Challenges in Manufacturing Sector Emphasizes Need for Dramatic Reforms Plan Strikes Balance by Reducing Costs for Businesses and Increasing Benefits for Injured Workers Governor George E. Pataki today proposed a comprehensive plan to reform New York’s Workers’ Compensation system by reducing costs for businesses while increasing benefits for injured workers. The new measures proposed by the Governor would further improve New York’s business climate, expand the State’s job-creation efforts and keep New York business -- especially manufacturing-based business -- competitive in the global marketplace. The Governor’s plan would reduce Workers’ Compensation costs for businesses by more than 15 percent, while increasing benefit levels for injured workers by 25 percent. The new reforms come on top of the historic workers’ compensation reforms the Governor fought to achieve in 1996 that have already reduced costs by 25 percent on average. The Governor proposed a series of additional reforms to the workers’ compensation system in 2004, but the Legislature failed to act on them. “Whether it’s cutting taxes, eliminating unnecessary regulations or reducing workers’ compensation costs, we know that lowering the cost of doing business is a proven way to create new jobs and that’s exactly what we’ve done in New York during the past 11 years,” Governor Pataki said. “In 1996, we worked together to achieve historic and long overdue reforms to the Workers’ Compensation system, which have already reduced costs for businesses by 25 percent. But Workers’ Compensation is one of the biggest costs for businesses and if left unchecked can be an impediment to creating new jobs.” “We’re working hard to help manufacturing-based businesses, such as Delphi in Western New York, stay competitive in the global economy and protect thousands of New York jobs, and these new reforms mark another step in those efforts,” the Governor said. “These new reforms strike a balance between controlling costs for those who create jobs – businesses -- with the needs of workers who risk their health and safety to provide for their families and keep New York’s economy growing. “The time to act is now. I urge the Legislature to work with me to enact these important reforms so that we can help New York businesses better compete, protect tens of thousands of jobs across the State and ensure benefits for injured workers,” the Governor added. The Governor’s plan would reduce workers’ compensation costs for businesses by 15 percent by creating a system of tiered benefit levels for injuries that are not currently scheduled under the law, reducing litigation, better coordinating anti-fraud efforts and authorizing comprehensive fee schedules for medical goods and pharmaceuticals. It would also increase benefit levels for workers injured on and off the job, increasing the maximum weekly indemnity benefits paid to injured workers by 25 percent from $400 to $500 per week. Daniel Walsh, President of the Business Council of New York State said, “We welcome this new initiative by Governor Pataki to craft a comprehensive workers' compensation package which recognizes the many inequities in the current comp system. Taken as a whole, this initiative will help employers of all sizes and types, particularly those in New York's manufacturing community. We look forward to working with the Governor and the Legislature in a good faith effort to bring the comp system more in line with that of our competitor states.” Randy Wolken, President of the Manufacturing Association of Central New York said, “It is imperative that New York realizes the impact workers comp costs truly have on employers, and our competitiveness with other states. The recent premium increase particularly impacts manufacturers; with MACNY members reporting increases of 15-29% since October 1st. Last year closed without a resolution to New York’s workers comp crisis. Now, more than ever, it is crucial to resolve this issue, and move forward on meaningful reform. We look to work with the Governor, the Legislature, labor, and others on this crucial issue to preserve high-paying manufacturing jobs in New York.” Andrew J. Rudnick, President & CEO, Buffalo Niagara Partnership, said, “For upstate employers, especially in manufacturing, workers comp costs are a particularly heavy burden. The Governor's proposed reforms go a long way to relieve that burden, and increased investment and jobs should be a direct result.” Mark Alesse, New York State Director of the National Federation of Independent Business said, "Governor Pataki’s exciting new Workers’ Compensation reform bill is welcomed news for the state’s 1.5 million small businesses and their workers. If the Legislature passes this initiative, worker benefits will rise, and overall Workers Comp costs will drop, fostering new employment growth.” Workers’ Compensation Board Chairman David P. Wehner said, “These reforms strike a balance between controlling costs and the needs of workers --addressing the major concerns of both the business and labor community. The Governor clearly understands that while New York must support injured workers, we must also keep our economy strong. We can fulfill and balance these obligations without piling unnecessarily high workers’ compensation rates on our businesses.” The Governor’s plan generates savings of more than 15 percent by reducing frivolous claims against the Second Injury Fund, expanding the Alternate Dispute Resolution program to include the unionized manufacturing sector and by joining 37 other states that have created a system of tiered benefit levels for permanent partial disabilities. Specifically, the Governor’s proposed legislation also addresses the following issues: PROTECTING INJURED WORKERS ● - Authorizes the phasing in of the first workers’ compensation benefit increases for workers injured on-the-job and their beneficiaries in New York State since 1992. ● - Authorizes a 100 percent increase in the maximum disability benefit for workers injured off-the-job (Disability Benefits) from the current $170 maximum to a maximum of $340. ● - Enables workers to protect themselves better by allowing for supplemental benefits in amounts up to two-thirds of their average weekly wages. ● - Allows claimants to receive non-emergency medical procedures costing less than $1,000 without prior insurer authorization. Currently injured workers must seek authorization before any non-emergency procedure over $500. ● - Requires employers to file an injury report (C2) to their carrier within 3 business days of notification of injury and to the Board within 5 days. ● - Requires that carriers or self insured employers provide the injured workers the option of a Section 32 settlement agreement on all claims. ● - All claims that are unresolved within one year or controvert will be transferred to the expedited hearing calendar giving this claim a higher priority status. ● - Requests for discretionary Full Board Review (Appeals) must be filed within 30 days and imposes a fine of $500 on employers, carriers or claimant representative for filing frivolous appeals. ● - Requires the Board to schedule a pre-hearing conference within 45 days upon learning that a claim is disputed. ● - Expands the successful “payment without prejudice” provision to include prescription medicines. Under this program, insurers may provide benefits for up to one year while a case is litigated, without admitting liability. ● - Accelerates the delivery of benefits to injured workers by enhancing the conciliation process to lessen potentially lengthy litigation. REDUCING COSTS FOR EMPLOYERS ● - Reduces employer assessment for the Second Injury Fund by more than $190 million by adjusting the calculation used to determine the assessments from 150 percent of the previous year’s disbursements to 115 percent. ● - Expands the Alternate Dispute Resolution (ADR) program to include the unionized manufacturing sector. Currently only unionized construction can utilize this cost savings program that enables employers to reduce litigation and trim costs by resolving claims outside of the workers’ compensation system under rules that are collectively bargained. ● - Establishes a Pilot Program to encourage the voluntary delivery of compensation and medical benefits to injured workers without intervention by the Board, but subject to the Board’s supervision. ● - Enacts savings by creating a tiered system with regard to the duration of benefits for permanent partial disabilities (PPD). This system would provide for benefits to be coordinated with the severity of an individual’s disability. (An independent study of New York’s workers’ compensation system conducted in 2001 by the Workers’ Compensation Research Institute concluded that New York’s average indemnity cost per PPD claim is 110 percent above the median state.) ● - Establishes a medical committee to develop objective medical criteria for determining the level of impairment sustained by injured workers. • Reduces the assessment for the Second Injury Fund by initiating a $250 filing fee for carriers or businesses seeking reimbursement from the Fund, of which $200 is returnable if the carrier/employer is successful in its claim for reimbursement. ● - Directs the Chair of the Workers’ Compensation Board to adopt a schedule of maximum fees allowable for prescription medicines and durable goods such as prosthetic devices, and requires that generic medicinal equivalents be used whenever possible. ● - Deems ineligible for benefits, all persons incarcerated and convicted of a crime. ● - Enables carriers or self-insured employers to contract with a network or networks to perform diagnostic tests, x-ray examinations, MRI’s or radiological exams and require claimants to use facilities within that network (except in emergency cases), giving employers greater control over medical costs. ● - Amends the Executive Law, the Insurance Law, requiring the Workers’ Compensation Board Fraud Inspector General, the State Insurance Department’s Insurance Fraud Unit and the State Insurance Fund’s fraud investigations unit to work with increased collaboration, including quarterly meetings to coordinate enforcement efforts. Workers' compensation is a no-fault wage replacement and health care benefit system that serves workers who are injured on the job. Payments of benefits are the responsibility of the injured worker's employer who is required by law to obtain insurance or self-insure to cover the costs of workers' compensation benefits. The Workers’ Compensation Board maintains permanent jurisdiction over injured worker claims whether they are opened or closed.

Tarrytown, NY - “The NYS Board of Chiropractic and the Education Department are committed to the protection of the public and to the highest standards of professional services.” Cynthia Laks, Executive Secretary State Board of Chiropractic April 2004. On October 21, 2005, Dr H. William Wolfson, ACA NYS Metro Delegate addressed the Board regarding the abuses managed care companies have been perpetrating on the public and chiropractors in New York State. The American Chiropractic Association, the countries largest chiropractic organization has been taking managed care companies to task. The ACA has received numerous complaints from D.C.’s here and around the country about the abuses of managed care companies. The following is the text Dr. Wolfson read to the NYS Board. PRESENTATION TO THE NYSBC Mr. Chairman, Ms. Executive Secretary and Ladies and Gentleman of the Board, my name is Dr. H. William Wolfson. I have been a practicing doctor of chiropractic for the past 23 years and currently serve as the New York Metropolitan Delegate for the American Chiropractic Association. I am also President of the New York State Chiropractic Association, Suffolk County Chapter. I thank you for your time today and the opportunity to present what I believe are serious issues facing patients of chiropractors in New York State. Doctors of chiropractic in this state and doctors of chiropractic everywhere have an ethical obligation to practice in the best interest of their patients. I also realize this Board takes its responsibility to protect patients in this state very seriously. Permit me then to draw your attention to the activities of the ACN Group and other managed care companies. I request that this Board act and question the practices of this and other companies, as they directly affect patient care in this state. Over the course of the past several months, I have received repeated complaints and concerns from ACA and NYSCA members to the effect that ACN policies and procedures severely impact the doctors ability to provide quality patient care. I present to you the following: a letter of September 6, 2005 from the American Chiropractic Association to the New York State Department of Health outlining in specific terms the concerns and problems reported to the ACA in connection with ACN’s policies and practices. I would direct your specific attention to a copy of an August 3, 2005 letter sent to ACA’s General Counsel from the New York Chiropractic College. The College reviewed the criteria utilized by ACN in its administration of chiropractic services in New York. The startling conclusion of the College stated in part that “If NYCC were to use the ACN material above as a cornerstone for our educational process, we would need to significantly alter our curriculum, protocols, and practices and would expect to see a significant decline in positive patient outcomes”. Also included in ACA’s correspondence is a very detailed statistical analysis prepared by Dr. Jeffrey Simonoff-a professor of statistics at New York University. Dr. Simonoff, in commenting on his analysis, stated: “the [ACN] summary statistics certainly suggest that such [cost and visit-limiting controls] could be affecting practice by [in effect] truncating the number of visits from above.” In our opinion, Dr. Simonoff’s analysis supports the view that chiropractic services are artificially being reduced by ACN’s statistical maneuvering. Consequently, chiropractic benefits that have otherwise been promoted and paid for by employers-are being denied to the detriment of patient health and well being. I have personally spoken with case managers from ACN regarding patient treatment parameters and was told the average was less than seven visits per patient per year. It appears ACN has shifted the bell curve over time, consistently terminating those providers who don’t fall within their arbitrary statistics. As noted, my members have complained to the ACA, NYSCA and to my office stating that ACN has prevented patients from receiving needed chiropractic care by placing arbitrary numbers on allowed visits. My members have told me that they have written the same exact information on the required ACN forms for different patients and have received totally different authorizations for allowable visits. In my opinion and in the opinion of the ACA, utilization and treatment parameters as well as other criteria utilized by ACN are arbitrary, not based on the chiropractic principles taught by New York Chiropractic College and are not consistent with commonly accepted standards of care practiced in this State. Therefore, in our view, such parameters and criteria pose an improper interference with the doctor patient relationship and restrict necessary patient care. I would also like to submit for your consideration a letter of September 29, 2005 from the Federation of Chiropractic Licensing Boards to all Federation member boards. I would imagine that this Board may have already received this communication. But with your indulgence, I would like to make reference to several statements contained in the letter. In its letter, Dr. N. Edwin Weathersby writes on behalf of a unanimous Board of Directors, that managed care organization utilization criteria or payment policies “which interfere (or attempt to interfere) in a doctor’s ethical obligation to use sound chiropractic case management in the treatment of his or her patient, or otherwise seek to limit or to restrict the provision of needed chiropractic services, may constitute an inappropriate interference in the doctor patient relationship and pose a threat to safe, quality patient care.” The FCLB letter goes on to cite the previously mentioned conclusion of New York Chiropractic College and states: “If MCO guidelines require and/or restrict doctors to incorporate standards of care which are below those which are accepted in the profession and taught in our chiropractic colleges, then corrective actions should be undertaken”. Ladies and Gentleman of the Board and fellow colleagues, I would respectfully implore you to take that recommendation under consideration and continue to insure that the publics right to chiropractic care remains unimpeded. I urge the Board to assist the appropriate state regulatory authorities in protecting the publics right to access chiropractic care. I thank you for your time and thank you for continuing to protect the rights and best interests of chiropractic patients in the great State of New York.

ABSTRACT Effects of Recreational Physical Activity and Back Exercises on Low Back Pain and Psychological Distress: Findings From the UCLA Low Back Pain Study Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD and Chi Chiao, MS, PhD Objectives. We sought to estimate the effects of recreational physical activity and back exercises on low back pain, related disability, and psychological distress among patients randomized to chiropractic or medical care in a managed care setting. Methods. Low back pain patients (n=681) were randomized and followed for 18 months. Participation in recreational physical activities, use of back exercises, and low back pain, related disability, and psychological distress were measured at baseline, at 6 weeks, and at 6, 12, and 18 months. Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain, disability, and psychological distress. Results. Participation in recreational physical activities was inversely associated—both cross-sectionally and longitudinally—with low back pain, related disability, and psychological distress. By contrast, back exercise was positively associated—both cross-sectionally and longitudinally—with low back pain and related disability. Conclusions. These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health. October 2005, Vol 95, No. 10 | American Journal of Public Health 1817-1824 Eric L. Hurwitz is with the Department of Epidemiology, School of Public Health, University of California, Los Angeles, and the Southern California University of Health Sciences, Whittier. Hal Morgenstern is with the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor. Chi Chiao is with the Department of Community Health Sciences, School of Public Health, University of California, Los Angeles.

The Federal Employee Plan Benefit for 2006 has been updated. These updates include expanded chiropractic coverage under the Standard Option Plan. Previously under the Standard Option there was no benefit for spinal manipulation. Attached please find the details of the new 2006 benefit. Under the Standard Option, benefits may be provided for covered services in a Medically Underserved Area as long as they are within the scope of licensure. American Chiropractic Association Kara Murray Project Manager Office of Professional Development and Research 800.986.4636 ext. 242 703.243.2593 (fax)

October is Spinal Health Month, which offers an outstanding opportunity to speak with your local chiropractor about the natural ways you can improve your spinal health and enhance your overall well being. The American Chiropractic Association (ACA) is offering a free patient information page on its Web site, "Tips For a Healthy Spine," that provides simple posture, lifting, and healthy lifestyle guidelines to ward off unnecessary back pain. Visit http://www.acatoday.com. "The goal of a doctor of chiropractic is to offer the highest-quality, professional health care, while teaching patients how to maintain their physical well being and a healthful lifestyle," says ACA President Dr. Richard Brassard. "Spinal Health Month is the perfect time to take control of your health by discovering this natural approach to wellness." With a thorough knowledge of the structure and functioning of the human body, doctors of chiropractic make diagnoses and take steps to correct problems using manual therapies, such as spinal adjustments; dietary and lifestyle advice; and other such natural tools to care for their patients. In fact, medical doctors, realizing the important role doctors of chiropractic can play in relieving pain and restoring health, are referring more of their own patients to doctors of chiropractic than ever before. This integrative health care approach is allowing professionals of different specialties to work together to improve patients' health. Over 30 million Americans sought chiropractic care last year alone, and recent studies show that patient satisfaction is extremely high for those who seek care from a doctor of chiropractic. Surveys have also indicated that chiropractic patients are willing to recommend chiropractic treatment to friends, family and colleagues. Dr. Brassard notes that the key to spinal health is prevention; listen to your body's warning signals and adjust your lifestyle. The ACA recommends the following tips to help prevent back injuries. * Don't lift by bending over. Instead, bend your hips and knees and then squat to pick up an object. * Don't twist your body while lifting. * Push, rather than pull, when you must move heavy objects. * If you must sit for long periods, take frequent breaks and stretch. * Wear flat shoes or shoes with low heels. * Exercise regularly. An inactive lifestyle contributes to lower-back pain. According to Dr. Brassard, "It is essential that we keep ourselves in good physical condition, and spinal health is a key aspect of overall well being. You can achieve optimum health with the help of your doctor of chiropractic."

Childhood immunizations are under greater levels of scrutiny by the public. Media stories publicizing the possible link of autism to vaccinations have resulted in parental refusal of immunizations for their young children. A recent study of pediatricians' attitudes toward patients who question the need for childhood immunizations found that many pediatricians would prefer to discharge patients who did not comply with their recommendations. Click on the URL below for the rest of this story:

WellPoint, Inc. (NYSE: WLP) and WellChoice, Inc. (NYSE: WC) jointly announced today that they have signed a definitive merger agreement whereby WellChoice would operate as a wholly owned subsidiary of WellPoint. The transaction brings together WellChoice, the parent company of Empire Blue Cross Blue Shield, the largest health insurer in the State of New York, and WellPoint, the nation's leading health benefits company. The combined company will now serve more than 33 million medical members as a Blue Cross or Blue Cross Blue Shield licensee in 14 states and through its HealthLink and UniCare subsidiaries. "This merger brings together two very strong companies focused on providing consumers with the best possible value in health benefits," said Larry C. Glasscock, president and chief executive officer of WellPoint. "Additionally, both companies share the strength and tradition of the Blue Cross Blue Shield brand, one of the most trusted brands in America." "Our companies also share a vision of improving health care," Glasscock said. "Together, we can make that vision a reality by continually developing innovative products that meet customers' needs, by enabling consumers to make better informed health care decisions, and by working collaboratively with hospitals and physicians to improve quality and safety. In doing so, we will help hold down the rising cost of health care." "While premiums must keep pace with rising health care costs, we can assure our members in all of our states that this merger will not add in any way to premium increases," Glasscock added. "Both WellPoint and WellChoice have strong track records of reducing administrative costs while improving customer satisfaction. The synergies we can achieve through this merger, along with the ability to spread administrative costs over a larger membership base, will contribute to our ongoing efforts to keep premiums affordable for customers. Because both WellChoice and WellPoint believe that all health care is local, our merger provides that WellChoice customers will continue to be served by the same local health plan they know today, with decisions made by local management based in New York City." After the close of the transaction, Michael Stocker, M.D., president and chief executive officer of WellChoice, will become president and chief executive officer of a newly combined Northeast Region of WellPoint. As such, Dr. Stocker will have responsibility for business operations in New York, Connecticut, New Hampshire and Maine. He will serve on WellPoint's Executive Leadership Team and report directly to Glasscock. The headquarters for the Northeast Region will be located in lower Manhattan. "This transaction serves the best interests of all our important constituencies and we are very pleased to become part of an enterprise that shares our vision and focus on quality health care at an affordable price," said Dr. Stocker. "Our customers will experience no disruption, and there will be no changes in our networks or benefits as a result of the merger. When combined, our companies will be ideally positioned to promote preventative health care, to engage consumers in maintaining their own good health, and to make the investments necessary to lead positive change in our country's health care system. At the same time, we will be able to draw upon the resources of the nation's leading health benefits company to serve our customers even better." Glasscock added, "It is more important today than ever before for companies to be socially responsible and actively involved in helping make their communities better places to live and work. Both WellChoice and WellPoint have long histories of significant charitable contributions and community involvement, and combined, our role in the community will be even more effective." The merger will strengthen WellPoint's leadership in providing health benefits to National Accounts - large employers with multi-state operations. New York City is the headquarters of more Fortune 500 companies than any other U.S. city, and the merger gives WellPoint a strategic presence in this important market. Both companies have achieved growth among large national employers, building on the strength of the Blue brand and its broad national networks of physicians and hospitals. With Blue plans in 14 states, the combined company can offer large national employers leading local presence in more markets than any other health benefits company. The merger will also enhance the combined company's ability to offer consumer-driven health solutions, which are a growing choice of consumers and employers alike. In June, WellPoint acquired Lumenos, a pioneer and leader in consumer-driven health plans, and WellChoice has incorporated Lumenos technology into its Empire Total Blue consumer-driven product. "Our recent acquisition of Lumenos, combined with WellChoice's successful deployment of Lumenos features in Empire Total Blue, will allow us to immediately offer Lumenos' full product line to new and existing National Accounts headquartered in WellChoice's service area," Glasscock said. Both companies believe that maintaining a strong local presence is very important in the delivery of health benefits, and that philosophy will continue with the merger. In addition, opportunities for professional growth could be created for employees of both WellPoint and WellChoice as a result of the merger. This transaction is expected to be neutral to 2006 earnings per share and accretive thereafter. At least $25 million in pre-tax synergies are expected to be realized in 2006 and approximately $50 million in 2007, with annual pre- tax synergies of at least $125 million expected to be fully realized on an annual basis by 2010. The transaction is structured as a merger of WellChoice, Inc. with a wholly owned subsidiary of WellPoint and is intended to be tax free with respect to the WellPoint stock to be received in the transaction by WellChoice stockholders. The consideration of $77.23 per share to be received by the stockholders of WellChoice will be comprised of $38.25 in cash and WellPoint stock at a fixed exchange ratio of .5191 of a share of WellPoint stock for each share of WellChoice stock (valued at $38.98 per share at the market close on September 26, 2005). The transaction will be accounted for under the purchase method of accounting. The New York Public Asset Fund, which currently owns approximately 52 million shares of WellChoice common stock, will receive approximately $1.989 billion in cash and approximately 27 million shares of WellPoint common stock from the merger based on Monday's closing stock price. The New York Public Asset Fund has agreed to vote its shares, representing approximately 62% of the outstanding shares of WellChoice, Inc., in favor of the transaction. The transaction will be subject to customary closing conditions, including approval of WellChoice's stockholders and various regulatory approvals. WellPoint and WellChoice currently expect the transaction to close in the first quarter of 2006.

The report in support of alternative therapies, such as chiropractic manipulations is to be sent to ministers (in London) in October. This study would report on money-saving benefits of complementary medicine if offered by the National Health Service (NHS) as standard. A study by research firm, Fresh Minds, which had been hired by Princes Charles, an enthusiast for complementary therapies, suggest that savings of between £500m and £3.5bn could be achieved by offering spinal manipulation therapies, such as chiropractic. If general practitioners (GP) offer homeopathy as an alternative to standard drugs up to 10% could be cut from the prescription drugs’ bill, totaling nearly £480m, the report emphasize.

Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women John P. Forman*; Meir J. Stampfer; and Gary C. Curhan Abstract Acetaminophen, ibuprofen, and aspirin are the most commonly used drugs in the United States. Although the frequency of their use has been associated with hypertension, prospective data examining the dose of these drugs and risk of hypertension are lacking. Furthermore, whether certain indications for analgesic use, particularly headache, mediate the association is unclear. We conducted 2 prospective cohort studies among older women 51 to 77 years of age (n=1903) from the Nurses’ Health Study I and younger women 34 to 53 years of age (n=3220) from the Nurses’ Health Study II who completed detailed supplemental questionnaires pertaining to their analgesic use and who did not have hypertension at baseline. We analyzed incident hypertension according to categories of average daily dose of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin. Information on indications for analgesic use as well as relevant confounders was also gathered prospectively. Compared with women who did not use acetaminophen, the multivariable adjusted relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women and 1.99 (1.39 to 2.85) among younger women. For nonsteroidal anti-inflammatory drugs, similar comparisons yielded multivariable relative risks of 1.78 (1.21 to 2.61) among older women and 1.60 (1.10 to 2.32) among younger women. These associations remained significant among women who did not report headache. Aspirin dose was not significantly associated with hypertension. Higher daily doses of acetaminophen and nonsteroidal anti-inflammatory drugs independently increase the risk of hypertension in women. Because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they may contribute to the high prevalence of hypertension in the United States. From the Renal Division (J.P.F., G.C.C.), Department of Medicine, Brigham and Women’s Hospital, Boston, Mass; Channing Laboratory (J.P.F., M.J.S., G.C.C.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and Department of Epidemiology (J.P.F., M.J.S., G.C.C.), Harvard School of Public Health, Boston, Mass. Hypertension published August 15, 2005, 0.1161/01.HYP.0000177437.07240.70

ABSTRACT Background: Ad libitum, low-carbohydrate diets decrease caloric intake and cause weight loss. It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake. Objective: We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake. Design: Appetite, caloric intake, body weight, and fat mass were measured in 19 subjects placed sequentially on the following diets: a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk. Blood was sampled frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve (AUC) for insulin, leptin, and ghrelin. Results: Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC. Mean (±SE) spontaneous energy intake decreased by 441 ± 63 kcal/d, body weight decreased by 4.9 ± 0.5 kg, and fat mass decreased by 3.7 ± 0.4 kg with the ad libitum, high-protein diet, despite a significantly decreased leptin AUC and increased ghrelin AUC. Conclusions: An increase in dietary protein from 15% to 30% of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss. This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets. American Journal of Clinical Nutrition, Vol. 82, No. 1, 41-48, July 2005 © 2005 American Society for Clinical Nutrition

Effect of Soybean Protein on Blood Pressure: A Randomized, Controlled Trial Jiang He, MD, PhD; Dongfeng Gu, MD, MS; Xigui Wu, MD; Jichun Chen, MSc; Xiufang Duan, MD; Jing Chen, MD, MSc; and Paul K. Whelton, MD, MSc ABSTRACT Background: Objective: Design: Setting: Patients: Intervention: Measurements: Results: Limitations: Conclusions:

ABSTRACT Objective. Each year, children die from heat stroke after being left unattended in motor vehicles. In 2003, the total was 42, up from a national average of 29 for the past 5 years. Previous studies found that on days when ambient temperatures exceeded 86°F, the internal temperatures of the vehicle quickly reached 134 to 154°F. We were interested to know whether similarly high temperatures occurred on clear sunny days with more moderate temperatures. The objective of this study was to evaluate the degree of temperature rise and rate of rise in similar and lower ambient temperatures. In addition, we evaluated the effect of having windows "cracked" open. Methods. . In this observational study, temperature rise was measured continuously over a 60-minute period in a dark sedan on 16 different clear sunny days with ambient temperatures ranging from 72 to 96°F. On 2 of these days, additional measurements were made with the windows opened 1.5 inches. Analysis of variance was used to compare how quickly the internal vehicle temperature rose and to compare temperature rise when windows were cracked open 1.5 inches. Results. . Regardless of the outside ambient temperature, the rate of temperature rise inside the vehicle was not significantly different. The average mean increase was 3.2°F per 5-minute interval, with 80% of the temperature rise occurring during the first 30 minutes. The final temperature of the vehicle depended on the starting ambient temperature, but even at the coolest ambient temperature, internal temperatures reached 117°F. On average, there was an 40°F increase in internal temperature for ambient temperatures spanning 72 to 96°F. Cracking windows open did not decrease the rate of temperature rise in the vehicle (closed: 3.4°F per 5 minutes; opened: 3.1°F per 5 minutes or the final maximum internal temperature. Conclusions. Even at relatively cool ambient temperatures, the temperature rise in vehicles is significant on clear, sunny days and puts infants at risk for hyperthermia. Vehicles heat up rapidly, with the majority of the temperature rise occurring within the first 15 to 30 minutes. Leaving the windows opened slightly does not significantly slow the heating process or decrease the maximum temperature attained. Increased public awareness and parental education of heat rise in motor vehicles may reduce the incidence of hyperthermia death and improve child passenger safety. To read the full report click on the link below. Full Text PEDIATRICS Vol. 116 No. 1 July 2005, pp. e109-e112

Abstract (provisional) Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractic as a primary care provider. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractic as a portal-of-entry provider, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles which would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession. © 2005 Nelson et al., licensee BioMed Central Ltd. Chiropractic & Osteopathy 2005, 13:9 doi:10.1186/1746-1340-13-9 Read the full version by clicking on the link below.

A new study funded by the Canadian Institute for Health Information’s Canadian Population Health Initiative shows that Old Order Mennonite children from Ontario living a similar lifestyle to that of previous generations tend to be fitter, stronger and leaner than children living a contemporary Canadian lifestyle—this despite the fact they do not have physical education classes and do not participate in organized sports. New analyses by obesity expert Dr. Mark S. Tremblay and a group of researchers from the University of Saskatchewan and University of Lethbridge found a strong link between contemporary lifestyles in Canadian children and reduced physical activity and fitness. “What this study proves is that you don’t need to do triathlons to stay fit and active,” says Dr. Tremblay, a Professor of Kinesiology at the University of Saskatchewan. “Children living traditional lifestyles have exercise embedded in their daily lives. In contrast, today’s children engage more in passive activities, such as video games. This may go a long way in explaining why they are less physically fit.” The study found that Old Order Mennonite children, on average, do up to 18 minutes more moderate or vigorous physical activity a day than urban and rural contemporary children. Researchers estimate that, all else being equal, this translates into a caloric difference between the Old Order Mennonite children and children living a contemporary lifestyle of approximately 15,000 kcal per year—or over 40 pounds of fat per person, per decade. The Old Order Mennonite children in the study also had leaner triceps than urban Saskatchewan children, a greater aerobic fitness score than rural Saskatchewan children, and greater grip strength than both rural and urban Saskatchewan children. These findings were true for girls and boys. Researchers attribute the Old Order Mennonite children’s strength and fitness to the fact they get a great deal of physical activity through walking, traditional farming activities and household chores. “Since obesity can lead to life-long health problems, including diabetes and heart disease, it may well be worthwhile to look at how aspects of modern lifestyles may contribute to childhood obesity,” says Lisa Sullivan, Manager of Research and Policy at the Canadian Population Health Initiative. “This research gives us a unique glimpse into the past that may help to explain the rising rates of obesity over the past few decades.” Approximately 30% of all the children in the study were classified as overweight—a figure that is consistent with nationally representative data. Methodology A cross-sectional study design was used to examine physical fitness and activity characteristics of three groups of children aged 8 to 13: Old Order Mennonite children from Ontario; Urban Saskatchewan children; and Rural Saskatchewan children. The data collection for this study took place from September to December 2002. Researchers assessed fitness by collecting height, weight, triceps skin fold, grip strength, push-ups, partial curl-ups and aerobic fitness measurements. Also, physical activity levels were measured for seven consecutive days using an accelerometer—an instrument that measures the intensity of body acceleration—and estimated from a self-reported physical activity questionnaire for older children. Canadian Population Health Initiative The Canadian Population Health Initiative (CPHI), which is part of the Canadian Institute for Health Information (CIHI), funded the research described in this media release. CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities. Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information (CIHI) is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI’s mandate, as established by Canada’s health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health. Media contacts: Leona Hollingsworth (613) 241-7860, Ext. 4140 Cell: (613) 612-3915

Today we celebrate the 229th birthday of the United States of America. On July 4, 1776, the Second Continental Congress unanimously adopted the Declaration of Independence, as we claimed our independence from Britain. On behalf of the NYSCA’s Officers, we want to wish you and your family a Happy 4th of July. To celebrate 4th of July with your own fire works show, click on the “Fire Works” below. Fire Works Also, examine the US Constitution by clicking on this link.

YONKERS, N.Y., -- Alternative medicine is no longer truly alternative. A Consumer Reports survey of more than 34,000 readers reveals that many people have tried it, and more and more doctors are recommending it. Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments, including prescription drugs, by readers with back pain. (Readers said it also provided relief for neck pain, but neck manipulation can be risky and is not recommended by CR.) Deep-tissue massage was found to be especially effective in treating osteoarthritis and fibromyalgia. While readers suffering from back pain deemed acupuncture and acupressure less effective than chiropractic and massage, one-fourth of readers who had tried these therapies said they helped them feel much better. Of all the hands-on alternative therapies, acupuncture has the most scientific support. Readers also reported good results for exercise, not only for conditions such as back pain, but also for allergies and other respiratory ills, anxiety, rheumatoid arthritis, high blood pressure, high cholesterol, depression, insomnia, and prostate problems. Those results are consistent with a broad range of clinical studies of treatments for all of these conditions except allergies and respiratory ailments. On the other hand, well-known, heavily promoted herbal treatments such as echinacea, St. John's wort, saw palmetto, melatonin, and glucosamine and chondroitin didn't work as well for readers. Readers reported that alternative treatments were far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. Interpreting these results of the reader survey is somewhat difficult because the U.S. regulates alternative and conventional medicines differently. Federal laws ensure that a bottle of prescription or over-the-counter pills contains the amount and kind of medicine stated on the label, and dosages are standardized, but no such standards apply to dietary supplements. Moreover, there are no standard recommended dosages. Treating symptoms of menopause A separate Consumer Reports survey of 10,042 women who had gone through menopause or were experiencing it found that a large minority of women have turned from hormone replacement, which can be risky, to black cohosh, soy supplements, and vitamin E for relief from hot flashes. However, those alternatives were far less effective. Sixty percent of respondents who took estrogen plus progestin said it helped them feel much better, as did 53 percent of those who took estrogen by itself. The botanicals scored far lower. Black cohosh was typical. It helped 17 percent of women feel much better, but 51 percent said it did nothing at all. Some, but not all, studies have found that black cohosh is modestly helpful against hot flashes and night sweats. However, its long-term safety has not been studied. Most studies of soy supplements have suggested that they're not very helpful, and breast-cancer patients should talk with their doctor before taking large amounts of soy. For other supplements, studies show little or no evidence of benefit. For specific, free advice on how to choose an alternative treatment, visit ConsumerReports.org during the month of July. In general, CR recommends the following: -- Ask your doctor. Many doctors will refer patients to preferred alternative practitioners. And your doctor may be able to steer you away from potentially hazardous alternative treatments. -- Do your own research. Objective online references include the National Center for Complementary and Alternative Medicine (nccam.nih.gov), part of the U.S. National Institutes of Health; Medline Plus (medlineplus.gov), for plain-language medical information; and Consumer Reports Medical Guide (ConsumerReportsMedicalGuide.org), which rates treatments, including alternative treatments, for several dozen common conditions. It costs $24 per year or $4.95 per month; the others are free. -- Consult other reliable sources. If your doctor doesn't have a referral list of practitioners, check with a local hospital or medical school. You can also turn to national professional organizations, many of which have geographic search functions on their Web sites. -- Check your health plan. Many cover some alternative therapies. -- Check the practitioner's credentials. Make sure your practitioner has the proper license, if applicable, or check for membership in professional associations, which require minimum levels of education and experience. Some also make practitioners pass an exam. The August 2005 issue of Consumer Reports is on sale now wherever magazines are sold. To subscribe, call 1-800-765-1845.

Abstract: Ambulatory Care Visits for Treating Adverse Drug Effects in the United States, 1995–2001: Zhan, Chunliu; Arispe, Irma; Kelley, Edward; Ding, Tina; Burt, Catharine W.; Shinogle, Judith; Stryer, Daniel Background:: Adverse drug events (ADEs) are a well-recognized patient safety concern, but their magnitude is unknown. Ambulatory visits for treating adverse drug effects (VADEs) as recorded in national surveys offer an alternative way to estimate the national prevalence of ADEs because each VADE indicates that an ADE occurred and was serious enough to require care. Methods: A nationally representative sample of visits to physician offices, hospital outpatient departments, and emergency departments was analyzed. VADEs were identified as the first-listed cause of injury. Results: In 2001, there were 4.3 million VADEs in the United States, averaging 15 visits per 1,000 population. VADE rates at physician offices, hospital outpatient departments, and hospital emergency departments were at 3.7, 3.4, and 7.3 per 1,000 visits, respectively. There was an upward trend in the total number of VADEs from 1995 to 2001 (p < .05), but the increases in VADEs per 1,000 visits and per 1,000 population were not statistically significant. VADEs were lower in children younger than 15 and higher in the elderly aged 65–74 than in adults aged 25–44 (p < .01) and were more frequent in females than in males (p < .05). Discussion: Although methodologically conservative, the study suggests that ADEs are a significant threat to patient safety in the United States. Joint Commission Journal on Quality and Patient Safety, July 2005, vol. 31, no. 7, pp. 372-378(7)

New study confirms conclusions from earlier studies linking sleep disorders and inattention in children. Children who snore may be at greater risk of becoming hyperactive later in life than those who sleep quietly. The study, published in the journal Sleep, corroborate earlier conclusions linking sleep disorders and hyperactivity, with snoring coming first followed by hyperactivity. ABSTRACT Autonomic Dysfunction in Children with Sleep-Disordered Breathing Louise M. O’Brien, PhD; David Gozal, MD - Kosair Children’s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY Study Objectives: To measure sympathetic responses in children with and without sleep-disordered breathing. Design: Prospective, observational study. Setting: Kosair Children’s Hospital Sleep Medicine and Apnea Center. Participants: Subjects were prospectively recruited from children undergoing overnight polysomnographic assessments and were retrospectively grouped according to the results of the polysomnogram. Sleep-disordered breathing was defined as an apnea-hypopnea index >5 and children were assigned to the control group if their apnea-hypopnea index was < 1. Intervention: N/A. Measurements and Results: During quiet wakefulness, pulse arterial tonometry was used to assess changes in sympathetic activity following vital capacity sighs in 28 children with sleep-disordered breathing and 29 controls. Each child underwent a series of 3 sighs, and the average maximal pulse arterial tonometry signal attenuation was calculated. Further, a cold pressor test was conducted in a subset of 14 children with sleep-disordered breathing and 14 controls. The left hand was immersed in ice cold water for 30 seconds while right-hand pulse arterial tonometry signal was continuously monitored during immersion and 20-minute recovery periods. Signal amplitude changes were expressed as percentage change from corresponding baseline. Results: The magnitude of sympathetic discharge-induced attenuation of pulse arterial tonometry signal was significantly increased in children with sleep-disordered breathing during sigh maneuvers (74.1%±10.7% change compared with 59.2%±13.2% change in controls; P<.0001) and the cold pressor test (83.5%±7.3% change compared with 74.1%±11.4% change in controls; P=.039). Further, recovery kinetics in control children were faster than those of children with sleep-disordered breathing. Conclusion: Children with sleep-disordered breathing have altered autonomic nervous system regulation as evidenced by increased sympathetic vascular reactivity during wakefulness. Journal SLEEP Volume 28/ Issue 6, June 1, 2005, Pages 747-752