The National Board of Chiropractic Examiners (NBCE) reports on the latest events at NBCE. The National Board of Chiropractic Examiners (NBCE) hosted a number of meetings including registrars from chiropractic colleges across the United States, and Part IV Examiners and Administrators Workshop. To view the full report click on the link below.

Seneca Falls: David Odiorne, M.S., D.C. has been appointed to the position of Executive Director of Institutional Quality and Assessment (IQA) at New York Chiropractic College after an extensive national search. Dr. Odiorne has been serving as Chief of Staff to the President of Bastyr University in Seattle, Washington. Prior to that, he spent four years as Provost and Executive Vice President for Academic Affairs at National College of Natural Medicine in Portland, Oregon. He also previously held appointments as Vice President for Academic Affairs and as Dean of Clinics at National University of Health Sciences in Lombard, Illinois. Odiorne received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1981, and his Master of Science in Educational Administration from the University of Southern Maine. Prior to embarking on his career in higher education, Odiorne spent fourteen years in private practice as a chiropractor in Lewiston, Maine. He served as president of the Maine Chiropractic Association and was honored as “Chiropractor of the Year in 1992.” In his position as Executive Director of IQA, Odiorne will be responsible for the supervision of institutional strategic planning, accreditation activities and all assessment and quality initiatives for the College.

Did you know that the Employee Retirement Income Security Act (ERISA) governs nearly 2.5 million health benefit plans nationwide? In total, these plans provide health care benefits to 134 million Americans. The far-reaching nature of ERISA regulations is important because these regulations have very specific requirements aimed at ensuring fair treatment to the beneficiary. ERISA regulations require a timely response from the insurer, delineate standards of claims decisions, and require the insurer to disclose detailed information regarding any adverse determinations. It is important to familiarize yourself with these regulations so you can assist your patients in ensuring their health plan is following ERISA regulations, if applicable. ACA has updated and simplified the information available for members regarding ERISA. Please take time today to have your staff review this information and think about whether you have any patients that might qualify for and benefit from an ERISA appeal. This resource can be found at:

After an intensive joint lobbying campaign by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC), Congress has once again affirmed its desire to ensure accessibility of chiropractic care within the military and has ordered the Pentagon to expand the availability of chiropractic services to 11 additional military bases.

The U.S. Health Resources and Services Administration (HRSA) has awarded a grant for $310,479 to the Palmer Center for Chiropractic Research (PCCR) to establish a practice-based research network to assess complementary and alternative medicine models of pain management. This is a collaborative research project, with Palmer sub-contracting half of the grant amount ($155,239) to the Jefferson-Myrna Brind Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia, Pa. The purpose of this collaborative, multi-disciplinary effort is to develop the infrastructure for a comprehensive descriptive database for a variety of pain management approaches, to test data collection protocols, and to establish a network of participating practices, clinicians and patient populations.

BLOOMINGTON, Minn. – Northwestern Health Sciences University hosted a site visit by the National Center for Complementary and Alternative Medicine (NCCAM) on July 30. The purpose of the visit was to assess progress of the CAM Research Education Project, which is funded by the National Center for Complementary and Alternative Medicine (National Institutes of Health) for $750,000. The aim of the project is to help integrate research into student education at the University. Northwestern has teamed up with the University of Minnesota to manage the project. Prior to the site visit, Northwestern’s CAM Research Education Project team was required to submit a progress report to the funding agency. A successful site visit, along with a progress report demonstrating satisfactory achievement of proposed activities, is necessary to receive continued funding for another three years. The program officer recommended that the project be approved for continued funding. Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 900 students on a 25-acre campus in Bloomington, Minnesota.

BLOOMINGTON, Minn. –Northwestern Health Sciences University has invested in new technology to expand educational resources for students and professors. Mediasite is a presentation capture system that provides an easy, reliable way to record presentations or class lectures. The presentations then get archived and can be viewed by students on demand via computer or iPod. Northwestern is using this technology to improve educational resources for students. Students will be able to attend class and listen to the lecture, simply letting the information soak in – the lecture will be available for online viewing; rewinding, fast-forwarding and pausing. Powerpoint slides and videos from lecture will also be available. Northwestern is committed to keeping up to date on student learning styles. According to Charles Sawyer, DC, senior vice president and provost, “Students today need to be taught differently than students 20 years ago. We need to keep up with them. One way to go about that is by providing them with an online resource for learning.” “I find Mediasite very useful,” explains Jamie Cortese, a T6 chiropractic student. “I use it to access the lectures and make sure that I got all the information; let’s be honest, there are times when your mind wanders and you miss a part of a lecture. With Mediasite I am able to hold myself more accountable. I also like to use it to review lectures before tests. It’s nice to know that our teachers really want us to succeed and are willing to do everything they can to help us.” Northwestern intends to use Mediasite for multiple purposes including continuing education, admissions, development, clinic tutorials and fundraising. What is the technology behind Mediasite? A mini-DV camera is hooked up to the Mediasite capture card device which is connected to a computer or laptop in the classroom. Another capture card is set up to capture the PowerPoint slides. The information is coded, and within minutes of the lecture being completed, the lecture is ready to deploy to Windows Media Player. Macintosh computers need some additional set up installations for the lectures to run, but PCs do not. “Mediasite has several benefits, and I think the benefits outweigh the disadvantages,” says Anita Manne, BS, DC, DACBR, a professor in Northwestern College of Chiropractic. “It gives students an alternative way to learn; gives them added flexibility; it is a great review tool; and helps students to make up classes that they were unable to attend.” Mediasite is an exciting technology that gives students the opportunity to learn anytime, anywhere. With student lives as busy as they are today, Northwestern has found a way to keep up with their students, and to create a learning environment that is technologically on par with their students. According to Dr. Sawyer, “Mediasite will enrich the educational experience our students receive.” Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 900 students on a 25-acre campus in Bloomington, Minnesota.

Acting Surgeon General Steven K. Galson, M.D., M.P.H., today issued a Call to Action to reduce the number of cases of deep vein thrombosis and pulmonary embolism in the United States. Galson urged all Americans to learn about and prevent these treatable conditions. Deep vein thrombosis and pulmonary embolism affect an estimated 350,000 to 600,000 Americans each year, and the numbers are expected to increase as the U.S. population ages. Together, deep vein thrombosis and pulmonary embolism contribute to at least 100,000 deaths each year. Deep vein thrombosis is a blood clot in a deep vein, most commonly in the lower leg or thigh. The clot can block blood flow and cause pain, swelling, and skin discoloration. In the most serious cases, deep vein thrombosis can lead to a pulmonary embolism — when part of the blood clot breaks loose and travels through the bloodstream to the lungs, where it can block a lung artery, causing damage to the lungs or other organs from lack of oxygen. "Deep vein thrombosis and pulmonary embolisms are often 'silent' conditions — they can occur suddenly and without symptoms," Galson said. "But we have made a lot of progress in understanding how these disorders develop and how to prevent, diagnose, and treat them. It's time to put this knowledge into action." Researchers have found that in most cases, deep vein thrombosis and pulmonary embolism develops in people who have an inherited blood clotting disorder or other risk factor, and who experience a triggering event. "Being hospitalized or confined to bed rest, having major surgery, suffering a trauma, or traveling for several hours can increase a person’s risk of deep vein thrombosis and pulmonary embolism," Galson said. “We want to increase the awareness and knowledge of these potentially deadly conditions and encourage patients and health care providers to take the steps to prevent them." The Call to Action urges a coordinated, multifaceted plan to reduce the numbers of cases of deep vein thrombosis and pulmonary embolism nationwide. The plan emphasizes the need for: Increased awareness about deep vein thrombosis and pulmonary embolism. Evidence-based practices for deep vein thrombosis. More research on the causes, prevention, and treatment of deep vein thrombosis. The Call to Action resulted from a Surgeon General’s Workshop on Deep Vein Thrombosis which was convened in May 2006. The workshop was co-sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. "Deep vein thrombosis and pulmonary embolism are major public health problems, and NHLBI is committed to continuing to support important basic and clinical research to advance our understanding of these disabling and potentially fatal conditions," NHLBI Director Elizabeth G. Nabel, M.D., noted. "Research is shedding light on genetic factors and the role of triggering events, behaviors, and conditions that increase the risk of developing dangerous blood clots. It is imperative that clinicians and public health experts work together to translate this scientific evidence to save lives." The Agency for Healthcare Research and Quality (AHRQ) contributed to the Call to Action with the release of two new guides — one for patients and another for health care providers — on how to prevent dangerous blood clots. “Fighting deep vein thrombosis and pulmonary embolism is a team effort that involves health care providers and patients,” said AHRQ Director Carolyn M. Clancy, M.D. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism 2008, is available at:

The most recent ABN released by the Centers for Medicare and Medicaid Services (CMS) was published in March 2008 and was previously required for use by Sept. 1, 2008. The date for implementation has now changed. The new ABN form is mandatory for use by March 1, 2009. Among other changes, the new form may be used for non-covered services, or anything that is NOT spinal CMT (CPT codes 98940, 98941, 98942). This includes exams, modalities, x-rays, labs, etc. This version of the ABN will also eliminate the need for the previous Notice of Exclusion from Medicare Benefits (NEMB) form, which was considered OPTIONAL by CMS. For more information, visit the ABN portion of the ACA Web site at: additional ABN information

Department of Banking and Insurance (DOBI) Commissioner Steven M. Goldman today announced that Health Net of New Jersey has paid $26 million in restitution and interest covering 88,000 New Jersey members to compensate them due to under-reimbursements for out-of-network services over more than a decade. These payments have already been issued to the affected New Jersey members. Health Net waived its right to a hearing and has agreed to resolve the matter with the payment of $14 million in unpaid claims, $12 million in interest on those claims, $2 million in examination fees and a record $13 million fine, for a total of $41 million. “Health Net dramatically underpaid claims to New Jerseyans to reimburse them for out-of-network health care services,” said DOBI Commissioner Goldman. “I’m pleased that we were able to obtain the return of this money to Health Net’s New Jersey members, together with interest, since this is what Health Net promised to pay but had not. The fine represents an appropriate penalty for this improper business practice.” The actions are the result of a 21 month examination into claims paid by Health Net, of Shelton, CT., and its predecessors, First Option Health Plan of New Jersey and Physicians Health Services of New Jersey, for out-of-network service to persons covered in New Jersey between 1996 to 2006. Health Net’s vendors for chiropractic services and for mental health services also made underpayments. Health Net cooperated with the investigation. The Department first became aware of the problem in 2002 through a consumer complaint. DOBI investigated and in December 2002 settled with Health Net for more than $800,000 in restitution to more than 4,700 Health Net members for underpayments. At that time Health Net represented that the underpayments occurred only from July 2001 through October 2002. In 2005, the Department learned that Health Net’s underpayments had begun earlier than it had previously disclosed. By the end of 2005, DOBI decided to conduct an examination of Health Net that concluded in May of this year with the finding that Health Net and its predecessors made underpayments of out-of-network medical claims from 1996 to 2005 and of out-of-network dental claims, mental health claims and chiropractic claims from 1999 to 2006. Health Net has acknowledged its responsibility to comply with all applicable laws, and has overhauled the systems and practices that led to its misconduct. The Department will continue to monitor the company for compliance. “Today’s announcement highlights DOBI’s commitment to protecting New Jersey consumers,” said DOBI Insurance Director Donald Bryan. “The Department’s mission to help consumers exists not only in the very important healthcare insurance sector, but in all financial services industries DOBI regulates.” To view the Consent Order E08-71 click on the link below:

BLOOMINGTON, Minn. – Construction for the new Standard Process Healing Garden at Northwestern Health Sciences University began at the beginning of July, 2008. Standard Process made a generous donation of $250,000 to underwrite this creation, which will be approximately 11,000 square feet. The garden is scheduled to be completed in the Fall of 2008. The Healing Garden, planned by MOM’s Landscaping and Design of Shakopee, Minn., will be a central place for students, staff, faculty and alumni to enjoy. The garden will feature a variety of unique design elements including: “rooms” intended as gathering places; themed sensory gardens planted with perennials; and four basalt columns representing the four foundational elements of the University mission and the four academic programs. Naming opportunities in the garden, as memorials or in recognition of donors, will be available as well. Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 1,000 students on a 25-acre campus in Bloomington, Minnesota.

BLOOMINGTON, Minn. – The College of Chiropractic at Northwestern Health Sciences University graduated 27 students on Aug. 1, 2008. The University presented 29 doctor of chiropractic degrees as well as nine bachelor of science degrees. Jason Scott Flaskey was named valedictorian. The commencement address was delivered by James. R. Brandt, DC, president of the American Academy of Chiropractic Orthopedists. Jeremy J. Nelson and Lynn M. Sandom, members of the graduating class, gave the student greeting. The presidential greeting was delivered by Mark Zeigler, DC, president of Northwestern. Graduating students hailed from seven states and one Canadian province. Northwestern Health Sciences University offers a wide array of choices in natural health care education including chiropractic, Oriental medicine, acupuncture, therapeutic massage and human biology. The University has nearly 1,000 students on a 25-acre campus in Bloomington, Minnesota.

ABSTRACT Background. Drug-related adverse events are an underappreciated consequence of antibiotic use, and the national magnitude and scope of these events have not been studied. Our objective was to estimate and compare the numbers and rates of emergency department (ED) visits for drug-related adverse events associated with systemic antibiotics in the United States by drug class, individual drug, and event type. Methods. We analyzed drug-related adverse events from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2004–2006) and outpatient prescriptions from national sample surveys of ambulatory care practices, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2004–2005). Results. On the basis of 6614 cases, an estimated 142,505 visits (95% confidence interval [CI], 116,506–168,504 visits) annually were made to US EDs for drug-related adverse events attributable to systemic antibiotics. Antibiotics were implicated in 19.3% of all ED visits for drug-related adverse events. Most ED visits for antibiotic-associated adverse events were for allergic reactions (78.7% of visits; 95% CI, 75.3%–82.1% of visits). One-half of the estimated ED visits were attributable to penicillins (36.9% of visits; 95% CI, 34.7%–39.2% of visits) and cephalosporins (12.2%; 95% CI, 10.9%–13.5%). Among commonly prescribed antibiotics, sulfonamides and clindamycin were associated with the highest rate of ED visits (18.9 ED visits per 10,000 outpatient prescription visits [95% CI, 13.1–24.7 ED visits per 10,000 outpatient prescription visits] and 18.5 ED visits per 10,000 outpatient prescription visits [95% CI, 12.1–25.0 ED visits per 10,000 outpatient prescription visits], respectively). Compared with all other antibiotic classes, sulfonamides were associated with a significantly higher rate of moderate-to-severe allergic reactions (4.3% [95% CI, 2.9%–5.8%] vs. 1.9 % [95% CI, 1.5%–2.3%]), and sulfonamides and fluoroquinolones were associated with a significantly higher rate of neurologic or psychiatric disturbances (1.4% [95% CI, 1.0%–1.7%] vs. 0.5% [95% CI, 0.4%–0.6%]). Conclusions. Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients. Clinical Infectious Diseases 2008;47:000–000 1058-4838/2008/4706-00XX DOI: 10.1086/591126

LOMBARD - Drs. Carl Kuttler, President of St. Petersburg College (SPC) of Pinellas County, Florida, and James Winterstein, President of National University of Health Sciences (NUHS) in Lombard, Illinois, signed a partnership agreement. Quality is the standard that unites SPC and NUHS in the recently signed partnership. True to its heritage, NUHS will not place emphasis upon numbers at its SPC program but on educational quality -- smaller classes and stronger educational outcomes. NUHS offers a number of complementary and integrative health sciences, and it is possible that several programs could be offered at the SPC site in the future. Initially, through the partnership agreement, National University of Health Sciences plans to offer a first professional doctoral degree in chiropractic medicine at one of the SPC campuses. NUHS is currently in the process of obtaining the necessary approvals from the Florida Department of Education Commission for Independent Education, and the accrediting agencies that accredit NUHS and its chiropractic degree program. St. Petersburg College, is known nationwide as a progressive and innovative institution which has developed partnerships with 16 other colleges and universities that offer various degree programs on one or more of SPC's 11 campuses to more than 61,000 students. National University of Health Sciences, which was founded in 1906 has a long and well recognized tradition of high quality educational programs with strong admission criteria. Students entering the DC program at the NUHS/SPC campus will be required to have a baccalaureate for matriculation just as students have been required to have at the NUHS Lombard campus since 1999. Appropriate administrative personnel will be stationed at SPC to assure that all necessary processes required for educational standards will be met in a timely manner. SPC/NUHS anticipates potentially admitting the first class in September of 2009. The program at SPC will be the same curriculum offered at the main campus in Lombard, Illinois and will be a part of the NUHS system but offered in partnership with SPC.

Seneca Falls: On August 2 and 3, New York Chiropractic College held commencement exercises at the campus’ Athletic Center conferring degrees upon candidates in its four graduate level programs: Doctor of Chiropractic, Master of Science in Applied Clinical Nutrition, Master of Science in Diagnostic Imaging, Master of Science in Acupuncture and Master of Science in Acupuncture and Oriental Medicine. On Saturday 36 graduates received their Doctor of Chiropractic degrees. Valedictorian, Lindsay R. Rae had the honor of addressing her class. Salutatorian was Christopher J. Farrell. The NYCC School of Applied Clinical Nutrition graduated its first class, conferring masters’ degrees upon 24 graduates and NYCC’s Master of Science in Diagnostic Imaging program issued a masters degree to its first graduate. The commencement address was delivered by William Morgan, DC, from the National Naval Medical Center in Bethesda, MD. Dr. Morgan opened the Navy’s first chiropractic clinic at Bethesda’s tertiary care center and also established an internship for NYCC students. He serves as the chiropractic consultant to the United States Capitol and the White House and has received numerous awards including “Chiropractor of the Year” from the American Chiropractic Association. On Sunday, the NYCC School of Acupuncture and Oriental Medicine (AOM) graduated 36 master’s candidates. B. Basia Kielczynska of Beth Israel Medical Center addressed the graduates. Kielczynska graduated from Tri-State College of Acupuncture in New York, N.Y., with a Master of Science degree in Acupuncture. She is currently a Clinical Faculty member at both Beth Israel Medical Center and Tri-State College of Acupuncture and has published numerous articles and case studies. For further information about New York Chiropractic College’s degree programs please visit our Web site at:

Congress overrides Bush's Medicare veto scheduled to take effect Tuesday, July 1, 2008 and cut 10.6% in Medicare payments to physicians. The US Congress canceled the reduction in Medicare payments to doctors treating elderly patients. Within hours of President Bush’s Veto Representatives voted 383-41 to override it. The Senate followed suit soon after, by a vote of 70-26.

Alarm Rings in Lousiana—Time for the Profession to Wake Up An Open Letter to Chiropractic From FCER President, Charles Herring, DC With the closing of the Louisiana legislative session it became even more apparent to me that the external influences on the chiropractic profession (and healthcare in general) are moving—in a very organized fashion—to use the literature (or the lack thereof) to make decisions regarding payment policies of the insurance industry (both health and workers’ compensation insurance). During the recent Louisiana legislative session it was learned that the National Insurance Commissioners Association has written a model piece of legislation. A major part of this legislation addresses the issue of denying care based on evidence or the lack of evidence. This model legislation is occurring because state legislatures have passed “Medical Necessity Review Organization laws” that limit the ability of the insurance companies to deny care on the basis of medical necessity. To combat these limits, the proposed bill would legally permit the insurance companies to stop denying care because it is not medically necessary and begin denying care on the basis that it is “observational and investigational.” They are attempting to change the rules of the game and will now deny claims because there is no evidence to support the effectiveness of a particular treatment. Methods to The Madness • For quite some time, health insurance has talked about “evidence-based practice,” but they have not actually done much to create standards and enforce the concepts of “Best Practices.” Medical necessity is routinely based on the demonstrated needs of the patient and the documented demonstration of a condition and the response to the treatment being rendered. The treatment rendered and the need for future care was then addressed by a consultant at the point of pre-certification. United Healthcare and ACN have typically used standards that they created from what they perceive to be the evidence-based treatment protocols in the literature. • The “length of care” determination has been arbitrary at best and is predominantly determined by the use of data comparisons with other chiropractors in the network. They have also used other outcome measures which may not address the specific problems of the patient that you are treating. • Until recently, the insurance companies deny payment for recently developed therapies—such as VAX-D and Low Level Laser—by making the determination that these new therapies are considered “observation and investigational.” The result is that all new technologies are being measured by the evidence that is available. In making these determinations, the required level of evidence has been high quality randomized controlled trials. • Many private insurance companies will not pay for cervical disc replacement with the new disc that allows movement of the motion unit. While a study of the disc approved by the FDA resulted in the approval of the device, the insurance companies have refused payment because the patients were not randomized, the treatment was not blinded, and the study did not compare the new treatment to a placebo. • Learning from their success with not paying for new therapies, health insurance companies are now creating policy language to limit payment for various long-standing, well-established treatments in chiropractic such as massage and various electrical modalities. Aetna now has a “clinical policy bulletin” that specifically addresses chiropractic care. This policy bulletin states that they will not pay for the treatment of scoliosis except during early adolescence. There are also a number of techniques that are not covered. This is all being denied because there is no evidence that the treatment is effective and therefore the treatment is considered “observational and investigational.” • Workers’ compensation insurance and business interests are now pushing very hard to pass legislation that will require the use of treatment guidelines in the treatment of injured workers. The Workers Compensation Research Institute (WCRI) has been providing data analysis reports of workers’ compensation costs in numerous states. Their reports have targeted medical cost and have suggested that certain treatments are major cost drivers—with chiropractic care being list at or near the top of the list. The insurance industry and business groups have also heard about the implementation of the American College of Occupational and Environmental Medicine (ACOEM) guidelines in California. They have been told that medical costs have significantly decreased since ACOEM guidelines were mandated by law in California. Guidelines only use the highest level of evidence—RCTs or systematic reviews that are based on RCTs. These two situations are creating and will continue to create great difficulties for the chiropractic clinician. • Our first problem is our lack of evidence. While there is a body of evidence that supports the major conditions that chiropractors treat, most of the evidence is not rated at the highest quality because it is difficult to blind the patient or the doctor and it is difficult to do a treatment comparison with a placebo or sham treatment. This affects the quality of the RCTs that have been done and thus weakens our argument that spinal manipulation is effective. • Other treatments, such as therapeutic modalities, have been tested and have been found to be ineffective within the standard RCT model of research. For example, electrical stimulation has been tested alone, in conjunction with spinal manipulation, and spinal manipulation alone in a single study. This study found that there were no prolonged treatment effects of electrical stimulation when performed alone or in conjunction with spinal manipulation at 30 days, 90 days, 6 months, and 12 months. Spinal manipulation was just as effective with and without electrical stimulation. I think we would all agree that there are no long-term therapeutic benefits to the administration of electrical stimulation. The research design prohibits a successful outcome because electrical stimulation was never intended to have long-term effectiveness. The effects on pain and spasm have shorter-term therapeutic benefits, but the studies do not measure the effectiveness with the context of how it is used in clinical practice thus the studies report that it is ineffective. Now the insurance industry says... “There are no studies to support the effectiveness of this treatment.” • Finally there is increasing competition between the chiropractic profession and the physical therapists. They have established doctoral programs and are doing a significant amount of research in universities. There is even talk in Washington that chiropractic should be considered a subset of physical therapy since PTs are more integrated into the education system and the medical treatment model. We are currently in a race to have cultural authority over manipulation, but when it comes to research to support this authoritative position we are losing the race. Meeting the Challenges Ahead What must our profession do? 1. We MUST fund research like our livelihoods depend on it—because they do. New studies are needed to demonstrate the benefits of chiropractic care with the public, government, and payers of healthcare services. Our lack of evidence is going to allow the insurance industry to continue to deny more and more treatments provided by the chiropractic profession. FCER is setting up practice-based research programs to create clinical data that can then be leveraged into Federal grants to do major research projects through our colleges and other institutions. FCER will need to fund small studies that can be used to obtain Federal grants. State associations will need to step up and support this effort and individual DCs will be needed to participate in these studies. 2. DCs MUST learn how to find, read, interpret, and apply evidence in their practices. We can no longer afford to do things just because BJ said it. We must be able to use evidence to guide our decisions with regard to the treatment of our patients. Society is now demanding that doctors practice in an evidence-based manner. The chiropractic profession must embrace this approach to providing care if we hope to participate in future government programs, insurance programs, workers’ compensation, as well as developing closer working relationships with the medical profession. Even public acceptance hangs in the balance. 3. We MUST fund programs that have the potential for developing more evidence and for training the profession to use evidence in practice. FCER must be funded at the level necessary to meet the professions needs both now and in the future. We do not have the benefit of outsiders who will foot the bill for us. We must look to ourselves for the major financial assistance that is needed. The time for us to act is NOW. We cannot wait any longer. Further delays will only result in our profession falling farther and farther behind in the evidence-based world. Please support FCER today and give on a continuing basis. Research evidence is the foundation for inclusion of chiropractic care in all programs. The responsibility for our profession falls on you as it falls on me; we can not rely on “them.” As the chiropractic profession’s oldest not-for-profit foundation, serving the profession since 1944, FCER is charged solely with providing the chiropractic profession with the research tools to battle exactly these challenges—and the Foundation is funded entirely by those within the chiropractic profession. FCER, based in Norwalk, Iowa, has as its mission to “Translate Research into Practice” by granting funds for research and producing practitioner and patient education materials including teleconferences, CDs, books and pamphlets. FCER is developing the profession’s only Evidence-Based Resource Center at www.DCConsult.com. More information on FCER, membership, and subscriptions to DCConsult can be found at www.fcer.org or by calling 515-981-9888.

INSIDE THIS REPORT: 1. NBCE Redesigns Web site 2. 2008 Annual Meeting Results 3. NBCE Updates Part IV Eligibility Policy 4. Part I and Acupuncture Test Committees Meet 5. Part IV Test Committee Gathers 6. NBCE International Update 7. NBCE Calendar 1. NBCE Redesigns Web site The NBCE launched its redesigned Web site in June. Please visit www.nbce.org to see the changes. The site has been reorganized to include information that was previously available only through printed materials. For example, examinees may now find test plans, test schedules and lists of reference texts for the written examinations online. Popular features such as online applications and online score reporting will continue to be available. The redesigned site is organized into two sections: one for examinees and one for professionals. The information for examinees includes written, practical and post-licensure examination information. The professionals section includes information about the NBCE Board of Directors, as well as the NBCE reports and publications, and links to other chiropractic organizations. The redesigned site features expandable menus for navigation between pages. In the coming months, we plan to add more features to the site, including RSS feeds and streaming video. The NBCE Web site is always the first and best place to seek information about this organization and we hope you will visit it often. 2. 2008 Annual Meeting Results It was gratifying to see so many of you at the meeting in Atlanta. On behalf of the NBCE Board, we are grateful for your confidence in the direction and leadership of the NBCE. A total of 39 voting delegates and alternates attended the NBCE business meeting. We truly believe that the voice of the delegate body is most effective when it is the voice of many! Dr. Ted Scott (Utah) was re-elected by acclamation to his second term as District IV Director. Additionally, the Executive Committee was returned with President Dr. Vernon Temple, Vice President Dr. Ed Weathersby (Arizona), Secretary Dr. Mary-Ellen Rada (New Jersey), and Treasurer Dr. Ted Scott. Proposed NBCE Bylaws Revisions The main purpose for all corporate and non-profit bylaws is to provide a blueprint for the operation of an organization. The existence of bylaws frees directors and management to manage and govern in a transparent and accountable manner—to concentrate on the true mission of the organization. The delegates and alternates therefore continue to fulfill their responsibility to provide input to the NBCE, not just for a year or two but into the 21st century. We sincerely appreciate that the delegates and alternates put so much thought and effort into re-examining the NBCE bylaws. Proposal 1 passed, amending the NBCE’s mission to clarify that our activities must be in the best interests of the Corporation (NBCE) and chiropractic testing. Proposal 2 passed, creating term limits for directors, reclarifying eligibility requirements and terms of service for district directors and FCLB-appointed directors. Proposal 4 passed, thereby eliminating the position of chairman of the board with the president serving as the presiding officer over meetings of the Executive Committee and Board. Proposal 5 passed, clarified that bylaws amendments will become effective at the adjournment of the Annual Meeting of Delegates, and that meetings will be governed by the Robert’s Rules of Order Newly Revised. The proposal also detailed the process for possible removal of an officer and the requirement that two-thirds of the entire board must vote to do so. Proposal 3 failed; it suggested a process for enacting change in the bylaws. FCLB Funding This past year, the National Board concentrated on revitalizing our relationship with the FCLB, especially to ensure their future financial stability and ability to support state licensing boards. The NBCE’s efforts have been directed towards the development of a funding plan to allow both organizations to accomplish their independent missions and yet to ensure financial stability. We are moving forward with an agreement that will provide funding for the FCLB for the year 2009 and beyond. We look forward to providing more details in the near future. Please visit www.nbce.org to view the 2008 NBCE Annual Meeting pictures, revised bylaws and press releases. 3. NBCE Updates Part IV Eligibility Policy Notices have recently been mailed to all state licensing boards that the eligibility requirements for the Part IV Practical Examination will change effective with the May 2009 administration. The new requirements will be: • The successful completion of all subjects in Part I • A graduation date falling within six months of the Part IV administration • Sign-off by the college registrar indicating the student is academically prepared to take Part IV Modifications to the current requirement will better accommodate the great diversity of course sequencing in the chiropractic curricula, as well as the wide range of graduation dates existing among chiropractic programs in the United States and Canada. 4. Part I and Acupuncture Test Committees Meet The Part I and Acupuncture test committees were held on April 18-19, 2008, at the headquarters of the National Board of Chiropractic Examiners (NBCE) in Greeley. NBCE District I Director Dr. Robin Lecy attended the test committee meeting and expressed his gratitude for the test committee members’ hard work. “Thank you for taking some of your valuable time and coming here today,” he said. “Your expertise and knowledge is appreciated by the Board. Your dedication to the test committee process is an integral part of our exam development; in fact we couldn’t do it without you.” During the two-day meeting, the test committees selected items that they felt would best assess an examinee’s knowledge. To ensure the fairness of the examinations, the test committees are composed of college instructors, subject matter experts and state licensing board members. These individuals are selected based on their expert knowledge of the subject matter. The NBCE examinations are offered twice yearly at chiropractic colleges across the United States and in several foreign countries. The Part I Examination is part of a battery of tests that candidates must pass prior to becoming licensed doctors of chiropractic. Part I consists of 110 standard multiple-choice questions in each of the six basic science areas: general anatomy, spinal anatomy, physiology, chemistry, pathology, as well as microbiology and public health. NBCE written examinations are accepted for initial licensure in all 50 states and the District of Columbia. Acupuncture is an elective exam for individuals who have received acupuncture instruction while in chiropractic college or those who have already graduated from chiropractic college, have complete 100 hours of acupuncture instruction and want to demonstrate their knowledge of the subject matter. This exam consists of 200 multiple-choice questions. Part I attendees were: General Anatomy: • Chad Maola, D.C., NBCE Staff Chiropractic Specialist and Moderator • Sheldon P. Clayton, Ph.D., Sherman College of Straight Chiropractic • Steve W. Kirk, D.D.S., Parker College of Chiropractic • Kim L. Swineheart, D.C., Northwestern Health Sciences University Spinal Anatomy: • Heather Kauffman, D.C., NBCE Moderator • James R. Carollo, M.S., Western States Chiropractic College • Christopher Coulis, D.C., University of Bridgeport, College of Chiropractic • John H. Romfh, Ph.D., Life University College of Chiropractic Physiology: • Kathleen Jones, Ph.D., NBCE Moderator • Kashif A. Ahmad, Ph.D., Northwestern Health Sciences University • Louis J. Freedman, D.C., Palmer College of Chiropractic, Davenport • Christopher A. Meseke, Ph.D., Palmer College of Chiropractic, Florida Campus Chemistry: • Jim Schreck, Ph.D., NBCE Moderator • John Gutweiler, Ph.D., Logan College of Chiropractic • Marc P. McRae, D.C., National University of Health Sciences • Bert Silverman, Ph.D., Life University, College of Chiropractic • Verena Van Fleet, Ph.D., Northwestern Health Sciences University Pathology: • Greg Crawford, D.C., NBCE Moderator • Samir Ayad, M.D., Southern California University of Health Sciences • Cynthia B. Gibbon, D.C., Sherman College of Straight Chiropractic Microbiology and Public Health: • Michelle Clark, D.C., NBCE Moderator • Shahla Abghari, Ph.D., Life University, College of Chiropractic • Sameh A. Awad, M.D., Southern California University of Health Sciences • Kim B. Khauv, D.C., Life Chiropractic College West Acupuncture attendees were: • Martin Kollasch, D.C., NBCE Staff Chiropractic Specialist and Moderator • Bruce Shotts, D.C., NBCE Moderator • David Dresner, D.C., Florida Practitioner • Manual A. Duarte, D.C., National University of Health Sciences • Michael D. Jacklitch, D.C., North Dakota Practitioner • Mary M. Jennings, D.C., National University of Health Sciences • Peter D. Lichtenstein, D.C., Northwestern Health Sciences University • Teresa Marshall, D.C., Minnesota Board of Chiropractic Examiners • Denise C. Natale, D.C., Vermont Board of Chiropractic • Gary Rosquist, D.C., Utah Practitioner 5. Part IV Test Committee Gathers Part IV test committee members gathered on June 20-21, 2008, at the National Board headquarters in Greeley, Colo. NBCE Executive Vice President Horace Elliott welcomed the test committee members and I addressed the group to express the Board’s appreciation for their efforts on this project. Sixteen participants from across the United States, who were chosen to review patient case scenarios and select case-related questions for the Part IV Practical Examination to be administered in November 2008 and May 2009. Part IV assesses clinical skills in diagnostic imaging, chiropractic technique and case management for applicants seeking state licensure. The NBCE Part IV Examination was administered for the first time in January 1996 and has been administered twice yearly to a total over 39,000 doctors. Part IV is presently accepted by 48 states and the District of Columbia for initial licensure in chiropractic. Part IV test committee members were: • Dr. David Allen, Mississippi • Dr. Mark Bledsoe, South Dakota • Dr. John Calisesi, Iowa • Dr. Gary Carver, Missouri • Dr. Marc Cohen, Pennsylvania • Dr. Frank Corner, North Dakota • Dr. Shannon Gaertner-Ewing, Idaho • Dr. Scott Hansing, Montana • Dr. Scott Kilmer, New York • Dr. Richard Lacey, South Carolina • Dr. Paul Morin, Maine • Dr. Harold Rasmussen, Washington • Dr. Duane Sadula, Maryland • Dr. Albert Stabile, New Jersey • Dr. Richard Tollefson, Minnesota • Dr. Rosemary Zimmerman, Alaska 6. NBCE International Update National Board of Chiropractic Examiner’s (NBCE) Director of International Operations, Dr. Martin Kollasch, visited Han Seo University in Korea during the month of June. At Han Seo University, students who study nursing, chiropractic, dentistry and other health sciences receive all their basic sciences as a group. Currently, 20 students plan to follow their bachelor degree program with entry into the chiropractic program, which is equivalent to a two-year master’s degree. In the second year, students transfer to the University of Bridgeport, College of Chiropractic, to complete their chiropractic education and receive their doctor of chiropractic degree. There is no legislation in place that protects the chiropractors of Korea. Chiropractors can be fined and imprisoned. Han Seo University is therefore seeking accreditation of a doctor of chiropractic program from the Council on Chiropractic Education Australasia (CCEA). With CCEA accreditation, Han Seo University is committed to encouraging legislation to officially recognize the profession, and to recognize licensed chiropractors as those who have graduated from an accredited program and who have completed the NBCE examinations. Also, in support of the chiropractic profession in Korea, Dr. Kollasch attended the World Federation of Chiropractic (WFC) council meeting. He was able to visit the WFC’s meeting as an observer during the same time as the Han Seo visit. In other NBCE international news, Italy passed chiropractic legislation in December 2007. In pursuit of establishing independence from the medical profession, the Italian Chiropractic Association (ICC), which is now recognized by the World Federation of Chiropractic (WFC), has asked for assistance from the National Board of Chiropractic Examiners to develop formalized protocals for recognition of chiropractors in Italy. The ICC requested examples of examinations similar to those that U.S. students must successfully complete for the NBCE. 6. NBCE Calendar Fall National Written Exams Administration- September 12-14 Part IV Practical Exam Administration- November 14-16 National Board of Chiropractic Examiners 901 54th Avenue Greeley, Colorado 80634 970-356-9100 To view the full report in Portable Document Format ( PDF ), click on the link below:

The U.S. Food and Drug Administration (FDA) has notified manufacturers of fluoroquinolone antimicrobial drugs that a Boxed Warning in the product labeling concerning the increased risk of tendinitis and tendon rupture is necessary. Through its new authority under the Food and Drug Administration Amendments Act of 2007 (FDAAA), the agency also determined that it is necessary for manufacturers of the drugs to provide a Medication Guide to patients about possible side effects. The FDA has notified the manufacturers of these drugs that a Risk Evaluation and Mitigation Strategy (REMS) is necessary to ensure that the benefits of the drug outweigh the risks. The Medication Guide will be considered to be an element of the REMS. The new Boxed Warning and Medication Guide would strengthen warning information already included in product labeling for the fluoroquinolone class of systemic antimicrobial drugs. Fluoroquinolones are drugs approved for the treatment or prevention of certain bacterial infections. Like other antibacterial drugs, fluoroquinolones do not treat viral infections such as colds or flu. "Fluoroquinolones are effective in treating certain bacterial infections, but health care professionals and patients need to be aware of the increased risk associated with the use of these drugs of developing tendinitis and tendon rupture, particularly for certain patient populations," said Edward Cox, M.D., director, Office of Antimicrobial Products, Center for Drug Evaluation and Research. "The FDA believes it is important to highlight and strengthen information regarding possible side effects of fluoroquinolones because it may affect decisions about the relative risks and benefits associated with these products." The FDA has conducted a new analysis of the available literature and post-marketing adverse event reports. This new analysisreconfirmsthat use of fluoroquinolones is associated with an increased risk of tendon rupture. It alsodemonstrates that despite the current warning of tendon rupture in the labeling for the fluoroquinolones, large numbers of tendon-related adverse events continue to be reported. The FDA considers this new analysis to be "new safety information" as defined in FDAAA. The FDA also issued Information for Health Care Professionals today to alert health care professionals to the increased risk of tendinitis and tendon rupture in patients taking these drugs and to highlight new information concerning who may be at higher risk for this side effect. The risk of developing fluoroquinolone-associated tendinitis and tendon rupture is further increased in people older than 60, in those taking corticosteroid drugs, and in kidney, heart, and lung transplant recipients. Patients experiencing pain, swelling, inflammation of a tendon or tendon rupture should be advised to stop taking their fluoroquinolone medication and to contact their health care professional promptly about changing their antimicrobial therapy. Patients should also avoid exercise and using the affected area at the first sign of tendon pain, swelling, or inflammation. Manufacturers are being notified of the need to change labeling so that all of the drugs in the class carry uniform updated warning language. These warnings would apply to fluoroquinolones for systemic use (e.g., pills, tablets, capsules and injectable formulations). The warnings would not apply to fluoroquinolones for topical ophthalmic or otic use (e.g., eye and ear drops). Fluoroquinolone manufacturers are required to submit the safety labeling changes, including the strengthened warnings and the Medication Guide, to the FDA within 30 days, or to provide a reason why they do not believe such labeling changes are necessary. If they do not submit new language, or the FDA disagrees with the new language the company proposes, FDAAA provides strict timelines for resolving the labeling changes and allows the agency to issue an order directing the labeling change as deemed appropriate to address the new safety information. In addition, in accordance with FDAAA, sponsors will be required to assess whether their REMS are achieving the goal of informing patients of the risk of tendon-rupture. These assessments may include a survey of patients' and prescribers' understanding of the risks of tendon-rupture and whether the Medication Guide is being distributed and dispensed with the drug. Health care professionals should consider the potential benefits and risks for each patient. While most patients tolerate these medicines well, occasionally some will develop other serious adverse reactions that may include convulsions, hallucinations, depression, abnormalities in heart rhythm, or severe diarrhea. The medications involved in this action are: Cipro and generic ciprofloxacin, Cipro XR and Proquin XR (ciprofloxacin extended release), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), and Floxin and generic ofloxacin. Information for Healthcare Professionals on Fluoroquinolone Antimicrobial Drugs:

The American Chiropractic Association (ACA) today announced it has mailed copies of a report issued by the Task Force on Neck Pain and its Associated Disorders to more than 16,600 neurologists across the country. The seven-year, international, multidisciplinary study was published in the journal Spine and is designed to help health professionals apply the best available evidence to prevent, diagnose and manage neck pain. In the cover letter accompanying the study, ACA President Glenn Manceaux, DC, noted that ACA encourages evidence-based clinical practice and interprofessional cooperation in patient care. “There is growth in the referral of patients between chiropractors and neurologists and therefore, it is important that all practioners be on the same page regarding the most current research in treating this pervasive condition,” Dr. Manceaux said. In distributing the study findings, ACA worked closely with NCMIC, the nation’s leading provider of chiropractic malpractice insurance for doctors of chiropractic. The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders considered almost 32,000 citations and performed critical appraisals of more than 1,000 studies in developing its 236-page report. The Task Force is an independent research group recognized by the United Nations and the World Health Organization. Task Force researchers found that some alternative therapies such as acupuncture, neck manipulation and massage are better choices for managing most common neck pain than many current practices. Also included in the short-list of best options for relief are exercises, education, neck mobilization, low-level laser therapy and pain relievers. In addition to its comprehensive review of the existing body of research on neck pain, the Task Force also initiated a new population-based, case-control and case-crossover study into the association between chiropractic care and vertebrobasilar artery (VBA) stroke. This Canadian study investigated associations between chiropractic visits and vertebrobasilar artery stroke and compared this with visits to primary care physicians and the occurrence of VBA stroke. The study — which analyzed a total of 818 cases of VBA stroke admitted to Ontario hospitals over a 9-year period (more than 100 million patient-years of observation) — concluded that VBA stroke is a very rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office appears to be no different from the risk of VBA stroke following a visit to a family physician’s office. To access the “Best Evidence Synthesis on Neck Pain: Findings” from The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, click here .