The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) has released the long-awaited initial draft of their low back best-practice document. This draft will remain posted on this site in order to solicit responses for 60 days, from May 11, 2006 until July 10, 2006. After that date, this draft will be removed from this site and your comments will be compiled by our survey contractor. The lower back team will then examine the results obtained for any potential impact on the chapter, with changes being made as necessary. The following draft includes introductory chapter background information. This is followed with rationale and other information that will assist the reader in the examination of the document and which will provide insights into the process that our organization followed when constructing this document. The full text information on the lower back is next followed by tables, appropriate references and search strategies employed. We request that the reader examines the draft in its entirety in order to be able to arrive at informed conclusions concerning the content. CCGPP has focused on typical presentations seen in a chiropractic office in this document and the subject material of other chapters may be found elsewhere on this site. Since wellness care has always been a traditional and significant focus of chiropractic practice, this topic is both woven into individual chapter information as well a separate chapter which also addresses this component of care. At the conclusion of the draft document, the reader will be directed to a third-party survey site to answer a few questions and to also provide additional comments, if it is appropriate. The site is: www.surveymk.com. Again, if you are an interested consumer, patient, third-party payor representative, representative of a governmental agency or other interested stakeholder, you may instead visit www,Spine-Health.com in order to examine more abbreviated lower back draft summary information and to also offer comments. Comments and additional references provided by the reader potentially can alter the draft, so we request that contributors formulate responses carefully and accordingly.

GREELEY, Colo.—Vernon R. Temple, D.C., of Bellows Falls, Vt., was elected as director-at-large and president of the National Board of Chiropractic Examiners during the Annual Meeting on May 6, 2006 in Portland, Ore. Dr. Temple was first elected to serve the National Board as District III director in the year 2000. He has previously served on the NBCE Executive Committee as secretary and vice president. In his work on the NBCE Board of Directors, Dr. Temple has also chaired the Computerization Committee and the Special Purposes Examination Committee. Dr. Temple is a graduate of Palmer College of Chiropractic in Davenport, Iowa, and has been in practice in Vermont since 1978. He is a diplomate of the American Board of Chiropractic Orthopedists. He is a former chairman of the Federation of Chiropractic Licensing Boards and has also served as president of the Vermont Board of Chiropractic Examination and Regulation. Headquartered in Greeley, Colorado, the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. The NBCE Executive Committee. Vernon Temple,DC - President Steve Willen, DC - Cchairman of the Board Jerry Blanchard, DC - Vice President Theodore Scott, DC - Treasurer Mary Ellen Rada, DC - Secretary Source: National Board of Chiropractic Examiners

(Washington, D.C - May 11, 2006) In a historic victory for chiropractors and their patients, S.1955, the Health Insurance Marketplace Modernization and Affordability Act, was withdrawn from the Senate floor today and effectively defeated when Democrats threatened to filibuster the bill. The controversial small business health plan legislation spurred an unprecedented grassroots lobbying campaign by the American Chiropractic Association and hundreds of provider and consumer groups that believed the bill would gut state patient protection laws and leave millions of patients without crucial health care benefits. “The ACA extends an enormous ‘thank you’ to the entire chiropractic profession – state associations, individual doctors, patients, students, chiropractic college leaders and other organizations – everyone who joined together to successfully defeat this potentially devastating legislation,” said ACA President Richard Brassard, DC. “A special thank you also goes out to our allies in Congress – Senators Tom Harkin, Jeff Bingaman, Ted Kennedy, Harry Reid and others – for their outstanding leadership on this important issue. Not only did we safeguard the health coverage of millions of patients across the country, but we also showed the nation’s decision makers that the chiropractic profession is a force to be reckoned with. I can assure you that your thousands of emails, faxes and phone calls to Congress, letters and news releases to local media organizations, and other grassroots efforts made the difference.” Deliberations on S.1955 began Tuesday, when Senate Democrats, in a procedural move, voted to allow the bill to advance to the Senate floor -- with debate limited to 30 hours. On Thursday afternoon, after Senate Majority Leader Bill Frist announced that debate would end and limited amendments to S.1955 would be considered, Senate Democrats voted against cloture and the bill was pulled from consideration. The defeat of S.1955 comes after a nearly two- month-long grassroots lobbying campaign kicked off in March at the ACA’s 31st annual National Chiropractic Legislative Conference (NCLC) in Washington, DC. During that meeting, ACA’s House of Delegates declared a “state of emergency” in response to S.1955 and committed to using “all available resources” to defeat the bill. Chiropractors nationwide joined together in the effort and flooded U.S. Senate offices with concerns about the bill. At the same time, ACA and a diverse coalition of labor unions, health care and consumer groups – including AARP, the American Cancer Society, the American Diabetes Association and the AFL-CIO -- shared information and resources in a national lobbying and media relations campaign to defeat the legislation. “Today, we can breathe a great sigh of relief,” added Dr. Brassard, “but only for a moment. The small business or association health plan concept is a popular one, and a new bill will almost certainly surface again in the very near future. The ACA will work to ensure that the chiropractic profession has a place at the table when a new proposal is developed, and we will once again call the chiropractic profession to action when necessary to ensure the health and well being of our patients.”

ABSTRACT Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood. Objective: To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care. Design: Observational cohort study. Setting: 2 managed care organizations. Patients: Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period. Measurements: Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview. Results: Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care. Limitations: Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage. Conclusions: Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality. Annals 2 May 2006 | Volume 144 Issue 9 | Pages 665-672

On April 30, 2006, a group of DC’s represented NYSCA at the the New York State Democratic Committee’s Dinner held at the famous Waldorf Astoria Hotel. In attendance were Dr. H. William Wolfson, President NYSCA Suffolk Chapter and ACA NYS Metro Delegate. Dr. Louis Lupinacci, NYSCA Board member and ACA NYS Alternate Metro Delegate. Dr. Don Littlejohn, NYSCA Board member and co-chair NYSCA Legislative Task Force. Dr. Michael Bernstein, President NYSCA Nassau Chapter, NYSCA Board member and co-chair NYSCA Legislative Task Force. Dr. Peter Samsone, President NYSCA Manhattan Chapter, and Dr. Michael Minardo a NYSCA member. These doctors attended, on behalf of NYSCA, and made their presence known to the elected officials. The doctors were able to meet and speak with the many Democratic leaders in attendance. Senator Hillary Clinton, Attorney General Eliot Spitzer, Assembly Speaker Sheldon Silver, former NYS Governor Mario Cuomo, former HUD Andrew Cuomo and Comptroller Alan Hevisi, are just a few democratic leaders these doctors were able to thank for their support of our profession. These leaders were all aware of NYSCA’s presence and told our members of their appreciation for attending this exciting event.

Norwalk, Iowa — In the April 1, 2006 issue of the Journal of the Royal Society of Medicine, Ernst and Canter summarized 16 systematic reviews published between 2000 and May 2005 on the effectiveness of spinal manipulation. The Foundation for Chiropractic Education and Research (FCER) is always open to results of research if the research proves to be of good quality and lacking bias. The biases in this study are painfully apparent, rendering the sweepingly negative “findings” little more than the authors’ personal opinions. Ernst and Canter concluded that these data do not demonstrate that spinal manipulation is an effective intervention for any condition.” According to them, the data fail to demonstrate that spinal manipulation is effective for treating back pain, neck pain, dysmenorrhea, infantile colic, asthma, allergy, cervicogenic dizziness, and any medical complaint. The exception was for back pain, where spinal manipulation may be superior to sham manipulation but not to conventional interventions. Considering the possibility of adverse events associated with spinal manipulation, the authors determined that their review "does not suggest that spinal manipulation is a recommendable treatment." This study is so far from what would be considered a methodical and robust systematic review without bias as to render it highly suspect if not meaningless. Its methods of analyses have not been validated but rather reveal the authors' own carelessness — if not outright distortion — of the literature which it cites. Many of its glaring defects are ones that the authors attempt to criticize in other work. It fails to grasp how the hypotheses and methods of analysis in the reviews that it cites are bound to deliver differing conclusions, such that Ernst and Canter go out of their way to criticize the positive findings of a single chiropractic author while overlooking their own consistently negative findings for chiropractic which appear in no less than 25% of the reviews that they include in their discussion. Finally, the authors fail to recognize the major flaws in several of the primary sources of data which comprise the systematic reviews under scrutiny in this research. There are issues surrounding the Ernst and Canter review that substantially undercut any prompt and uncritical acceptance of its conclusions. These include (1) the failure of systematic reviews and meta-analyses to consider subgroups of patients receiving treatment, (2) the design flaws of a large number of the randomized controlled trials which comprised the systematic reviews addressed in this report, (3) the failure to consider that modern evidence-based medicine is based upon clinical observation as well as randomized clinical trials, (4) the failure to adequately address the relative risks of other treatments available in conventional medicine for the conditions discussed in this review, and (5) numerous revelations of bias of one of the authors (Ernst) which have been amply demonstrated and refuted elsewhere. Under these circumstances, Ernst and Canter's study can be greeted only with the most extreme skepticism. In lacking many of the elements required for a meaningful presentation of the evidence required for supporting treatment alternatives, this current report should not be considered worthy of guiding a clinical decision. As such, the glaring weaknesses of the report only serve to undermine the public's confidence in science as a means to inform health policy.

DALLAS, TEXAS – February 27, 2006 – A consensus conference was held February 17 through February 19 at the National University of Health Science outside of Chicago to focus on recommendations in a plan of action for the chiropractic profession as a whole. Leading the Chiropractic Strategic Planning Conference was John J. Triano, D.C., Ph.D., who focused on issues of credibility and appropriate utilization of chiropractic care by the public. “It is nice to have a forum for our physicians to discuss the hurdles chiropractic care has to overcome, independent of formal professional association politics,” said Triano, who served as head of the conference’s steering committee. “Chiropractic care has come a long way in past years and this gives us a way to mold the profession to reach higher goals and better serve our patients in the future.” Attending the conference were leaders in chiropractic education, research and practice who heard recommendations from experts in the study of health professions, health care futurists, medicine and federal research programs. Together, the group worked to come to a resolution on important issues related to the current and future state of chiropractic care. Among the issues discussed were the barriers to and opportunities for greater integration and interprofessional cooperation. From these discussions, two distinct priority areas emerged, integrity and trust and equitable public support for education and research. (please see below for exact wording of resolution) Regarding the issue of integrity and trust, those in attendance focused on the inappropriate treatment and billing practices adopted by some members of the chiropractic profession that often place the economic interests of these chiropractors before the best interests of the patients. The attendees resolved that this treatment undermines public trust in all members of the chiropractic profession, whether they are participants in the practice or not. The other topic heavily discussed was equitable public support for education and research. Attendees at the conference voiced their concern of the absence of fair and equitable public funding and support for chiropractic education and research in both public and private institutions. Specifically, the conference found a lack of support within the academic and interdisciplinary environments, including participation with publicly funded universities and health care facilities. “I, along with the rest of the conference, urge the chiropractic profession along with its leaders and regulators to address the issue of integrity and trust among our profession,” said Triano. “I feel that the ultimate goal of improved quality care within the North American health care system can only be reached when all members of the profession, along with stakeholders, strive for and demand equitable public support for education and research within the chiropractic care sector.” Jim Winterstein, D.C. who also serves as a member of the steering committee added, “The chiropractic profession has much to offer the public in the way of health care. It is my hope that this planning process can begin to turn the tide toward greater cultural authority for the chiropractic profession and better care for our patients.” Future conferences are in the planning stages under the conferences multidisciplinary steering committee, which consists of professional journal editors, association leaders, a college president, private chiropractic practitioners and a medical physician who serves as director of the Samueli Institute. Formal Resolution by The Chiropractic Strategic Planning Conference: At the Chiropractic Strategic Planning Conference, leaders in chiropractic education, research, and practice resolved that the ongoing fuller integration of chiropractic education and practice within the North American health care system, and improved communication and collaboration between doctors of chiropractic and other health professionals, are in the interests of patients and all parties concerned. Following a review of the barriers to, and the opportunities for, such greater integration and interprofessional cooperation, the conference identified and acknowledged two priority areas that need to be addressed, namely: a. Integrity and trust. The inappropriate treatment and billing practices adopted by some members of the profession that place the economic interests of the chiropractor before the best interests of the patient undermines public trust in all members of the profession. b. Equitable public support for education and research. There is an absence of fair and equitable public funding and other support for chiropractic education and research in either public or private institutions. Specifically, there is a lack of support within the academic and interdisciplinary environments, including participation with publicly-funded universities and health care facilities. The Conference urges the chiropractic profession, and its leaders and regulators, to address the first above matter, and the profession and all other stakeholders to address the second above matter, to the ultimate end of improved quality care within the North American health care system. CONTACT INFORMATION: Wendy B. Kula, APR 972-991-5852 [email protected] Britney B. Chambers, MJ 972-991-5852 [email protected] The Chiropractic Strategic Planning Conference is lead by an interdisciplinary ad hoc steering committee of concerned professionals convened to address issues involved with the chiropractic care industry. Attendees and speakers at events are invited from lists of leaders, authors, scientists, practitioners and educators in chiropractic, medicine and law in North America. Members of the Samueli Institute and the National Center for Complementary and Alternative Medicine also attend the conference. A progressive, formal consensus process defining methods of improving professional transparency, accountability and appropriate utilization of these services are followed. The conference was initially conceived as a one-time event, but attendees voted that an additional meeting be convened during the spring or summer of 2006 to make further advances on critical patient care issues. For more information on the future event, please contact John J. Triano, D.C., Ph.D., at [email protected].

Nation’s Largest Independent PPO Poised for Growth New York, NY – MultiPlan, Inc. and The Carlyle Group yesterday completed the previously announced acquisition by Carlyle of MultiPlan, the largest independent PPO in America. This acquisition will facilitate the growth of MultiPlan’s market share and expansion of its medical cost management solutions, which include the national PPO network, specialty networks, negotiation services and a claim transaction and information management engine. Mark Tabak, Chief Executive Officer of MultiPlan, said, “These are exciting times for MultiPlan, and MultiPlan is an exciting company for our time. We’re a significant player in a trillion-dollar market, and with new owners committed to our success we’re even better positioned for impressive growth.” Karen Bechtel, Managing Director and Co-head of Carlyle’s Healthcare Group, said, “We’re pleased to have gotten to this important stage. MultiPlan has the proven technology and management depth necessary to bring its growth plan to fruition. We look forward to supporting the company’s strategy and making this a successful investment.” Headquartered in New York, MultiPlan is the oldest and largest independent Preferred Provider Organization (PPO) network offering nationwide access to more than 4,300 hospitals, 100,000 ancillary care facilities and 450,000 physicians and specialists. MultiPlan serves a base of 2,000 large and mid-sized insurers, third-party administrators, self-funded plans, HMOs and other entities that pay claims on behalf of health plans. The company’s top 10 clients together deliver health coverage to more than 70 million Americans. About MultiPlan For 35 years, MultiPlan has helped healthcare payers and providers partner together to combat rising healthcare costs. MultiPlan serves as a single gateway to a host of primary, complementary and out-of-network strategies for managing the financial risks associated with healthcare claims. Clients include large and mid-sized insurers, third-party administrators, self-funded plans, HMOs and other entities that pay claims on behalf of health plans. About The Carlyle Group The Carlyle Group is a global private equity firm with $39 billion under management. Carlyle invests in buyouts, venture & growth capital, real estate and leveraged finance in Asia, Europe and North America, focusing on aerospace & defense, automotive & transportation, consumer & retail, energy & power, healthcare, industrial, technology & business services and telecommunications & media. Since 1987, the firm has invested $18.1 billion of equity in 463 transactions for a total purchase price of $73.2 billion. The Carlyle Group employs more than 650 people in 14 countries. In the aggregate, Carlyle portfolio companies have more than $46 billion in revenue and employ more than 184,000 people around the world.

The Power of the Yankee Fans New Book features all the characteristics and elements that define the Yankee faithful There is no doubt in professional sports that teams will never succeed without the support of their fans. In the case of the New York Yankees, their history in baseball is filled with many great moments, many unforgettable players and the fact that millions have cheered and supported them all through the years. Such a following is now a multi-generational phenomenon and readers can find out by joining author Joan Fallon as she presents an in-depth look at what being a Yankee fan is all about with the release of her exciting new book 27: The Voice of the Yankee Fans. 27 looks at what it will take for the Yankees to win their 27th world championship in the future as well as the fans’ role in that championship. Aside from showcasing the team’s fabled history and legendary players (including Babe Ruth and Mickey Mantle), the book also explains elements of the new and old baseball thinking, provide readers a unique look at fan participation in baseball, and finally it defines the Yankee fan as a unique individual whose love for the team can never be doubted or ignored. Thanks to its amazing content and compelling photography, and illustrations by the award-winning sports artist James Florentino, 27 is highly recommended to Yankee fans and baseball fans of all ages, and it will undoubtedly make them understand their role with the team. Even non-fans or spectators will find the book attractive not only to satisfy their interest in baseball but it will also give them the clearest definition of what is it really like to be a Yankee fanatic. For your reading pleasures, feel free to look for 27: The Voice of the Yankee Fans online at Xlibris.com, www.amazon.com and at major bookstores and libraries today! About the Author Dr. Joan Fallon, a New York chiropractor and former assistant professor at Yeshiva University and presently CEO of CureMark, a biotechnology company, is a life-long Yankee fan and student of the game. Wiith two major passions in her life baseball and children; “Dr. Joan” as she is called by her patients, has passed on her love of baseball and the Yankess to two generations of children in her office. A nationally-ranked squash player in college, “one-on-one” champion in High School and the first female to enter the Westchester County Jounior golf tournament, sports has always been a big part of her life. She has been honored to have a letter written to Mickey Mantle chosen for his farewell book: Letters To Mickey, as well as having authored numerous professional texts and papers. She takes great pride in her chiropractic pediatic practice as she is able to help numerous children, many of whom have developmental disabilities. As a patent holder and CEO of CureMark she hopes to bring significant help to children with ADD, ADHD, and autism in the very near future.

Assemblyman Latimer, of the 91st District, a strong and outspoken proponent of Chiropractic attends NYSCA District 8 (Westchester) April 12 Meeting. The Assemblyman 91st District encompasses City of Rye, Town of Rye (Village of Port Chester, Rye Brook, and Mamaroneck), Town of Mamaroneck, Larchmont and part of New Rochelle. Assemblyman started his appearance before the NYSCA District 8 meeting with a comparison. "Political life is like being Elizabeth Taylor's seventh husband - you know what's expected of you but can you equal the performance?" District 8 President Dr. Janusz Richards stated that Assemblyman Latimer equaled the performance Wednesday night, with his most informative talk, giving all present very specific direction on how to best accomplish our legislative aims. "Get your story to the legislators - let them know what you do." Mr. Latimer distributed handouts of our insurance equality correction bill (A04527) and our workers compensation bill (A08340) both of which he is a co-sponsor. He has worked closely with us in the past. However, he admitted that Wednesday's meeting was a learning experience for him, i.e. NYS Business Council's history of opposition to chiropractic legislation and the reasons why. Although a freshman Assemblyman, who is running for re-election this November, he comes from a most accomplished background. Originally schooled and worked in the hotel industry he is married with one daughter. He is a former City of Rye Councilman, Past Chairman of the Westchester County Democratic Party, and Past Chairman of the Westchester County Board of Legislators. It was a most profitable evening for all those that attended. All came away with strong feelings of support for this true friend of the profession. Ms. Taylor would be proud of him!

Through private market reforms, all Massachusetts citizens to be insured by 2009 Governor Mitt Romney signed landmark legislation today that through a private, market-based reform will make health insurance available to every resident of Massachusetts within the next three years. “An achievement like this comes around once in a generation, and it proves that government can work when people of both parties reach across the aisle for the common good,” said Romney. “Today, Massachusetts is leading the way with health insurance for everyone, without a government takeover and without raising taxes.” The legislation was approved by a bipartisan 154-2 margin in the House of Representatives and a 37-0 vote in the Senate. It was signed at a Faneuil Hall ceremony attended by hundreds of people. “This would not have been possible without the courageous work of Senate President Travaglini, Speaker DiMasi, providers, insurers, consumer groups and all the other industry stakeholders who recognized an opportunity to do something historic,” said Romney. The law requires every individual in the state to purchase health insurance by July 1, 2007. Of the approximately 500,000 uninsured, about 100,000 are eligible for Medicaid, another 200,000 making less than 300 percent of the federal poverty level, but not eligible for Medicaid will receive premium assistance on an income-based sliding scale for policies with no deductibles, and another 200,000 with incomes above 300 percent FPL will be able to purchase lower-cost policies in the private market. Premium assistance will be financed by redirecting a portion of the $1 billion currently spent by state government on the uninsured. Beginning on January 1, 2008, failure by individuals to purchase health insurance will result in the loss of their state tax refund equal to 50 percent of an affordable health insurance premium. Penalties will be assessed for each month without creditable coverage. The creation of an entity, the Commonwealth Care Health Insurance Connector, will allow individuals to now purchase affordable plans on a pre-tax basis. The Connector will administer premium assistance for low-income individuals and facilitate employer contributions for both full-time and part-time workers and those working at more than one company. Eligible to purchase through the Connector are non-working individuals, working individuals at companies that do not offer health insurance, workers not eligible for coverage at their place of business such as part-timers, contractors and new employees, small businesses with 50 or fewer employees, and those who are self-employed. The legislation also enhances the goal of greater transparency in health care cost and quality through the collection and publication of data needed by consumers to make informed decisions. The information will allow consumers to compare the quality, track record and cost of hospitals and providers. The passage of the legislation moves Massachusetts closer to the implementation of a waiver that will allow the state to continue to receive $385 million in federal funding for each of the next two years. The waiver was negotiated by Governor Romney and Senator Kennedy last year, and was dependent on the state developing a “demonstration project” to reduce the rate of uninsured. The Executive Office of Health and Human Services has already begun providing details of the Massachusetts plan for review by federal Medicaid officials. Former U.S. Health and Human Services Secretary Tommy G. Thompson commended Governor Romney for signing what Thompson termed “groundbreaking legislation to provide health coverage to all Massachusetts families.” “Massachusetts is showing us a better way, one I hope policy makers in Statehouses and Congress will follow to build a healthier and stronger America,” said Thompson, a former Republican governor of Wisconsin. The Governor vetoed the creation of a new fee on businesses. The $295 per employee fee would have been assessed to employers with 11 or more full-time workers who do not offer and contribute to their employees’ health insurance. The Governor said the fee is “not necessary to implement or finance health care reform.” The Governor also vetoed a provision to provide dental benefits to adult Medicaid recipients, which will cost $75 million annually. Romney said the benefits expansion is financially unsustainable and noted that it provides a service not offered by most Massachusetts employers. Sixty percent of employers in Massachusetts do not provide dental coverage to their workers.

Transitions, New York Chiropractic College’s alumni magazine, has won two Awards of Distinction from The Communicator Awards 2006 Print Competition. The Communicator Awards is an international competition that recognizes excellence in the field of communication. Transitions magazine was judged by industry professionals and recognized for exceeding industry standards in communicating a message or idea. Over 5,000 entries were received and Transitions was presented with an Award of Distinction in the Educational Institution category for two recent issues; “’Tis the Season” and “Jobs”. Transitions magazine is produced by NYCC’s Department of Institutional Advancement.

According to a study released on Monday April 3, 2006 by HealthGrades medical errors remain a leading cause of death and injury at hospitals nationwide. New York hospitals ranked at the bottom when it comes to keeping patients from developing complications or new infections while in the hospital. To read the full study click on the link below. Third Annual Patient Safety in American Hospitals Study Note: You must have Adobe Acrobat Reader to view the study.

A Randomized Controlled Trial Context Prolonged calorie restriction increases life span in rodents. Whether prolonged calorie restriction affects biomarkers of longevity or markers of oxidative stress, or reduces metabolic rate beyond that expected from reduced metabolic mass, has not been investigated in humans. Objective To examine the effects of 6 months of calorie restriction, with or without exercise, in overweight, nonobese (body mass index, 25 to <30) men and women. Design, Setting, and Participants Randomized controlled trial of healthy, sedentary men and women (N = 48) conducted between March 2002 and August 2004 at a research center in Baton Rouge, La. Intervention Participants were randomized to 1 of 4 groups for 6 months: control (weight maintenance diet); calorie restriction (25% calorie restriction of baseline energy requirements); calorie restriction with exercise (12.5% calorie restriction plus 12.5% increase in energy expenditure by structured exercise); very low-calorie diet (890 kcal/d until 15% weight reduction, followed by a weight maintenance diet). Main Outcome Measures Body composition; dehydroepiandrosterone sulfate (DHEAS), glucose, and insulin levels; protein carbonyls; DNA damage; 24-hour energy expenditure; and core body temperature. Results Mean (SEM) weight change at 6 months in the 4 groups was as follows: controls, –1.0% (1.1%); calorie restriction, –10.4% (0.9%); calorie restriction with exercise, –10.0% (0.8%); and very low-calorie diet, –13.9% (0.7%). At 6 months, fasting insulin levels were significantly reduced from baseline in the intervention groups (all P<.01), whereas DHEAS and glucose levels were unchanged. Core body temperature was reduced in the calorie restriction and calorie restriction with exercise groups (both P<.05). After adjustment for changes in body composition, sedentary 24-hour energy expenditure was unchanged in controls, but decreased in the calorie restriction (–135 kcal/d [42 kcal/d]), calorie restriction with exercise (–117 kcal/d [52 kcal/d]), and very low-calorie diet (–125 kcal/d [35 kcal/d]) groups (all P<.008). These "metabolic adaptations" (~ 6% more than expected based on loss of metabolic mass) were statistically different from controls (P<.05). Protein carbonyl concentrations were not changed from baseline to month 6 in any group, whereas DNA damage was also reduced from baseline in all intervention groups (P <.005). Conclusions Our findings suggest that 2 biomarkers of longevity (fasting insulin level and body temperature) are decreased by prolonged calorie restriction in humans and support the theory that metabolic rate is reduced beyond the level expected from reduced metabolic body mass. Studies of longer duration are required to determine if calorie restriction attenuates the aging process in humans. JAMA. 2006;295:1539-1548.

A Message from the Comptroller Dear Friend, The State of New York is currently holding billions of dollars in unclaimed funds. Some of this money may belong to you! For your protection, banks, insurance companies, utilities, investment companies and many other businesses are required by State law to surrender inactive accounts to the State. As State Comptroller, I serve as custodian of this money until you claim it. The State of New York never takes ownership of this money. If you can prove you are entitled to the money, I will gladly return it to you, at any time, without charge. This website will tell you how to avoid having your money turned over to the State and how to get it back if it is abandoned.

American dieters just got some new help in their battle of the bulge. New York Chiropractic College (NYCC) in Seneca Falls, New York, is instituting a nutritional program that will prepare experts to assist patients with their diet-related problems. NYCC’s new program, founded by world-renowned nutritionist, Dr. Shari Lieberman, will enable matriculating healthcare professionals to blend clinical nutrition applications with existing preventative and treatment options. It is structured to provide comprehensive professional education to prepare graduates to practice in a wide range of clinical, consulting and industry settings. It will emphasize an integrative approach to healthcare with the specific aim to provide a professionally oriented curriculum, focused on clinical nutrition and its application in prevention and disease management. The program emphasizes an integrative approach to healthcare, and is applicable to practice in a wide range of clinical, consulting and industry settings. The 36-credit hour (540 hours), six-trimester program differs significantly from many nutrition curricula because of its focus on applied clinical nutrition and its application in prevention and disease management. Graduates will be able to individually design intervention programs that encompass diet, exercise, nutritional supplementation (e.g., vitamins, minerals, botanicals, essential fatty acids, amino acids), well suited for private practitioners, for integrative practice with other professionals, and for consultant roles with research and industry. Coursework: When and Where? The program is designed for working health professionals who are currently healing patients and working to prevent the onset of illness. Consequently, NYCC’s coursework is uniquely designed to be taught one weekend per month allowing busy professionals to participate. Coursework is delivered through NYCC’s interactive video teleconferencing system located in each location: Levittown, NY (Long Island), Seneca Falls, NY, and DePew, NY (near Buffalo) and is supplemented with online computer modules. The College has found that this method of teaching offers a number of benefits for its students. Delivery of the course to students in all three locations allows students to interact with the instructor and other students in real time, thereby allowing for personal interaction between instructor and students to occur at each site at least once per term. The faculty – all highly accredited seasoned professionals with clinical research experience – will “rotate” teaching in each of the centers during the trimester, thereby allowing for physical interaction between instructor and students to occur at each site at least once per term. For more information about New York Chiropractic College’s Applied Clinical Nutrition program, contact the office of Admissions at 1-800-234-6922, visit the College at 2360 State Route 89 in Seneca Falls, N.Y., or log on to www.nycc.edu.

We incorporated the views of patients to develop a comprehensive set of ideal physician behaviors. Telephone interviews were conducted in 2001 and 2002 with a random sample of 192 patients who were seen in 14 different medical specialties of Mayo Clinic in Scottsdale, Ariz, and Mayo Clinic in Rochester, Minn. Interviews focused on the physician-patient relationship and lasted between 20 and 50 minutes. Patients were asked to describe their best and worst experiences with a physician in the Mayo Clinic system and to give specifics of the encounter. The interviewers independently generated and validated 7 ideal behavioral themes that emerged from the interview transcripts. The ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Ways that physicians can incorporate clues to the 7 ideal physician behaviors to create positive relationships with patients are suggested. Mayo Clin Proc. 2006;81(3):338-344 To read a review by Ann Edmundson, MD click on the link below.

U.S. Senator Mike Enzi (R-Wyoming) Chairman of the U.S. Senate Health Education and Labor (HELP) Committee is the primary sponsor of S.1955, proposed legislation intended to help small businesses and associations obtain more affordable group health insurance for their employees. While well intended, this legislation would extend ERISA’s preemption to cover the small group insurance market now regulated at the state level. As a practical matter, this legislation would render useless state-enacted legislation such as chiropractic specific mandates, any-willing provider, and insurance equality laws intended to protect health care providers and consumers. If enacted into law, S.1955, would preempt all state mandated benefit legislation not just those that are specific to the chiropractic profession. Press Release LANDMARK AGREEMENT REACHED ON HEALTH INSURANCE MARKET REFORM BILL, ENZI SAYS; MARK-UP SCHEDULED Washington, D.C. - U.S. Senator Mike Enzi (R-WY), Chairman of the Senate Health, Education, Labor and Pensions Committee (HELP Committee), today announced a landmark agreement between key stakeholders on a broad-ranging health insurance bill to provide more affordable health insurance options to America’s small businesses and working families - and confirmed that the Committee will markup up the bill next week. “Working with a diverse group of Senators and business groups representing small business, we’ve bridged the gap between small business proponents of traditional AHPs and state-based interests worried about the prospects of dramatic regulatory changes in health insurance markets,” Enzi said Thursday. The bill is cosponsored by Senator Ben Nelson (D-NE) and Senator Conrad Burns (R-MT). Enzi has scheduled a mark-up of the bill on Wednesday, March 8th at 10 a.m. in the HELP Committee. Senator Nelson said: “If we don’t do something to help small businesses cope with the costs of health care, soon we will have an entire workforce without health insurance coverage. Health care premiums are experiencing double-digit growth annually; small businesses can’t keep up with the costs. As a result, fewer employers are offering health coverage and fewer employees are covered. The continuing problem of skyrocketing heath care costs is a grave threat to our working families. I am pleased to be working with the Chairman to finding a workable solution to this problem.” Senator Burns said: “The Health Insurance Marketplace Modernization and Affordability Act represents the best opportunity to bring affordable health insurance to small businesses in Montana and across the nation. I know this is a goal for all Senators, and I look forward to working with members from both sides of the aisle in achieving this important goal.” The bill, “The Health Insurance Marketplace Modernization and Affordability Act,” (S.1955) will allow business and trade associations to band their members together and offer group health coverage on a national or statewide basis in direct response to runaway costs that are driving far too many employers and families from comprehensive health insurance. Since 2000, for example, group premiums for family coverage have grown nearly 60 percent, compared to an underlying inflation rate of 9.7 percent over the same period. Designed to enhance the market leverage of small groups as well as individual policy holders, “The Health Insurance Marketplace Modernization and Affordability Act” will: give associations a meaningful role on a level playing field with other group health plans; streamline the current hodgepodge of varying state regulation; preserve the primary role of the states in health insurance oversight and consumer protection; make lower-cost health plan options available; and achieve meaningful reform without a big price tag. “We are nearing almost five years of double-digit growth in health insurance premiums – increases that have repeatedly exceeded more than five times the rate of inflation,” Enzi said. “This inflationary spiral is lowering the quality of life for countless families and hurting our economy. But those hardest hit are America’s small businesses and families outside of employer-provided insurance. Never before has there been a more urgent need to encourage market reforms like those proposed in this bill.” It responds to pleas from small business trade groups to be allowed to pool their members and provide group health insurance, called Small Business Health Plans (SBHPs) under the Enzi bill, but will also include safeguards to protect against adverse effects that could result if new group plans were given a blanket exemption from consumer protections available under state laws and regulations. Enzi praised the support of Senator Nelson and Senator Burns, the bill’s cosponsors, saying: “I’m pleased to be joined by my colleagues, Senator Nelson and Senator Burns. They bring invaluable experience to this effort and I am grateful for their commitment to this issue.” He also praised the cooperation of Senator Olympia J. Snowe (R-ME), Chair of the Senate Committee on Small Business, and Senator Jim Talent (R-MO), who have been working for years to give more affordable health insurance options to America’s small businesses. “I want to thank them for their constant efforts,” Enzi added. “We owe them thanks for never losing sight of that important goal.”

Arlington, Va.- President Bush signed legislation yesterday that not only reverses the current 4.4 percent Medicare physician payment reduction, which went into effect on the first of year, but will also provide automatic reprocessing of claims retroactive to Jan. 1, 2006. The legislation was included in the Deficit Reduction Act. “The ACA is extremely pleased that Congress has halted the current cut in physician Medicare payments and that they have made the change retroactive,” said ACA President Dr. Richard G. Brassard. “The return to the 2005 rate is at least partial recognition by Congress that health care providers face significant challenges in today’s practice environment.” The Centers for Medicare & Medicaid Services (CMS) said it expects contractors to begin paying new claims using 2005 rates within two days of the legislation’s enactment. In addition, doctors of chiropractic will not need to resubmit existing claims submitted between Jan. 1 and Feb. 8, 2006. Contractors will automatically reprocess any claims that used the rates effective as of Jan. 1, 2006, and will instead use the zero percent update retroactive to Jan. 1. CMS estimates contractors should be able to reprocess all claims by July 1, 2006. Providers will receive retroactive payment for the differential in a lump sum. Physician fee schedule amounts are determined by regulation and the only way they can be changed is through legislation; this puts the issue in the hands of Congress. In late 2005, Congress evaluated the issue, but technical amendments in the Senate prevented final action on this critical issue until this week. CMS, recognizing that the physician payment adjustment could increase beneficiaries’ co-payments and deductibles for previously billed services, has suggested to the Department of Health and Human Services (HHS) that if a beneficiaries’ co-pay changed on Jan. 1, 2006, a physician waiver of the amount now owed by the beneficiary should not be considered inducement. More information will be available on the ACA Web site once a final decision has been made by HHS. “The ACA will continue to lobby on behalf of its members for fair reimbursement of Medicare services. It is imperative that Congress and HHS develop a permanent solution to the physician fee schedule because those most affected by this annual dilemma are not doctors, but patients,” said Dr. Brassard. Therapy Caps For most doctors of chiropractic – with the exception of those DCs participating in the Medicare Demonstration Project – coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine. However, the ACA has received numerous questions concerning therapy caps. With language included in Deficit Reduction Act, the President also authorized the Centers for Medicare and Medicaid Services (CMS) to develop a new exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the $1,740 cap in 2006. The ACA will provide more information as it becomes available on its web site.

The Women's Health Initiative Randomized Controlled Dietary Modification Trial ABSTRACT Context The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure Invasive breast cancer incidence. Results Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison. Ross L. Prentice, PhD; Bette Caan, DrPH; Rowan T. Chlebowski, MD; Ruth Patterson, PhD; Lewis H. Kuller, MD; Judith K. Ockene, PhD; Karen L. Margolis, MD; Marian C. Limacher, MD; JoAnn E. Manson, MD; Linda M. Parker, DSc; Electra Paskett, PhD; Lawrence Phillips, MD; John Robbins, MD; Jacques E. Rossouw, MD; Gloria E. Sarto, MD; James M. Shikany, DrPH; Marcia L. Stefanick, PhD; Cynthia A. Thomson, PhD; Linda Van Horn, PhD; Mara Z. Vitolins, DrPH; Jean Wactawski-Wende, PhD; Robert B. Wallace, MD; Sylvia Wassertheil-Smoller, PhD; Evelyn Whitlock, MD; Katsuhiko Yano, MD; Lucile Adams-Campbell, PhD; Garnet L. Anderson, PhD; Annlouise R. Assaf, PhD; Shirley A. A. Beresford, PhD; Henry R. Black, MD; Robert L. Brunner, PhD; Robert G. Brzyski, MD; Leslie Ford, MD; Margery Gass, MD; Jennifer Hays, PhD; David Heber, MD; Gerardo Heiss, MD; Susan L. Hendrix, DO; Judith Hsia, MD; F. Allan Hubbell, MD; Rebecca D. Jackson, MD; Karen C. Johnson, MD; Jane Morley Kotchen, MD; Andrea Z. LaCroix, PhD; Dorothy S. Lane, MD; Robert D. Langer, MD; Norman L. Lasser, MD; Maureen M. Henderson, MD JAMA. 2006;295:629-642. FOR FREE FULL TEXT CLICK ON THE LINK BELOW: