Relief and Health Care Act of 2006, the omnibus bill that contained the physician fee provision, provides no increase in the congressionally mandated sustainable growth rate (SGR) mechanism which works to hamper spending in the Medicare program. The president is expected to sign the bill. “The ACA is pleased that Congress has halted this portion of the upcoming cuts in physician Medicare payments,” said ACA President Dr. Richard G. Brassard. “It is completely unreasonable to expect providers to take on further financial constraints when they are already being hit from all sides with fee decreases. We applaud this move as a significant recognition of the increasingly stressful environment for physicians in Medicare.” Although the Tax Relief and Health Care Act of 2006 provides some measure of relief, providers in Medicare still face many types of fee cuts for 2007. Under a final rule—issued by CMS per the congressionally mandated five-year review of the work values of billing codes—doctors of chiropractic will face an average 8 percent cut starting in February 2007. This rule also imposes significant cuts to radiological and imaging services. The bill also includes a provision that will allow for a 1.5 percent increase in reimbursement for providers who report on existing quality measures established by CMS. Quality measures are developed by several different organizations through a rigorous process grounded in evidence-based medicine. The measures, approved by CMS, are geared toward primary care practices and have been utilized in the Physician Voluntary Reporting Program. “The ACA will continue to lobby on behalf of its members for fair reimbursement of Medicare services. It is imperative that Congress and the Department of Health and Human Services develop a permanent solution to the physician fee schedule because those most affected by this annual dilemma are not doctors, but patients,” Dr. Brassard said. Because the fee schedule has many different components, including a geographic consideration, doctors of chiropractic should contact their local Medicare carriers/contractors for information on what their fees will be in 2007. The 8 percent decrease is only an average and percentages may vary depending on location. Therapy Caps For most chiropractors—with the exception of those participating in the Medicare Demonstration Project—coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine. However, the ACA has received numerous questions concerning therapy caps. Also included in the Tax Relief and Health Care Act of 2006, the President authorized CMS to continue an exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the cap in 2007. The ACA will provide more information as it becomes available.

New York Chiropractic College conferred the Doctor of Chiropractic degree upon 96 graduates on Saturday, December 2, 2006, during a commencement ceremony held in the Athletic Center Gymnasium of the college’s Seneca Falls campus. Dr. Frank J. Nicchi, president of NYCC, expressed his pride for the new graduates. “It gives me a great sense of satisfaction that this class of new doctors will soon be administering quality care to the many patients in need of chiropractic.” Jennifer Marie Conway and Patricia Marie West were co-valedictorians and had the honor of addressing their class at the commencement ceremony. Tiffany Anne Grace was salutatorian. The commencement address was delivered by Peter D. Ferguson, D.C., past chairman and current member of the NYCC Board of Trustees, whose son, Brian was among the graduates. Dr. Ferguson is a graduate of National College of Chiropractic, has been in practice for 32 years in Ohio, and is licensed in 10 other states. He has served on the Ohio State Board of Chiropractic Examiners, the National Board of Chiropractic Examiners, the Executive Board of Directors of the Federation of Chiropractic Licensing Boards, and the Council of Chiropractic Education Board of Directors. He also sits on the U.S. Department of Defense Chiropractic Health Care Oversight Advisory Committee, which has facilitated the setting up of chiropractic practices at military bases across the United States. In addition, Ferguson is a member of the Advisory Committee on Interdisciplinary, Community Based Linkages for the U.S. Department of Health and Human Services, has served as the chiropractor to the Professional Football Hall of Fames since 1995, and has lectured on various sports chiropractic topics around the country. For further information about New York Chiropractic College’s degree programs in chiropractic, acupuncture and Oriental medicine, and applied clinical nutrition, visit the college’s Web site at:

Abstract Objective: To examine the effects of smoking on cartilage loss and pain at the knee in those with knee osteoarthritis (OA). Methods: We examined 159 men with symptomatic knee OA who participated in a 30-month, prospective, natural history study of knee OA. The more symptomatic knee was imaged using MRI at baseline, 15- and 30-months follow-up. Cartilage was scored using the WORMS semi- quantitative method at the medial and lateral tibiofemoral joint and at the patellofemoral joint. At baseline and follow-up visits, the severity of knee pain was assessed using a visual analogue scale (VAS) pain score (0-100 mm). Results: Among the 159 men, 19 (12%) were current smokers at baseline. Current smokers were younger (mean age ± SD: 62 ± 9 vs. 69 ± 9 years) and leaner (mean body mass index (BMI): 28.9 & [plusmn] 3.2 vs. 31.3 ± 4.8 kg/m2) than men who were not current smokers. Adjusted for age, BMI and baseline cartilage scores, we found that men who were current smokers had an increased risk for cartilage loss, at the medial tibiofemoral joint (odds ratio (OR): 2.3, 95% CI: 1.0 to 5.4) and the patellofemoral joint (OR: 2.5, 95% CI: 1.1 to 5.7). Current smokers also had higher adjusted pain scores at baseline (60.5 vs. 45.0, p<0.05) and follow-up (59.4 vs. 44.3, p <0.05) compared with men who were not current smokers. Conclusions: Men with knee OA who smoke sustain greater cartilage loss and have more severe knee pain than men who do not smoke. Source reference: Amin, S, et al "Cigarette Smoking and the Risk for Cartilage Loss and Knee Pain in Men with Knee Osteoarthritis" Ann Rheum Dis 2006: online: 2053-2060 Shreyasee Amin 1*, Jingbo Niu 2, Ali Guermazi 3, Mikayel Grigoryan 3, David J Hunter 2, Margaret Clancy 2, Michael P LaValley 2, Harry K Genant 3 and David T Felson 2 1 Mayo Clinic College of Medicine, United States 2 Boston University School of Medicine, United States 3 University of California, San Francisco, United States

Many are now aware that the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is creating a chiropractic best practices process entitled the "Chiropractic Clinical Compass". In May of 2006 the CCGPP released the initial draft of the Introduction and Low Back evidence stratification and synthesis. This document has generated considerable commentary and concern throughout the profession. The purpose of presenting the initial draft document on the internet was to generate just such feedback. The CCGPP Council and Commission members wanted to promote the best practices concept as an iterative process. We have been monitoring all the responses and thank everyone who has presented constructive criticism and creative suggestions to enhance the document. The CCGPP also recently held a spirited forum at the COCSA annual meeting. The focus of that forum was additional clarification of the "Compass" process. This additional feedback will also be considered for use in the final document. However, the intent of this article is to dispel some confusion that has arisen regarding the best practices process. Most importantly, the initial low back draft document that many have reviewed is NOT the "Chiropractic Clinical Compass" (See Figure 1). What you have seen to date is merely the evidence stratification for the most common low back conditions seen in the average chiropractic clinic. The Council understands that this evidence stratification is a dry, difficult to understand and implement document. From the outset, the CCGPP has recognized and planned for translating the science to the field for ease of application in the treatment room with the patient. This is the nature of the DIER (Dissemination, Implementation, Evaluation, and Revision) process. It is this process that will ultimately become the Chiropractic Clinical Compass. Studies indicate that it takes 17 years for today's research to become common practice in the treatment room. They also indicate that the body of healthcare research is doubling every 3.5 years and quickly overwhelming even the most diligent reader. This is why the Bush administration has made Evidence Based Medicine/Care and Knowledge Translation national priorities. These were contributing factors as to why the CCGPP adopted the best practices model. Our DIER committee has reviewed 41 case studies of the evidence based care procedures to learn what has and has not worked in order to get doctors to utilize the latest research in their practices. The common denominator in virtually every study has been a lack of enthusiasm and confidence in the information by stakeholder populations, particularly providers. Therefore, to ensure its credibility the CCGPP adopted the internationally renowned AGREE instrument as the template for our best practices process. The synthesis of the aforementioned review indicated that the most promising approach to changing provider behavior was the use of a variety of interventions including audit and feedback, reminders, patient mediated intervention and educational outreach. The CCGPP intends to utilize those proven knowledge translation strategies to maximize the successful adoption of the best practices process for the chiropractic profession. Some of these tools will include: * Educational CD * Literature searches * Online Survey * Clinical Vignettes * Development of Evidence based online course * Development of Evidence based test * Development of Certification Course * Development of Certification Test * Development of interactive website * Development of Rapid Response Team * Development of full version BP document * Development of Clinician Quick Reference Guide * Development of Patient Version of BP * Harvesting of newly released literature * Pre and post release surveys Best practices dissemination needs to be planned, active, sustainable and ensure high accessibility. This is the mission of the CCGPP DIER committee. Best practices should also target multiple audiences (professionals, patients and policymakers) and be available in suitable formats for the different groups. Among existing chiropractic providers the successful introduction of chiropractic evidence based care needs to be patient-centered, easy to adopt and validate the doctor's clinical judgment and skills. The best way to introduce evidence based care is through the training of future chiropractors. Currently, our chiropractic colleges are adopting best practices curricula in varying degrees. CCGPP hopes the "Chiropractic Clinical Compass" will become the resource for that curriculum. Facilitating the use of the best practices document as a valuable and valid decision-making tool for healthcare administrators and policymakers will be vital in order to promote sound healthcare industry decisions, both for the good of the overall healthcare system and to protect chiropractic providers from inappropriate punitive external administrative abuse. Chiropractic patients are the stakeholders who stand to benefit the most from the chiropractic best practices initiative. As the primary decision makers in health care, they represent a very important stakeholder population. Therefore, the best practices document needs to get directly to them such that they begin to ask their doctors about how evidence based care applies to their individual cases. After the full "Chiropractic Clinical Compass" process has been implemented the CCGPP will evaluate its impact on clinical practice. The literature will also be reevaluated for relevant enhancements, whether new research on existing topics and/or topic expansion. This will lead to the revision portion of the DIER process. CCGPP is committed to review the literature every two years to ensure its efficacy. It is through this iterative process that the "Chiropractic Clinical Compass" will improve into the useful, dynamic database that the CCGPP envisions doctors using every day in their treatment rooms to the benefit of their patients. At that point the chiropractic profession as a whole will realize the evidence based care equation: Science + Doctor's Clinical Experience + Patient Values = Chiropractic Best Practices ABOUT THE AUTHOR: Dr. Mark D. Dehen is a second generation Doctor of Chiropractic practicing in North Mankato, MN. He does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the MN Chiropractic Association and recipient of the MN Chiropractor of the Year award. Currently, he serves as Vice Chair of the CCGPP

In support if its mission to provide positive press for the chiropractic profession, the Foundation for Chiropractic Progress is excited to announce that a testimonial on the benefits of chiropractic will air on the Fox Network in January 2007. More than 150 million households will have the opportunity to see Sarah Harding, Ms. Fitness USA 2006, share a message about how chiropractic has allowed her to maintain an active lifestyle. “We believe that as the reigning Ms. Fitness USA, Sarah will have a tremendous impact on the viewing audience,” said Kent S. Greenawalt, President of the Foundation. This commercial, a first for this widely successful campaign, will be seen on the Fox Network during the Ms. Fitness USA contest during the weekend of January 6th and 7th. It will also air during the contests’ reruns including a national viewing on January 15, 2007. The Foundation is also preparing a commercial of Sarah Harding that will be made available to state associations that are partners of the F4CP’s positive media campaign. If you wish to make a pledge and/or contribution to the Foundation, please visit www.foundation4cp.com. Contributions are also received at P.O. Box 560, Carmichael, California 95609-0560

A new study published in the Journal of the British Medical Journal, reports that patients taking folic acid supplements may reduce the risk of heart attacks. This study reaffirms previous studies, which reported the benefit of folic acid as a daily supplement. Using folic acid can be an economical way of reducing the risk of strokes and heart disease. To learn more click on the link below:

State chiropractic leaders gathered in Baltimore over November 8-12, 2006 for the annual meeting of the Congress of Chiropractic State Associations. Set to the theme "Sailing into the Future with a New Vision," over 120 delegates from 50 state chiropractic associations participated in round table discussions and workshops aimed at improving their operations and overall effectiveness in serving their members and advancing the chiropractic profession. In addition to providing association management training for state elected leaders and staff, the meeting covered chiropractic's hottest issues, the introduction of new COCSA programs and policies, and the election of COCSA leaders for 2007. Sponsors of the 2006 meeting were Airpacks, Breakthrough Coaching, CBG, ChiroCode, Chiropractic America, Chiropractor Monthly, Foot Levelers, Interactive Health, Lippincott Williams and Wilkins, Maryland Chiropractic Association, NCMIC, Now You Know, Palmer College of Chiropractic, Parker Chiropractic College, Standard Process, Texas Chiropractic College, Dr. Terry Yochum, and Voice for Health. Following is a brief summary of the primary activities and issues of the 2006 Congress. CCGPP Best Practices Recommendations Over eight hours of the program was spent in intense discussion with CCGPP about their efforts to develop a best practices document. Despite heated debate and disagreement, the meeting was conducted very professionally and allowed for a true exchange of ideas with the final outcome being that COCSA members unanimously approved the following recommendations to CCGPP: • Consider the written recommendations received and make the appropriate revisions to the current draft to allow for the concerns, additions and omissions to be considered and follow this procedure for future drafts. • Change the name of the document to truly reflect the intent and use of the document. • Ensure expanded input allowing the duly elected CCGPP representatives to truly act as liaisons between the member associations and the CCGPP Board. • Consider redrafting the document's overview and introduction to make it easier to read and understand, including a shorter more concise narrative, written in non-academic language with bullet points for better understanding. • The process will remain open to allow other organizations and researchers and concerned stakeholders to be included in the process. • Consider rewriting the research compilation to make it more user-friendly to those affected. • Ensure that the commentary process will be well advertised in advance so that the stakeholders will be fully engaged. • In the absence of higher levels of evidence and research, consider the use of the clinical experience and case studies/course studies. In response, CCGPP unanimously agreed to "resubmit the low back draft to stakeholders for comment on the 'user-friendly' status, format and for consideration of responses to stakeholder comments." The chiropractic profession, as well as all other stakeholders, will receive 45 days notice before release of this new draft and an additional 45 days to respond to the draft when it is released. Furthermore, CCGPP agreed to adopt the title "Chiropractic Clinical Compass" for the CCGPP Best Practice process and defined the process as follows: "The Chiropractic Clinical Compass, which is an iterative process, shall include but not be limited to the research literature synthesis and stratification, the application of and utilization of this process in practice, and the dissemination, implementation, evaluation, and revision process applied to the various aspects of our profession: to include the experiential, experimental and clinical orientation of practitioners in order to promote Best Practices and improve the quality of patient care within our profession." Mr. Russ Leonard, executive director of the Wisconsin Chiropractic Association, an outspoken critic of the initial CCGPP draft prefaced the COCSA vote by applauding the CCGPP's patient-centered model. "The willingness of CCGPP to consider this broad set of recommendations should be commended. This is a significant step towards producing a practice document that reflects a broad consensus within the profession. Should that occur, the chiropractic profession will take a giant leap forward in its ability to attract new patients to the profession". Similarly, Dr. Don Hirsh, President of the Maryland Chiropractic Association and one of the more vocal participants in the debate, praised those involved on both sides of the discussion for their professionalism and willingness to work together towards a common goal. COCSA President Dr. Jerry DeGrado applauded the efforts of everyone involved. "Our profession took a huge step forward. We did not circle the wagons but instead chose the high road and ended the weekend with mutual concessions and respect for one another. There were points throughout the weekend at which both sides had to agree to disagree, but we did not let those disagreements kill the spirit of unity or prevent us from reaching an acceptable conclusion. I have tremendous hope for the future of our great profession---that we can, even in the midst of disagreement, move forward." However, he warned, "We must be mindful that this is only the first chapter in the book, and the rest of our story is yet to be told. As the plot thickens, it is imperative that we continue to consider the destiny of the chiropractic profession and work together for the betterment of our chiropractic family. " Resolution on Proper Documentation and Record Keeping As a participating member of the OIG Task Force, COCSA approved the following resolution emphasizing COCSA's support of the OIG Task Force Action Plan. Other members of the Task Force are the Association of Chiropractic Colleges, the American Chiropractic Association, and the Federation of Chiropractic Licensing Boards: RESOLUTION ON DOCUMENTATION AND RECORKEEPING Whereas, the 2005 report from the US Office of Health and Human Services= Office of the Inspector General extrapolates from a review of records from 2001 that a number of chiropractic claims submitted to Medicare were flawed, and Whereas, the same report noted 2/3 of all chiropractic claims failed to document medical necessity, and Whereas, the public interest is best served by all health care providers maintaining accurate records of patient visits, including appropriate documentation of medial necessity; and Whereas, chiropractic state associations are empowered to provide appropriate training on documentation and recordkeeping practices for their member doctors of chiropractic, and Whereas, it is anticipated that chiropractic colleges may soon add documentation and recordkeeping to the chiropractic curriculum, and Whereas, it is anticipated that chiropractic licensing board may soon require approved continuing education in documentation and recordkeeping as a condition for relicensure; and Whereas, the Congress of Chiropractic State Associations (COCSA) is participating in the OIG Task Force with the Association of Chiropractic Colleges, the American Chiropractic Association, and the Federation of Chiropractic Licensing Board on developing appropriate documentation and recordkeeping curriculum; and Whereas, the OIG Task Force will also develop and offer "train the trainer" sessions to familiarize instructors on appropriate documentation and recordkeeping curricula; now therefore be it Resolved, that COCSA encourages member state associations to provide approved training seminars for their member doctors; and be it Further resolved, that COCSA will work with state associations to ensure proper training of their documentation and recordkeeping instructors, and be it Further resolved, that COCSA will continue to work with the OIG Task Force to represent the interests of all state associations to ensure that their member doctors develop proper documentation and recordkeeping practices. Focus on COCSA Programs COCSA leaders reviewed the successes of the past year and announced several new programs for 2007. Among those introduced were World Class Conferencing, CERV Team, the new National Backpack Safety Program offered in affiliation with Core Products, and the development of implementation kits for the Quit for Life smoking cessation program. During the Saturday luncheon, Yolanda Davis of Foot Levelers presented a $14,250 check to Drs. Steve Simonetti and Jerry DeGrado, representing state association use of the Foot Levelers Speakers Grant Program. Checks were also presented to COCSA from NCMIC, Eclipse/Chiromatic, and TPK Backsaver Wallet. Congress members also received an update on the advances and successes during the past year of the Straighten Up America program. Information on all these programs can be found on the COCSA website. COCSA's New Mission, Vision and Leaders During the planning meeting held earlier in the year, the COCSA board approved changes to its mission statement and adopted a vision statement. At the Baltimore meeting, the board presented and received unanimous approval from the COCSA membership for the following policy statements: Mission Statement: The mission of the Congress of Chiropractic State Associations is to provide an open, nonpartisan forum for the advancement of the chiropractic profession through service to member state associations. Vision Statement: The Congress of Chiropractic State Associations is the forum for unifying the profession and inspiring the achievement of universal understanding and utilization of chiropractic. Elected to lead the Congress in 2007 are: • President - Dr. Jerry DeGrado of Kansas • 1st Vice President - Dr. Jeff Fedorko of Ohio • 2nd Vice President - Dr. John Galbreath of Illinois • Treasurer - Dr. Kate Rufalo of Pennsylvania • Secretary – Dr. Walt Engle of Pennsylvania • Past President – Dr. Stephen Simonetti of New York • District 1 Director - Dr. Don Hirsh of Maryland • District 2 Director - Dr. Ken Hughes of Michigan • District 3 Director - Ms. Lili Montoya of Florida • District 4 Director - Dr. David Kassmeier of Nebraska • District 5 Director – Mr. Bill Howe of California • At Large Director – Ms. Kathy Chittom of Louisiana Dr. Kevin Donovan of Rhode Island, the outgoing Past President, was voted an Honorary Member of the Congress for his many years of service on the COCSA board. Several districts elected representatives to serve on the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). COCSA representatives to CCGPP for 2007 are: • District 1 – Dr. Tom Augat, Maine Chiropractic Association • District 2 – Dr. David Radford, Ohio State Chiropractic Association • District 3 – Dr. Robert Hayden, Georgia Chiropractic Association • District 4 – Dr. Jeff Askew, North Dakota Chiropractic Association • District 5 – vacant • At Large – Dr. Len Suiter, Missouri State Chiropractors Association. The next meeting of the Congress will be held on November 7-11, 2007 in Nashville, Tennessee. For additional information about the Congress, visit:

The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial