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

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

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

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

One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government's annual, comprehensive report of Americans' health, Health United States, 2006, released today by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics. "We chose to focus on pain in this report because it is rarely discussed as a condition in and of itself - it is mostly viewed as a byproduct of another condition," said lead study author Amy Bernstein. "We also chose this topic because the associated costs of pain are posing a great burden on the health care system, and because there are great disparities among different population groups in terms of who suffer from pain." Low back pain is among the most common complaints, along with migraine or severe headache, and joint pain, aching or stiffness. The knee is the joint that causes the most pain according to the report. Hospitalization rates for knee replacement procedures rose nearly 90 percent between 1992-93 and 2003-04 among those 65 and older. Some of the other pain statistics include: One-fifth of adults 65 years and older said they had experienced pain in the past month that persisted for more than 24 hours. Almost three-fifths of adults 65 and older with pain said it had lasted for one year or more. More than one-quarter of adults interviewed said they had experienced low back pain in the past three months. Fifteen percent of adults experienced migraine or severe headache in the past three months. Adults ages 18-44 were almost three times as likely as adults 65 and older to report migraines or severe headaches. Reports of severe joint pain increased with age, and women reported severely painful joints more often than men (10 percent versus 7 percent). Between the periods 1988-94 and 1999-2002, the percentage of adults who took a narcotic drug to alleviate pain in the past month rose from 3.2 percent to 4.2 percent. The report also finds that the United States spent an average of $6,280 per person on health care in 2004. Seven percent of adults under 65 said they passed up getting needed care in the past 12 months due to costs. The report also notes a number of other significant health findings: Life expectancy at birth reached a record 77.9 years in 2004, up from 77.5 in 2003 and from 75.4 in 1990. Since 1990, the gap in life expectancy between men and women has narrowed from seven to just over five (5.2) years. At birth, life expectancy for females is just over 80 years and nearly 75 for males. The gap in life expectancy between white and black Americans also has narrowed from seven years in 1990 to five years in 2004. Infant mortality fell to 6.8 deaths per 1,000 live births in 2004, down from 6.9 deaths per 1,000 live births in 2003. Heart disease remains the leading killer, but deaths from heart disease fell 16 percent between 2000 and 2004, and deaths from cancer - the No. 2 killer - dropped 8 percent. The age-adjusted death rate for heart disease was 217 deaths per 100,000 in 2004; for cancer the rate was 186 per 100,000. Diabetes poses a growing threat, especially among older adults. Eleven percent of adults aged 40-59 years, and 23 percent of those 60 and older have diabetes. Health United States, 2006 is available at:

Superintendent of Insurance Howard Mills today announced that the New York State Insurance Department has levied fines totaling $310,300 against 21 health insurers and health maintenance organizations (HMOs) for violations of New York’s Prompt Pay Law. The violations and subsequent fines stemmed from complaint files that were closed by the Insurance Department between Oct.1, 2005 and March 31, 2006. New York’s Prompt Pay Law requires health insurers and HMOs to pay undisputed health insurance claims within 45 days of receipt, ensuring timely payment. Since Governor Pataki signed this measure into law in 1997, the Insurance Department has levied nearly $6.8 million in fines against health insurers and HMOs for Prompt Pay Law violations. By agreeing to pay the fines imposed by the Insurance Department, the companies are acknowledging that they failed to pay certain claims within the state-mandated timeframe. Moreover, health insurers and HMOs are also required to pay interest on undisputed claims in which payments were delayed. "New York’s Prompt Pay Law has been extremely effective in ensuring that consumers and healthcare providers are paid in a timely fashion and remains an excellent deterrent against entities slow to pay undisputed claims," Superintendent Mills stated. The fines announced today, by company, are: Health Ins. -- Fine Aetna -- $8,400.00 Affinity -- $5,000.00 Americhoice -- $30,100.00 Careplus -- $1,900.00 Centercare -- $3,400.00 CIGNA -- $2,100.00 Empire -- $5,000.00 Excellus -- $3,200.00 Fidelis -- $1,200.00 GHI HMO Select -- $2,300.00 Group Health, Inc. -- $13,800.00 Guardian -- $1,400.00 Health Plus -- $65,300.00 HealthNet -- $58,800.00 HealthNow -- $3,100.00 (includes Community Blue) HIP -- $7,400.00 Horizon -- $1,800.00 MDNY -- $22,900.00 Oxford -- $19,100.00 United Healthcare -- $16,300.00 Vytra -- $37,800.00 Consumers and healthcare providers with prompt pay complaints should call the New York State Insurance Department’s toll-free hotline at 1-800-358-9260.

Influenza vaccination: Policy versus evidence Each year enormous effort goes into producing influenza vaccines and delivering them to appropriate sections of the population. But a review of the evidence in this week's BMJ suggests that they may not be as effective as we think. So is this effort justified, asks vaccine expert Tom Jefferson? Public policy worldwide recommends the use of inactivated influenza vaccines (vaccines that contain dead viruses) to prevent seasonal outbreaks. But because influenza viruses mutate (change) and the number doing the rounds varies from year to year, it's difficult for scientists to study the precise effects of vaccines. The most reliable way to judge their effects is to use systematic reviews – impartial summaries of evidence from many different studies. Evidence from systematic reviews in this field shows that inactivated influenza vaccines have little or no effect on many influenza campaign objectives, such as hospital stay, time off work, or death from influenza and its complications. Furthermore, most studies are of poor quality (especially in the elderly) and show evidence of bias. And there is surprisingly little evidence on the safety of these vaccines. The large gap between policy and what the data tell us is surprising, writes Jefferson. Reasons for this are not clear, but may stem from the confusion between influenza and influenza-like illness (the acute respiratory infection which looks like influenza but is not), a lack of accurate and fast surveillance systems, and the fact that vaccines are available. The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking, he says. But given the huge resources involved, a re-evaluation should be urgently undertaken. "The problem is that the UK has no transparent process for evaluating the effectiveness or cost effectiveness of vaccines," adds BMJ Editor, Fiona Godlee. "NICE would like to take this on. The government should let it."

Congress has passed legislation requiring the Pentagon to conduct a study on providing chiropractic care to all members and former members of the Armed Forces, their families, and reservists. The legislation was included as a provision in HR 5122, the National Defense Authorization Act for Fiscal Year 2007, which passed the House on Sept. 29 and the Senate on Sep. 30. The study must be completed and submitted to Congress by March 31, 2008. The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) worked jointly with key allies in Congress to secure passage of the legislation. “Both ACA and ACC believe that guaranteeing access to chiropractic care is paramount, especially to our troops overseas in harm’s way,” said ACA President Richard Brassard, DC. “I am confident that upon further review, the Pentagon will not only find chiropractic care cost effective and essential, but will move to expand chiropractic care to Tricare beneficiaries and reservists as well.” “The passage of this language is a victory for our men and women in uniform who deserve no less than the best health care this country can offer,” added ACC President Frank Zolli, DC, Ed. D. "The chiropractic profession extends a sincere thank you to the Chairs and ranking members of the House and Senate Armed Services committees, and especially to Senator Jim Talent and Representatives Jeb Bradley, John McHugh, Mike Rogers and others who were instrumental in advancing this important legislation.” Congress expects the study mandated by the legislation to consider any relevant findings of an upcoming Navy research report designed to assess progress of the military chiropractic program and the efficacy and application of chiropractic health care services in reducing musculoskeletal disabilities among active-duty personnel. Currently, only 42 medical treatment facilities in the military health system, all within the continental United States, offer chiropractic health care services. Last year in a step toward full implementation, Congress directed the Air Force to place a doctor of chiropractic at 11 additional bases in the United States. The Air Force has yet to act on that order. HR 5122 has been sent to the White House, where the president is expected to sign the legislation. Click here for a copy of the bill. Go to section 712 (page 205), which deals specifically with the chiropractic benefit.

A new federal study published in the Journal of the American Medical Association, revealed that more than 700,000 ER visits each year are caused by the harmful reactions to some of the most frequently used medicines. Allergic reactions and accidental overdoses related to prescription drugs were the most common cause of serious illnesses. The worst offenders were the blood-thinner warfarin, the diabetes drug insulin and the heart medicine digoxin along with Amoxicillin, aspirin and trimethoprimsulfamethoxazole, an antibiotic. The study also revealed that ER visits for those over 65 were twice that of younger people. ABSTRACT National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events Daniel S. Budnitz, MD, MPH; Daniel A. Pollock, MD; Kelly N. Weidenbach, MPH; Aaron B. Mendelsohn, PhD, MPH; Thomas J. Schroeder, MS; Joseph L. Annest, PhD Context: Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited. Objective: To describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States. Design, Setting, and Participants Active surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. Main Outcome Measures: National estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments. Results: Over the 2-year study period, 21 298 adverse drug event cases were reported, producing weighted annual estimates of 701 547 individuals (95% confidence interval [CI], 509 642-893 452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117 318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%). Conclusions: Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies. Author Affiliations: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Coordinating Center for Infectious Diseases (Drs Budnitz and Pollock and Ms Weidenbach), Office of Statistics and Programming, National Center for Injury Prevention and Control (Dr Annest), Centers for Disease Control and Prevention, Atlanta, Ga; Office of Drug Safety, Center for Drug Evaluation and Research, US Food and Drug Administration, Rockville, Md, and Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention (Dr Mendelsohn); and US Consumer Product Safety Commission, Bethesda, Md (Mr Schroeder). Dr Mendelsohn is now director of epidemiology, Product Safety, MedImmune, Gaithersburg, Md. JAMA. 2006;296:1858-1866.

The most comprehensive annual study of hospital quality in America examines 41 million hospitalization records at 5,000 hospitals over three years; shows mortality rates decline. The largest annual study of hospital quality in America, issued today by HealthGrades, finds a typical patient, on average, has a 69 percent lower chance of dying at the nation's 5-star rated hospitals compared with the 1-star hospitals. This "quality chasm" between the best and poorest-performing hospitals has grown by approximately 5 percent since last year's study, even as overall mortality rates have improved by nearly 8 percent. The ninth annual HealthGrades Hospital Quality in America Study analyzes 40.6 million Medicare hospitalization records, from the years 2003 through 2005, to rate the quality of care at each of the nation's more than 5,000 nonfederal hospitals. To help consumers compare the quality of local hospitals, HealthGrades posts its ratings free of charge on its consumer Web site, HealthGrades.com, and in its suite of decision-support tools that major employers and health plans offer as a benefit to employees and plan members. "This year's study finds that mortality rates among Medicare patients continues to decline, however the differences in patient outcomes between 5-star and 1-star hospitals remains large and is getting larger, a concerning finding," said Samantha Collier, MD, the author of the study and the vice president of medical affairs at HealthGrades, the leading independent healthcare ratings organization. "But these are more than numbers. According to the study, more than 300,000 Medicare lives could have been saved during the three years studied if all hospitals performed at the level of hospitals rated with 5 stars." For example, the study shows that a typical patient having coronary bypass surgery has a 72.9 percent lower risk of mortality, on average, if they have the procedure at a 5-star rated hospital compared with a 1-star rated hospital. If all Medicare coronary bypass surgery patients from 2003 to 2005 went to 5-star hospitals, 5,308 lives could have been saved. The annual HealthGrades study rates every nonfederal hospital with a 1-, 3- or 5-star rating indicating poor, average or excellent outcomes in each of 28 medical categories. Taken together, the individual hospital ratings produce the following findings: • The nation's in-hospital risk-adjusted mortality rate improved, on average, 7.89 percent from 2003 to 2005. But the degree of improvement varied widely by procedure and diagnosis studied. • Five-star rated hospitals had significantly lower risk-adjusted mortality rates across all three years studied and improved, over the years 2003 to 2005, 19 percent more than the U.S. hospital average and 57 percent more than 1-star rated hospitals. • A typical patient would have, on average, a 69 percent lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital, and a 49 percent lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average. If all hospitals performed at the level of a 5-star rated hospital across 18 of the procedures and diagnoses studied, 302,403 Medicare lives could have potentially been saved from 2003 through 2005. Fifty percent of the potentially preventable deaths were associated with just four diagnoses: Heart Failure, Community Acquired Pneumonia, Sepsis and Respiratory Failure. The full study, along with its methodology, can be found at: HealthGrades

CARMICHAEL, Calif. – October 16, 2006 -- The Foundation for Chiropractic Progress, a not-for-profit organization dedicated to increasing public awareness of benefits of chiropractic, announced today an overwhelming positive response to the initial run of its year-long educational advertorial campaign in major national publications including Newsweek, U.S.News and World Report, Sports Illustrated and Business Week. Center to this campaign is a full-page advertorial featuring spokesperson Sarah Harding, two-time winner of the Ms. Fitness USA title, sharing her positive experience with chiropractic care. “Sarah Harding is ideal for this position, having earned the title Ms. Fitness USA partially the result of a dynamic fitness routine which showcased her physical strength, flexibility and endurance,” says Kent Greenawalt, President of the Foundation. “But, there is more to Sarah. She is an All American Honors graduate of Stanford University with an undergraduate degree in East Asian Studies and a Master’s Degree in Communication.” At Stanford, Harding earned All American honors on floor exercise, scored a perfect “10,” and will forever share the school record on the floor. Her entertainment career includes principal choreographer, dancer and acrobat at several theme parks worldwide. In 2003, she joined a highly successful acrobatic troupe in Las Vegas, NV where she performs high falls, acrobatic acting, and stunt work in two shows nightly for nearly 2,000 people per show. Chiropractic has always played an important role in Sarah’s life. “Chiropractic allowed me to pursue gymnastics,” she said. “Even at an early age, it enabled me to lead an active life style. Chiropractic literally changed my life. If you’re looking to make wellness a part of your life, Chiropractic is a great place to start. I am pleased to be part of a campaign that demonstrates the value of this great profession.” Greenawalt looks forward to a long association between the Foundation and Ms. Harding. ”Sarah is a woman for all seasons, combining beauty, athleticism and intelligence. I can’t think of anyone better to articulate the benefits of chiropractic care.” About F4CP The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public’s awareness of the benefits of chiropractic. 916.359.0327

Associated Press (AP) Business Writer reports that UnitedHealth CEO McGuire received stock options of 1.6 BILLION DOLLARS as of the end of 2005. AP also reported that “UnitedHealth Group Inc. announced on Sunday that Chairman and Chief Executive William McGuire will step down.” To view the entire article click on the link below:

Norwalk, Iowa—Recognizing the need for the chiropractic profession to develop its own research infrastructure, the Foundation for Chiropractic Education and Research (FCER) took the lead many years ago to develop a research Fellowship program. To date, FCER has provided financial assistance to 148 promising scholars who had expressed a desire to study various aspects of chiropractic methods of care. FCER is therefore pleased to announce the Foot Levelers and National Board of Chiropractic Examiners financial support of FCER’s 2006 Fellows, as well as the recipients of those awards. Renewed Fellows All four of the renewed FCER Fellows have demonstrated achievements that continue to impress the FCER Research Committee. The renewed Fellows are: Kathleen Linaker, D.C., is seeking her Ph.D. in higher education: leadership foundations and counseling psychology at Loyola University in Chicago, IL. In the last year, Dr. Linaker has completed a first draft of a Masters of Diagnostic Imaging program at Life University; the program has been submitted to the Board of Directors for review. In addition, the compilation of radiology pathology files which she has overseen for use by interns and residents at National University of Health Sciences now contains over 1300 cases. She has co-developed a Case Review Panel for upper quarter students at Life University. She is preparing a paper on treating musculoskeletal injuries with monochromatic infrared light, to be submitted to the Journal of Manipulative and Physiological Therapeutics, and she is completing two other studies—on facet tropism and a correlation of L4 and L5 spondylolisthesis with S1 spina bifida occulta—which will also then be prepared for publication. Jacqueline D. Bougie, D.C., seeks a DPH in preventive care at Loma Linda University in California. The transcripts provided by Loma Linda University show Dr. Bougie displaying a near perfect record thus far in her program. She brings an extensive clinical research background to the program and has won the admiration of her colleagues and professors. Anthony D’Antoni, D.C., M.S, seeks his PhD. in health sciences at Seton Hall University, in South Orange, NJ. Dr. D'Antoni completed a research investigation with Dr. Arthur Croft on the prevalence of herniated intervertebral discs of the cervical spine in asymptomatic subjects using MRI scans that is to be published in the Journal of Whiplash and Related Disorders; it was also presented at the ACC-RAC X conference in March 2006. He has been asked to write a review paper on the topic of applying mind-mapping technique for the Journal of Chiropractic Humanities. Dr. D'Antoni also presented a paper called "Federico di Montefeltro's Hyperkyphosis: A Visuohistorical Case Study with Applications for Chiropractic Education" at FCER's Conference on Chiropractic Research (CCR) in September 2006. Stephen Burnie, BSc, D.C., seeks his MSc in Rehabilitation Sciences from McMaster University, Hamilton, ONT. Showing a perfect record on his transcripts from the University in biostatistics and rehabilitation sciences, Dr. Burnie was also recognized as a Canadian Institutes of Health Research "Strategic Training Fellow in Rehabilitation Research" in October 2005, and he was a guest lecturer at Canadian Memorial Chiropractic College. His proposed to complete his thesis on the systematic review of the literature on neck manipulation for pain and he will use the results to formulate a dose-response study for treating neck pain with adjustments. New FCER Fellowship Support In order to obtain an FCER Fellowship, applicants must show financial need in addition to providing satisfactory documentation that establishes superior transcripts; detailed, insightful and enthusiastic letters of recommendation; and a feasible, lasting interest in research. The purpose of the FCER Fellowship awards is to provide the chiropractic profession with a steady supply of high-quality, dedicated researchers and to increase the research base of the profession. The 2006 FCER Fellows are: Steven Passmore, D.C., seeks his PhD in Human Biodynamics at McMaster University. Before entering chiropractic college at NYCC, Dr. Passmore earned his Masters of Science in kinesiology, specializing in human motor behavior, and was therefore able to design an IRB approved research study while at NYCC. The results of this study were published as an abstract in the Journal of Sport and Exercise Physiology, presented at the North American Society for the Psychology of Sport and Physical Activity, and will be submitted for publication in a peer-reviewed journal. As a student intern at the Buffalo Veterans Affairs Medical Center, Dr. Passmore reports that he was able to design and implement clinical research projects at multiple sites with the Veterans Health Administration populations. He intends his current program's thesis to focus on developing appropriate quantitative measures to evaluate chiropractic intervention based on patient performance. Paul Nolet, D.C., seeks his MPH at Lakehead University in Thunder Bay, ONT. As a private practitioner with multiple publication in the Journal of the Canadian Chiropractic Association, Dr. Nolet now intends to continue his education at Lakehead. He proposes to work with Dr. Pierre Cote and use the data from the Saskatchewan Health and Back Pain Survey to do a prospective, longitudinal cohort study comparing neck pain and headaches n the general population of Saskatchewan to those in the province who have a history of neck trauma due to motor vehicle collision. Sydney Rubinstein, D.C., is pursuing a PhD in Epidemiology at the Institution for Research in Extramural Medicine, one of the research institutes at the VU University Medical Center in Amsterdam, The Netherlands. Dr. Rubinstein has one of the most extensive and distinguished bibliographies ever seen from an applicant for FCER Fellowship. He is currently one of the principal investigators of a prospective cohort study of 580 chiropractic patients in The Netherlands who are undergoing cervical manipulation. With Dr. Scott Haldeman, Dr. Rubinstein has developed a model and attempt to explain the etiology of dissection with specific reference to manipulation. He plans to examine why the medical profession views cervical manipulation as dangerous in the absence of definitive information. "Nothing less than the future of chiropractic research rests with these individuals who have chosen this demanding yet rewarding career path," said FCER’s Director of Research and Education, Anthony L. Rosner, Ph.D. "Their achievements at this stage already rival those of far more senior faculty, and we are as proud as hopeful that these Fellows show every indication that their contributions to the research literature will be recognized for years to come." Information on FCER, its programs, funded research, products that support further research, and more may be found at

In the ongoing professional debate about the CCGPP Best Practice Initiative CCGPP Executive Committee, presented the fallowing views. The opinions of CCGPP do not reflect the views of New York State Chiropractic Association and are solely presented here for informational purpose. The following observations are submitted to challenge those who believe the CCGPP Best Practice Initiative will limit chiropractic care. We have a differing opinion. Please consider the following: Observation…Chronic care: The CCGPP Best Practice low back draft recommends treatment beyond every guideline in existence today. Given that reality, how could this document be used to limit chiropractic? This is the ONLY document we’ve seen supporting chiropractic treatment of chronic conditions. (see pages 5-19) Show us any others. Observation…Literature ratings: "B" and "C" ratings in the scientific community are not all bad, in fact, with nearly every category of low back condition, no treatments are rated higher than spinal manipulation. (see pages 27-30) Therefore how could this document be used to limit care? “B” and “C” are the equivalent of hitting a triple (using a baseball analogy) in the world of science. There are few home runs in the scientific literature, but manipulation for acute, subacute, and chronic care are rated at the highest levels in the CCGPP Best Practice document, thus improving our chances of expanding benefits. (see pages 27-30) Observation…Passive Modalities: Given that the insurance industry is fully aware of the low rating on passive modalities present in every guideline with which we are aware (ODG, ACOEM, AHCPR, Milliman and Robertson, etc.), what proof do the critics have that this will lead to a 30-40% reduction in income? This issue represents fear mongering at the lowest levels. Observation…X-ray: Given that the CCGPP x-ray recommendations have set the bar as low as "pain and/or limitation of motion" (see page 69), how could this document be used against us, unless you are one of the 1.9% of the DC population who believes in x-raying every patient no matter how uncomplicated the case? Again, why would this lead to a 30-40% drop income? Is there any proof? Answer: NO. Observation…Website as a Resource: Consider the incredible potential every DC will have by having access to reams of data supporting care at the click of a mouse using the website. We also will have the ability to share that information with those who would deny care using a cookbook guideline like ODG, Milliman and Robertson, and ACOEM. Observation…Best Practice vs. Guidelines: The Best Practice Initiative represents an important shift from cookbook guidelines to the "process of care", educating the payors that medical necessity must be based upon clinical decision-making, patient values, risk factors, and documentation, i.e., the uniqueness of each case, versus a guideline cookbook. Encouraging the “process of care” may be the main benefit of CCGPP’s Best Practice Initiative. Observation…Pragmatic viewpoint: To summarize, if the treatment recommendations for the core of what we do, manipulation and active care, expand from acute and subacute into the chronic pain patient population, and the x-ray and PT recommendations are basically no different from what we've been living with for the past 10 years, what is the real problem with this document? This document increases the support for chiropractic management of acute to chronic care in the third party reimbursement world. This document will enhance patient care. (again, please read pages 5-19, What Constitutes Evidence for Best Practice?”

In the ongoing professional debate about the CCGPP Best Practice Initiative Dr. Ronald J. Farabaugh, CCGPP Secretary, presented the fallowing views. His opinions do not reflect the views of New York State Chiropractic Association and are solely presented here for informational purpose. Have you ever been sued for malpractice? I have. The suit was spawned after an ignorant statement from an ER physician. He eagerly told my patient that a DC should not have been treating a herniated disc. Once the seed of malpractice was planted the patient found the possibility of a large cash award too irresistible and filed suit. The case was dropped but the issue illustrated the need for our profession to educate other medical professionals and the public at large about the literature and evidence-based benefits of chiropractic management of herniated discs. By the way, the patient consulted the ER only because he had no insurance and found that trading services with my office (he cleaned my carpets) was unrealistic. He consulted the ER since they were obligated to treat him regardless of coverage. I considered suing the ER physician, but decided to educate him instead. I also attempted to understand him. In his 1997 North American Spine Society Presidential address, Dr. Saul stated: “…physicians often prescribe treatment for their patients based upon their most recent success or failure. We skim our journals for articles that appeal to us, and sort out information that does not support our frame of reference. Even learned people will tend to gather and synthesize information preferentially as it supports and relates to their own opinions and objectives.” “Sort out the information”…….I wonder how many of us are guilty of that level of creative rationalization? Bottom line: despite the uncanny ability for us humans to selectively consider evidence, including literature, we must educate the masses. Recognition of this tendency has let our group, CCGPP, to develop a useable means of sifting through the literature, and it is important to understand the how Best Practice will benefit you and your practice. Please consider the short list of BP benefits: 1. Education of medical providers: This document can be used to educate medical professionals of all types (MDs, DOs, PTs, optometrists, podiatrists, dentists, athletic trainers, nurses, surgeons, personal trainers, massage therapists) in your geographical area about the benefits of DC treatment, especially spinal manipulation and active care, which received the highest rating for the most common conditions treated by DCs. Those who educate win!! 2. Stimulate Referrals: When the medical field has confidence in the literature, and they have a relationship developed thru various forms of communication (email, letters, research summaries, DVDs, websites, etc.) they will readily refer in an effort to help their own patients. This document provides you the resources and confidence you need to begin a consistent program of communication. 3. Education of third party payors, benefit managers, and employers to potentially expanded benefits: We have a better chance to preserve or enhance benefits related to the services provided by DCs given the high rating related the core of a chiropractic practice: manipulation and active care. This document provides us the tools/information we need to educate decision-makers in order to influence benefits in a positive manner. 4. Fight bad consultants. This document can and will be used to illuminate the illogical profit-driven opinions of income-dependant, predictably negative consultants. This document clearly supports chiropractic management for chronic pain, a hot button area of consistent denial by bad consultants who seem oblivious to the literature supporting chiropractic treatment of the chronic pain patient. If you want to shoot back, you need ammunition! 5. Allows greater discretion for physician decision-making. Probably the greatest benefit of this document is the shift away from consultant denials based on traditional guidelines and literature only, and supports the reality that medically necessary care is based upon the combination of: (a) literature, (b) clinical experience, and a consideration of risk factors/stratification that affects the natural history of a condition, and (c) patient preferences. Gone forever should be the consultant denial language of “there is no literature”. Why? Support for care depends more upon the documentation and response to care, versus the literature alone. Literature provides a foundation for care, but should not tyrannize care. This document honors the fact that each patient is unique. 6. More good news: This document clearly identifies the fact that the average chiropractic practice is on an equal, if not superior, scientific foundation compared to most other forms of medical treatment. 7. Patient information: Patients today are Internet savvy, intelligent, and have an emerging knowledge of “Best Practice”. This document and process, along with the other information technologies including interactive websites, DVDs, patient focused publications, etc., will be utilized by those looking for an evidence-based, best practice DC. Patients will seek you out if you become BP certified. What if we do nothing? If we do nothing in the area of evidence-based practice we risk being tyrannized by those who will do it for us, without chiropractic input. It’s been happening for years. We’ve all felt the negative effects of ODG, ACOEM, Milliman and Robertson, and other guidelines that consultants and third party payors have used inappropriately to limit your care. We need to move in a different direction. The Best Practice movement is a concept long overdue. Either we gather and rate the evidence or it will be handed to us on someone else’s financially motivated platter. The future is bright for chiropractic, IF we accept that times are a chang’in. Remember, “Life is Change. Growth is Optional.” Let’s grow together!

Consumption of Vitamin D tablets was found to cut the risk of pancreatic cancer nearly in half, according to a study led by researchers at Northwestern and Harvard universities. The findings point to Vitamin D’s potential to prevent the disease, and is one of the first known studies to use a large-scale epidemiological survey to examine the relationship between the nutrient and cancer of the pancreas. The study, led by Halcyon Skinner, Ph.D., of Northwestern, appears in the September issue of Cancer Epidemiology Biomarkers & Prevention. The study examined data from two large, long-term health surveys and found that taking the U.S. Recommended Daily Allowance of Vitamin D (400 IU/day) reduced the risk of pancreatic cancer by 43 percent. By comparison, those who consumed less than 150 IUs per day experienced a 22 percent reduced risk of cancer. Increased consumption of the vitamin beyond 400 IUs per day resulted in no significant increased benefit. “Because there is no effective screening for pancreatic cancer, identifying controllable risk factors for the disease is essential for developing strategies that can prevent cancer,” said Skinner. “Vitamin D has shown strong potential for preventing and treating prostate cancer, and areas with greater sunlight exposure have lower incidence and mortality for prostate, breast, and colon cancers, leading us to investigate a role for Vitamin D in pancreatic cancer risk. Few studies have examined this association, and we did observe a reduced risk for pancreatic cancer with higher intake of Vitamin D.” Skinner, currently in the Department of Population Health Sciences at the University of Wisconsin School of Medicine and Public Health, and his colleagues analyzed data from two long-term studies of health and diet practices, conducted at Harvard University. They looked at data on 46,771 men aged 40 to 75 years who took part in the Health Professionals Follow-up Study, and 75,427 women aged 38 to 65 years who participated in the Nurses’ Health Study. Between the two studies, they identified 365 cases of pancreatic cancer. The surveys are considered valuable for their prospective design, following health trends instead of looking at purely historical information, high follow-up rates and the ability to enable researchers like Skinner to incorporate data from two independent studies. Pancreatic cancer is a rapidly fatal disease and the fourth-leading cause of death from cancer in the United States. This year, the American Cancer Society estimates that 32,000 new cases of cancer will be diagnosed. About the same number of people will die this year from the disease. It has no known cure, and surgical treatments are not often effective. Except for cigarette smoking, no environmental factors or dietary practices have been linked to the disease. In addition to Vitamin D, the researchers also measured the association between pancreatic cancer and the intakes of calcium and retinol (Vitamin A). Calcium and retinol intakes showed no association with pancreatic cancer risk, although retinol is an antagonist of Vitamin D’s ability to influence mineral balances and bone integrity. For that reason, further research is necessary to determine if Vitamin D ingestion from dietary sources, like eggs, liver and fatty fish or fortified dairy products, or through sun exposure might be preferable to multi-vitamin supplements, which contain retinol. The potential benefits of vitamin D for pancreatic cancer were only recently established by other laboratory studies. Normal and cancerous pancreas tissue contain high levels of the enzyme that converts circulating 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D, the vitamin’s active form. Other studies have shown an anti-cell proliferation effect of 1,25-dihydroxyvitamin D, potentially inhibiting tumor cells. “In concert with laboratory results suggesting anti-tumor effects of Vitamin D, our results point to a possible role for Vitamin D in the prevention and possible reduction in mortality of pancreatic cancer. Since no other environmental or dietary factor showed this risk relationship, more study of Vitamin D’s role is warranted,” Skinner said. Skinner’s colleagues in the study include Dominique Michaud, Edward Giovannucci, Walter Willett and Graham Colditz of Harvard, and Charles Fuchs of the Dana-Farber Cancer Institute. News release, American Association for Cancer Research.

Benjamin Ofori, Driss Oraichi, Lucie Blais, Evelyne Rey, Anick Bérard ABSTRACT BACKGROUND: Many women take non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy but the risks for the infant remain controversial. We carried out a study to quantify the association between those women prescribed NSAIDs in early pregnancy and congenital anomalies. METHODS: A population-based pregnancy registry was built by linking data from three administrative databases in Quebec between 1997-2003. The inclusion criteria were mothers of live singleton infants, between 15-45 years of age, covered by the RAMQ drug plan 12 months before and during pregnancy, and prescribed an NSAID or other medications during pregnancy. We selected as cases infants with any congenital anomaly (ICD-9; 740-759) diagnosed in the first year of life. Up to 10 controls, defined as infants with no congenital anomalies detected were selected for each case. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. RESULTS: Within the registry, 36,387 pregnant women met the inclusion criteria. We identified 93 births with congenital anomalies in 1056 women (8.8%) who filled prescriptions for NSAIDs in the first trimester of pregnancy, compared to 2478 in 35,331 (7%) women who did not. The adjusted OR for any congenital anomalies for women who filled a prescription for NSAIDs in the first trimester was 2.21 (95% CI=1.72-2.85). The adjusted OR for the anomalies related to cardiac septal closure was 3.34 (95% CI=1.87-5.98). There were no significant associations with anomalies of other major organ systems. CONCLUSIONS: Our study suggests that women prescribed NSAIDs during early pregnancy may be at a greater risk of having children with congenital anomalies, specifically cardiac septal defects. Birth Defects Research (Part B), 2006. © 2006 Wiley-Liss, Inc. Benjamin Ofori 1, Driss Oraichi 1, Lucie Blais 2, Evelyne Rey 3, Anick Bérard 1Research Center, Sainte-Justine Hospital, Montreal, Quebec, Canada 2Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, Montreal, Quebec, Canada 3Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, Montreal, Quebec, Canada

With approximately 2 million spectators lining its route and 270 million watching world wide the ING New York City Marathon is a monumental international event which redefined marathoning. To runners everywhere this is THE marathon. Now is your chance to join the large team of chiropractors and chiropractic students who volunteer along with thousands of other health professionals to provide first aid to the runners and help them make it to the finish line. Dr. Stephen Perle, who is the chiropractic coordinator for the ING NYC Marathon is asking for your support by volunteering to be a part of the medical team. There are many D.C.s for whom their experience at the ING NYC Marathon has provided them with the skills to work at their local road races and serve their local communities better. Volunteers will be providing first aid only to runners. So no need to bring any equipment. There will be shirts, and rain suits supplied to all medical staff volunteers. Everyone MUST attend one of two obligatory orientation in the evening of Monday or Tuesday before the race (Oct 30 or 31) at the Hilton New York. One MUST attend ONE of the orientations. The application must be mailed (no faxes or emails) to Dr. Perle so he has it by September 25th. So do not hesitate fill it out and mail it today to: Stephen M. Perle, D.C., M.S. Chiropractic Coordinator, ING New York City Marathon University of Bridgeport 225 Myrtle Ave Bridgeport, CT 06604 Please see the race web site for more information about the race in general - www.ingnycmarathon.org. If you are interested or have more specific questions about being a volunteer on the medical team, please contact Dr. Perle via email [email protected]. Below please find the application to be a medical volunteer at the 2006 ING New York City Marathon.

Patients in New York who need physical therapist services can now go directly to their physical therapist without having to wait to receive a referral from a physician. New York is the 43rd state to pass "direct access" legislation that eliminates, under certain conditions, the physician referral requirement for patients needing physical therapist services. The Consumer Access to Physical Therapy bill, S3169/A5622, passed the legislature with bipartisan support and was signed into law late yesterday by Governor George E Pataki. It will become effective in 120 days. This new law will allow patients to directly access the services of a licensed physical therapist for ten visits or thirty days, whichever comes first. "Physical therapists have been working with the state legislature to achieve direct access for patients for nearly 25 years. Now patients in New York, like patients in many other states, will have improved access to physical therapy care. This bill is a thoughtful piece of legislation with patient safety taking the highest priority," said James Dunleavy, PT, MS, president of the New York Physical Therapy Association (NYPTA). "The American Physical Therapy Association (APTA) applauds the state legislature for passing this important legislation to provide patients with direct access to physical therapist services," said APTA President R Scott Ward, PT, PhD. "Direct access helps to remove unnecessary barriers to healthcare and gives consumers a choice in accessing physical therapist services. Many states have had direct access laws on the books for nearly 30 years and evidence has shown that direct access to physical therapist services is cost-effective, safe and has improved access to care. Now residents of New York will be able to benefit from the same access to quality physical therapy services." The New York Physical Therapy Association (NYPTA) is a non-profit professional association of approximately 5,000 physical therapists, physical therapist assistants and students. The NYPTA is dedicated to serving the public's health interests, improving the standard of health for people of all ages and advancing the benefits of physical therapy and the interests of physical therapy professionals in the state of New York. The American Physical Therapy Association is a national professional organization representing more than 66,000 members. Its goal is to foster advancements in physical therapy practice, research, and education. For more information visit The New York Physical Therapy Association (NYPTA) by clicking on the link:

The New York Road Runners this year initiated a new race the NYC Half Marathon which will go from Central Park to Battery Park. This race in the past has been only in Central Park. For its initial year this race was limited to ten thousand runners and it took only 5 minutes to "sell out." Dr. Stephen Perle who is the chiropractic coordinator for the ING NYC Marathon is asking for your support by volunteering to be a part of the medical team. He says that this is a good opportunity to "get ones feet wet" at a "smaller" race before volunteering for the ING NYC Marathon. There is no obligation to volunteer for this race in order to volunteer for the ING NYC Marathon or visa versa. Volunteers will be providing first aid only to runners. So no need to bring any equipment. There will be shirts and possibly hats supplied to all medical staff volunteers from Nike. Unlike the ING NYC Marathon there is no obligatory orientation. Volunteers will need to show up around 6 am and should be done around 10:30 Please see the race web site for more information about the race in general - New York Road Runners Club. If you are interested or have more specific questions about being a volunteer on the medical team, please contact Dr. Perle via email [email protected] Please keep your eyes on NYSCA's web site for information about volunteering at the ING NYC Marathon which will be November 5th. Keep that date open we would love to see hundreds of chiropractors volunteering.