Arlington, Va. (June 23, 2005) — The American Chiropractic Association today responded to the report issued by the Office of the Inspector General with the following statement: It is the opinion of the American Chiropractic Association (ACA) that the findings stated in the report issued by the Department of Health and Human Services, Office of the Inspector General reflect a universal problem in physician documentation and do not represent a concerted effort by doctors of chiropractic to over bill the government for non-reimbursable Medicare services. As has been shown with other physician groups, the documentation process frequently presents challenges and oftentimes results in perceived errors; however, it is simply wrong to conclude, based solely on this report, that chiropractic care typically rendered to Medicare beneficiaries is not necessary or appropriate. In far too many instances, chiropractic providers are simply failing to adequately document the medically necessary care provided. The ACA is committed to working with Centers for Medicare and Medicaid Services (CMS) to develop and implement efficient mechanisms to greatly improve the documentation process and help eliminate errors. It is unfortunate that the Inspector General’s report, drawn from 2001 data, provided only a passing reference to a program initiated in October 2004 that specifically addresses the very problems mentioned in this report. In addition, the Inspector General’s analysis completely ignores ACA’s vigorous and ongoing development of a documentation manual for use by doctors of chiropractic, and its educational programs targeted at state associations, chiropractic colleges, and Medicare carriers. The solution offered by the Inspector General -- to impose arbitrary caps or limits on chiropractic services -- does not take into account the individual needs of the patient. Medicare beneficiaries have the right to receive care which is reasonable and necessary, and the solution offered by the OIG arbitrarily cuts short this right, rather than to addressing the true problem of documentation. The ACA contends that placing arbitrary limits -- or caps -- on care is not an appropriate solution. Lastly, the ACA strenuously objects to the suggestion made in the report that it, at any time, supported the notion of arbitrary caps on services. The cited letter does not support that contention. The ACA is highly confident that the chiropractic care being provided through the Medicare program is both appropriate and medically necessary. We believe access to chiropractic care in Medicare saves taxpayer dollars as it is typically far less expensive than alternative forms of treatment, which often require the use of drugs and surgery. The ACA will continue to pursue all possible means to ensure that doctors of chiropractic have access to the resources they need to help correct the documentation issues raised in this report. We will also continue to protect the rights of all Medicare beneficiaries so they may continue to receive chiropractic services.

According to the Inspector General (IG) report, the government overpaid nearly $285 million in 2001 for chiropractic services. To prevent abuses, the IG recommends that caps should be placed on the number of treatments a chiropractor could bill Medicare. The ACA said that the government instituted new procedures last year to help Doctors of Chiropractic avoid improperly billing Medicare, nothing that the IG’s data cited is four years old. To examine the IG’s report click on the link below:

Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection Paul Little, MD; Kate Rumsby, BA; Joanne Kelly, BSc; Louise Watson, PhD; Michael Moore, MRCGP; Gregory Warner, MRCGP; Tom Fahey, MD; Ian Williamson, MD ABSTRACT Context Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. Objective To estimate the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection. Design, Setting, and Patients A randomized controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics). Intervention Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics). Main Outcome Measures Symptom duration and severity. Results A total of 562 patients (70%) returned complete diaries and 78 (10%) provided information about both symptom duration and severity. Cough rated at least "a slight problem" lasted a mean of 11.7 days (25% of patients had a cough lasting 17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days; 95% confidence intervals [CI], –0.37 to 1.88; immediate, 0.11 days; 95% CI, –1.01 to 1.24) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001), fewer patients were "very satisfied" (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P<.001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet, 0.11; and leaflet, 0.17; P = .02). Conclusion No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics. Author Affiliations: Primary Medical Care Group, University of Southampton, Highfield (Drs Little, Watson, and Williamson, and Mss Rumsby and Kelly); Nightingale Surgery, Romsey, Hants (Dr Warner); Three Swans Surgery, Salisbury (Drs Moore and Fahey), England; and Department of Primary Care, Dundee University, Dundee, Scotland (Dr Fahey). JAMA. 2005;293:3029-3035

ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Author Affiliations: Department of Public Health, University of Massachusetts, Amherst (Dr Bertone-Johnson); Channing Laboratory (Drs Hankinson, Willett, and Manson) and Division of Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; Departments of Epidemiology (Drs Hankinson, Willett, and Manson) and Nutrition (Dr Willett), Harvard School of Public Health, Boston; GlaxoSmithKline Consumer Healthcare, Parsippany, NJ (Dr Bendich); and Department of Obstetrics and Gynecology, The University of Iowa, Iowa City (Dr Johnson). Arch Intern Med. 2005;165:1246-1252.

IMMEDIATE ACTION REQUIRED Earlier this week, Senate Bill S.3169a and Assembly Bill A.5622a, legislation that would grant physical therapists “direct access” in New York state were amended to “A” prints and started to move. The former Senate Bill, S.3169, contained protections penned into the legislation by the NYSCA and the Medical Society in the Fall of 2002. These protections have been completely discarded in the “A” print of S.3169 – now S.3169a. The companion legislation in the state Assembly, A. 5622a, has been amended to mirror the Senate legislation making the possibility of passage of Physical Therapy Direct Access more probable. YOU NEED TO ACT NOW. For more information, click on the link below.

One of the most common disorders of premenopausal women is premenstrual syndrome (PMS) however, women that get plenty of calcium and vitamin D may prevent PMS. ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Archives of Internal Medicine 2005;165:1246-1252.

ABSTRACT: Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19–64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixty-one million) were under- or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage. You can view the article (full text) by clicking on the link below:

According to a research published in the June 11, 2005 issue of The British Medical Journal, painkillers with ibuprofen may increase the risk of heart attacks by up to 24 percent. Abstract Aims To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) in primary care between 2000 and 2004; to determine these risks in patients with and without pre-existing coronary heart disease and in those taking and not taking aspirin. Design Nested case-control study. Setting 367 general practices contributing to the UK QRESEARCH database and spread throughout every strategic health authority and health board in England, Wales, and Scotland. Subjects 9218 cases with a first ever diagnosis of myocardial infarction during the four year study period; 86 349 controls matched for age, calendar year, sex, and practice. Outcome measures Unadjusted and adjusted odds ratios with 95% confidence intervals for myocardial infarction associated with rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, and other selective and non-selective NSAIDS. Odds ratios were adjusted for smoking status, comorbidity, deprivation, and use of statins, aspirin, and antidepressants. Results A significantly increased risk of myocardial infarction was associated with current use of rofecoxib (adjusted odds ratio 1.32, 95% confidence interval 1.09 to 1.61) compared with no use within the previous three years; with current use of diclofenac (1.55, 1.39 to 1.72); and with current use of ibuprofen (1.24, 1.11 to 1.39). Increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs; these risks were significant at < 0.05 rather than < 0.01 for current use but significant at < 0.01 in the tests for trend. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease. Conclusion These results suggest an increased risk of myocardial infarction associated with current use of rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs. BMJ 2005;330:1366 (11 June)

A Kansas City nonprofit organization has formed to try to begin offering chiropractic degrees and to improve people’s health by opening wellness centers according to an article in The Kansas City Star. According to this article written by Lynn Franey a higher education reporter for The Kansas City Star, Gerald Jensen a former vice chancellor at the University of Missouri-Kansas City has created the Chrysalis Institute. Most recently, Jensen was an administrator at the Cleveland Chiropractic College in Kansas City, Missouri. To learn more read the complete story in The Kansas City Star by clicking on the link below. The Kansas City Star - Institute is planning chiropractic degrees or Chrysalis Institute

The New York State Chiropractic Association is proud to announce the May 2005 election results. The individuals below are elected to the following office: PRESIDENT Dr. Mariangela Penna VICE PRESIDENT Dr. Bruce A. Silber SECRETARY Dr. Robert Brown TREASURER Dr. Richard J. Tesoriero DIRECTOR Dr. Robert J. DeSantis, Jr.* Dr. Malcolm Levitin Dr. Louis Lupinacci* Dr. David B. Kartzman Dr. Lloyd Kupferman (* serving for a 2nd term) The new officers and Directors will assume their elected office on June 1, 2005. NYSCA thanks all the candidates that participated in this year’s election and congratulates our new Officers and Directors. In this election, nearly 450 ballots were cast representing one of our highest voter “Turn-Out” ever.

ACA Asks Doctors Nationwide for More Data into Problems Affecting Patient Care and Reimbursement (Arlington, Va) The American Chiropractic Association (ACA), as part of its ongoing aggressive campaign to correct the wrongful practices of certain chiropractic managed care networks, is asking doctors of chiropractic nationwide to provide additional information that will assist in putting an end to these practices. Among the wrongful practices that the ACA is gathering information about are the following: • Automatic downcoding or limiting physician discretion in the planning of care: The doctor submits the network's forms after examining the patient and is advised of the frequency, duration and type of care that will be covered. Requested treatment is often reduced or denied. Claims are downcoded without the doctor of chiropractic being provided the opportunity to provide any documentation supporting the claim as submitted. • Bundling: The submitted CPT code is incorporated into another submitted CPT code. • Improper utilization review including refusal to recognize coding modifiers: Managed care organizations sometimes refuse to recognize "modifiers" that chiropractors append to CPT codes to report a service or procedure that has been performed and which has been altered by some specific circumstance. • Performance management issues: Managed care networks often disregard the doctor's discretion to diagnose and treat, and limit the number of visits, x-rays and modalities. Doctors say they are reprimanded and threatened with the loss of their contract when the care they prescribe is outside the managed care organization's set standards. "For too long, there has been a misguided perception within the profession that ACA somehow condones the unfair practices of certain chiropractic networks," explained ACA President Donald Krippendorf, DC. "In reality, the ACA strongly denounces these practices and needs your support and information to put an end to what we view as unconscionable activity by these groups." The latest campaign to correct these harmful practices is an outgrowth of a resolution passed by the ACA House of Delegates in March 2002 formally outlining ACA's opposition to the improper practices of chiropractic networks and authorizing ACA staff to collect data identifying the types of abuses doctors of chiropractic experience at the hands of third-party administrators. As part of this effort, ACA recently retained the services of Milberg Weiss, one of the nation's largest class action law firms, to assist in the collection and analysis of this information. Over the past three years, hundreds of doctors of chiropractic have contacted ACA and completed "managed care data collection" forms detailing their troubling experiences with chiropractic networks - and the names of several specific organizations and trends have emerged. According to the data collected by ACA, doctors of chiropractic are most troubled by the actions of American Chiropractic Network (ACN), American Specialty Health Plans (ASHP) and Landmark Healthcare. These carriers routinely deny requested treatment and improperly reduce and deny reimbursement, putting patients and quality of care at risk, according to doctors who contacted ACA. ACA's data collection efforts have uncovered an array of serious concerns with these carriers, but more information is needed regarding particular problem areas. "We have heard your complaints, and we are further analyzing our options to deal with these activities," added Dr. Krippendorf. "We need your continued support and information to protect not only your practice and profession, but also the quality of care you provide your patients." In addition to canvassing the chiropractic profession for more data into specific problem areas, the ACA is also contacting certain chiropractic networks and demanding that they cease the misleading use of ACA's name and trademark in their communications and treatment forms. In a May 13, 2005, letter to ASHP President George DeVries, ACA Executive Vice President Garrett F. Cuneo demands that ASHP remove the "unauthorized and misleading reference and use of the ACA name" in the company's "Clinical Treatment Form." "Please be advised that the ACA views this unauthorized use of its name in connection with the misleading representation contained in your form as defamatory, a violation of its trademark and a continuing unfair trade practice that has resulted and continues to result in damage to the association," Cuneo wrote. The full letter can be found on ACA's Web site at: letter to American Specialty Health (ASHP). The ACA is requesting that doctors of chiropractic who have experienced problems with ACN, ASHP, and Landmark in the areas of restriction of treatment, downcoding, bundling and improper use of modifiers fill out the data collection form found on ACA's website at: CARE DATA COLLECTION FORM. Please fax the completed form to (703) 243-2593, Attention: PDR Department. Your information will be kept in strict confidence and your name will not be released to any managed care network. You will also find additional information and resources regarding ACA's data collection campaign and what you can do to assist in this effort on ACA's Web site at: Are You Having Problems with Chiropractic Networks and Managed Care Organizations? For more information: Felicity Feather Clancy Vice President, Communications [email protected] phone: (703) 276-8800, ext. 241 or Angela Kargus Communications and Public Relations Manager [email protected] phone: (703) 276-8800. ext 240

The Chiropractic Learning Resource Center (CLRC) planned for construction on the Palmer College of Chiropractic campus will now include state-of-the-art outpatient clinic facilities, College officials have announced. Groundbreaking for the CLRC, to be located on the east side of Brady Street, will take place later this year with an anticipated completion date in 2007. The new building is the centerpiece of the College’s $35 million capital campaign, which has raised nearly $26 million in gifts and pledges and is now in its completion phase. College officials expect to complete the campaign by the end of 2006. “The new Chiropractic Learning Resource Center and its world-class clinic facility will further enhance the education students receive at Palmer,” said Palmer President Donald Kern, D.C. “We are so excited to add clinic facilities to this new building, which will be a focal point on campus, a crossroads for the entire profession, and will provide alumni, faculty, students and researchers with an educational resource found nowhere else in the chiropractic profession.” Preliminary plans call for the facility to include more than 40,000 square feet of space, which will be used to house: • Community outpatient clinic facilities • Clinical learning resources for students • Radiology services • Rehabilitation services • Visitor center The Palmer College capital campaign goals are as follows: • $12.9 million for Chiropractic Learning Resource Center • $7.1 million for revitalization of campus facilities • $5 million for annual operating funds • $10 million for cash and deferred endowment needs As part of total contributions to the campaign thus far, Palmer College has received $5.2 million in federal funding, of which $3.9 million has been designated for the CLRC. “We are so appreciative, amazed and humbled by the level of support we have received thus far in our capital campaign,” added Palmer’s Chief Development Officer Drew Boster. “Our alumni, friends, employees and the local community have been extremely generous with their gifts and their time in this endeavor. I would like to take this opportunity to thank our local alumni and community leaders who have been instrumental in our progress thus far. Reaching our goal will ensure that we continue to graduate the most talented and skilled chiropractors in the profession by giving them the best tools, education and inspiration here at The Fountainhead of chiropractic.”

Peter D. Ferguson, D.C., of Canton, Ohio was re-elected President of the National Board of Chiropractic Examiners during their Annual Meeting May 7 in Montreal, Quebec, Canada. Dr. Peter Ferguson was elected to return as NBCE President after serving for one year as Chairman of the Board, during which Dr. James Badge served as president. Following the elections, Dr. Ferguson took the opportunity to address his intentions for the coming year. Although I was reluctant to once again serve as president, I am honored to do so. Under the circumstances that this position is only for one year, and that year being such a short period of time, my aim is to continue building upon Dr. Badge’s work over this past year and to also build upon the work that I accomplished during my previous tenure as president. I am dedicated to the continual pursuit of reducing expenses of the Board and increasing communication with the delegates, alternate delegates, state board members, chiropractic colleges and students and the chiropractic profession. My overall goal is to do the right thing for the chiropractic profession and that is continuing to do what the Board has done so well for the past 42 years—providing excellent pre-licensure examination services that regulatory bodies can depend on as appropriate and legally defensible. Dr. Ferguson was first elected to serve the National Board as Director-at-Large in 1999. When Dr. Ferguson was elected as President to the Board in 2000, the National Board was at a crossroad. Under Dr. Ferguson’s guidance, the NBCE made many changes. In response to a continual decline in exam revenue the Board cut its budget and found it necessary to increase exam fees for the first time since 1992. In 2000 Dr. Ferguson initiated National Board Days at chiropractic colleges to improve relations with the chiropractic college students. Since 2000, an NBCE director has visited every chiropractic college at least once and the NBCE has also welcomed members of chiropractic college student leadership to its facilities. Another noteworthy change experienced by the NBCE during Dr. Ferguson’s term as president was the first election of a female to the NBCE Board of Directors. Additionally, since 2000, the National Board has introduced two new, optional examinations: Acupuncture in 2003 and the NBCE Ethics and Boundaries exam in 2004. With the Board’s commitment to improving communications with the profession, the National Board began printing a quarterly newsletter in 2000, and in March 2003 introduced monthly reports. Over the past five years the Board has also been committed to the development of a comprehensive Web site that provides information on the Board and NBCE examinations, as well as news updates and other relevant information. During the past year, exam brochures and applications were included on the NBCE Web site as a convenience for examinees so that they could fill out these forms online before submission to the board. A graduate of National College of Chiropractic in Illinois, Dr. Ferguson’s responsibilities outside the NBCE have included being a member to both the U.S. Department of Defense Chiropractic Health care Demonstration Oversight Advisory Committee and to the Advisory Committee on Interdisciplinary, Community-Based Linkages, U.S. Department of Health and Human Services. In 1998, Dr. Ferguson received the prestigious George Arvidson Award for Meritorious Service to Chiropractic Licensure for his involvement with the Federation of Chiropractic Licensing Boards (FCLB), which Dr. Ferguson previously chaired. He is a fellow of the International College of Chiropractors, and also a fellow of the American College of Chiropractors. Dr. Ferguson is also a member of the Board of Trustees at New York Chiropractic College, the former director for the Council on Chiropractic Education, former president of the Ohio State Board of Chiropractic Examiners, member of the President’s Advisory Board at Walsh University and Chairman of the Civil Services Commission in Canton, Ohio. 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.

"Perseverance is the hard work you do after you get tired of doing the hard work you already did". -Newt Gingrich On May 3rd a historic course of events took place when over 100 doctors of chiropractic "Marched on Albany" to make our voices heard and that of our patients'. We met one on one with individual legislators and explained why they needed to support NYSCA/NYCC Joint Legislative Task Force's Technical Corrections Bill and other relief legislation. The DC's who attended were well briefed and prepared to answer the questions asked by these legislators. Afterwards, we all met for an informal gathering to wind down and socialize with each other. The day was a huge success and time will tell if out efforts were worthwhile. We will discuss the day's event at our meeting. In addition, the delegates report will be given on what transpired at the House meeting May 14-15, 2005. No matter what the outcome, all of us need to decide what our purpose is--in practice, in life, family… More than ever before we need to come together as chiropractors and fight this battle and win…once and for all. It will take hard work, commitment-both financial and time, but the ultimate victory will benefit all of us and our patients. We are unique, we are different and we are here to stay!

On April 28, 2005 the New York Chiropractic Legislative Task Force met with Attorney General Eliot Spitzer and the chief of the AG's Health Bureau, Mr. Joseph Baker regarding our issues with insurance inequality. Officers of both, the New York State Chiropractic Association and the New York Chiropractic Council as well as NYSCA attorney Ross Lanzafame, Esq. and NYSCA legislative counsel Don Mazzullo, Esq. and the NYCC legislative counsel, Andy Roffé, Esq. represented the Task Force. The meeting gave the Task Force the opportunity to discuss the non-compliance with the insurance equality law and the abuses put forth by the carriers and their IPA/Utilization Review agents. Mr. Spitzer and Mr. Baker understood our issues and recognize the areas where they might be of assistance in intervening with the Insurance Department. The Task Force will be in continuing communication with the Attorney General’s office with regard to these issues and there will be future meetings with the Health Care Bureau and the Attorney General’s aides to resolve these issues.

The New York State Department of Health (DOH) today released changes in New York's health advisories in the 2005-06 'Chemicals in Sportfish and Game.' This year's guide highlights health advisory changes for 25 ponds, lakes and reservoirs across the state. Twenty-four of the 25 advisories were issued due to mercury contamination identified in fish. As a result of these findings, the DOH is advising women of childbearing years and children under the age of 15 to avoid eating ANY FISH from the waters listed below. They should also avoid eating specific species of fish (northern pike, pickerel, walleye, largemouth bass, smallmouth bass and larger yellow perch) from ALL WATERS in the Adirondack and Catskill Mountain regions because of mercury contamination. The DOH recommends that all other individuals adhere to the advisories and the specified limits listed below when eating fish. The New York State Department of Environmental Conservation (DEC) regularly samples fish in New York State waters. The new information on mercury in fish is part of a comprehensive DEC study supported by the New York State Energy Research and Development Authority. Mercury and other contaminants may affect the nervous system and organs in the fetus, newborns and young children. Some of these contaminants may also build up in women's bodies and some chemicals may be passed to newborns in their mother's milk. Because some contaminants may accumulate and remain in the body for a long time, women should follow the stricter consumption advice throughout their childbearing years. New York State's waters include more than 70,000 miles of rivers and streams, three million acres in thousands of lakes, reservoirs and ponds and one million acres of marine waters. New York's fish monitoring and advisory program is among the most comprehensive in the nation. The DOH's annual health advisories provide advice for sports anglers, hunters and the general public about how to reduce exposure to chemical contaminants in the State's sportfish and game. Specific advisories now apply to 117 New York waters. This year, the DOH reviewed DEC sampling data collected from more than 2,500 fish in 84 waters across the state. A general, and long-standing, statewide advisory applies to sportfish taken from any fresh waters in the state and some marine waters at the mouth of the Hudson River. The general advice is to EAT NO MORE THAN ONE MEAL (1/2 pound) of fish per week. The fish advisories are published in the Fishing Regulations Guide and the game advisories are published in the Hunting and Trapping Regulations Guide issued by DEC. The complete Health Advisories and additional information can be obtained from the DOH's web site at http://www.nyhealth.gov/nysdoh/fish/fish.htm or by contacting the Department's toll-free information line at 1-800-458-1158. New DOH health advisories have been issued for the following waters: • Breakneck Pond (Rockland County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Canada Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches and chain pickerel (all sizes). • Chase Lake (Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Chodikee Lake (Ulster County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Crane Pond (Essex County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Dunham Reservoir (Rensselaer County) – EAT NO walleye and EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Elmer Falls Reservoir (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • Francis Lake (Lewis County) –EAT NO MORE THAN ONE MEAL PER MONTH of chain pickerel (all sizes). In addition, based on lower mercury levels in smaller yellow perch, the previous advisory for yellow perch has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches (the previous advisory applied for all sizes of yellow perch.) • Franklin Falls Flow (also known as Franklin Falls Pond; Franklin and Essex Counties) - EAT NO walleye (all sizes). • High Falls Pond (Lewis County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Kings Flow (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Loch Sheldrake (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Meacham Lake (Franklin County) - EAT NO smallmouth bass and EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes of both species). • Middle Stoner Lake (Also known as East Stoner Lake; Fulton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Moshier Reservoir (Herkimer County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass (all sizes). • North-South Lake (Greene County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass larger than 15 inches. • Red Lake (Jefferson County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Rio Reservoir (Orange and Sullivan Counties) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Russian Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of yellow perch larger than 9 inches. • Salmon River Reservoir (Oswego County) - EAT NO MORE THAN ONE MEAL PER MONTH of largemouth bass and smallmouth bass (all sizes of both species). • Spy Lake (Hamilton County) - EAT NO MORE THAN ONE MEAL PER MONTH of smallmouth bass larger than 15 inches. • Sunday Lake (Herkimer County) - EAT NO chain pickerel (all sizes). • Swinging Bridge Reservoir (Sullivan County) - EAT NO MORE THAN ONE MEAL PER MONTH of walleye (all sizes). • Weller Pond (Franklin County) - EAT NO MORE THAN ONE MEAL PER MONTH of northern pike (all sizes). • Advisory Change for Canadice Lake Canadice Lake (Ontario County) – The advisory for Canadice Lake trout has been changed to EAT NO MORE THAN ONE MEAL PER MONTH of lake trout larger than 25 inches, based on lower PCB levels in smaller lake trout (the previous advisory applied to all sizes of lake trout.) A previous advisory to EAT NO MORE THAN ONE MEAL PER MONTH of brown trout (all sizes) remains in effect.

The Institute of Alternative Futures wants YOUR input. Ordinarily, an organization like the Institute for Alternative Futures draws on the views of knowledgeable “experts” handpicked or recommended to the Institute from a variety of sources in an effort to divine trends and various scenarios into the future. In the case of chiropractic, this has the unfortunate side effect of leaving out the mass “experts” who are slugging it out everyday practicing chiropractic and eking out a living in the ever-evolving health care marketplace. Recognizing this, the Institute is providing YOU with the opportunity to CHIME IN and SOUND OFF on what YOU think the future holds for chiropractic. The IAF link (below) allows you to express your “expert” views on the future of chiropractic. Before you render your expert opinion, however, the NYSCA suggests that: • you provide yourself sufficient time to be thoughtful and contemplative; • don’t vent just after you had a trying day or nasty argument with the latest machinations of a claims adjuster or clinical peer reviewer of some insurer/HMO/network or utilization review agent; • try to be calm, collected and relaxed; • close your office door and put on some soothing back ground music; • grab a cup of jo, tea or a bottle of your favorite spring water; • sit down, close your eyes and take a deep breath, • read portions of the full IAF report – The Future of Chiropractic Revisited: 2005-2015 – before venturing an answer (downloadable through the NYSCA Website); at the very minimum read through the IAF Executive Summary (found in the IAF report and excerpted below), so you can make informed decisions and educated choices about where YOU see the future of chiropractic going. Enrich the profession by sharing your insights, your experience and your “expert” opinion with the rest of the profession. Your expert opinion will be added to the opinions solicited from attendees at the Association of Chiropractic Colleges/Research Agenda Conference this past March in Law Vegas, Nevada. Results can be monitored directly by logging on to the IAF website link (included elsewhere before). By sharing your expert opinion, YOU stand a good chance of influencing the future direction of chiropractic. Be an EXPERT. Do it Now! The link to the IAF report: The Future of Chiropractic Revisited: 2005-2015 – can be found at: Future of Chiropractic Revisited The link to the IAF survey page is: Expert Survey The link to the survey tool is: Survey tool The results of this expert canvass tabulated thus far can be accessed at: Results thus far The results are filterable, that is, they can be filtered to show only the results of a select population of “experts.” IAF Highlights In 1998 the Institute for Alternative Futures (IAF) was commissioned by the National Chiropractic Mutual Insurance Company (NCMIC) to conduct a study and issue a report on the future of chiropractic care in the United States. That report received a lot of attention from various reviewers and readers in the health care system. Last year, the IAF was asked to revisit their analysis and forecasts focusing on issues and trends in the chiropractic field that have taken place since the publication of their 1998 findings. In January 2005, the Institute issued its updated report (featured below on the NYSCA Web homepage. The report may also be downloaded from the Institute for Alternative Futures website at The Future of Chiropractic Revisited As anyone knows, “[t]he future is uncertain and remains so” acknowledges the IAF, nonetheless, the Institute seeks to provide boundaries to the uncertainty that exists “in order to provide alternative views of how the future might unfold.” The Institute examined chiropractic’s strengths, its many weaknesses, the opportunities available in the health care system and the threats arrayed against chiropractic to draw four conclusions on a possible chiropractic future – some bright, others bleak. The four scenarios were as follows: Scenario 1—Slow, Steady Growth. Chiropractic continues its slow, steady growth in the numbers of chiropractors. The evidence for manipulation for back pain and neck pain is positive and cost competitive with other approaches. Wellness care for geriatric patients is also proven to improve health and mobility. Chiropractic is somewhat better integrated into the medical community though rotations during college, and because of successful integration into large delivery systems. The Department of Veterans Affairs (VA) and the Department of Defense (DoD) make chiropractic a popular covered option. Other health care delivery systems include chiropractic care as an elective option. Each year leading to 2015, chiropractic college graduates have more opportunities to practice with other types of healthcare providers than the previous class. Doctors of physical therapy (DPTs), massage therapists, and osteopathic physicians are all competitors. This competition has slowed the growth of fees and reduced the average number of visits to chiropractors. Wellness or maintenance visits are less common in most chiropractic practices, as neither the evidence nor managed care plans support them for most patients. The exception is geriatric chiropractic, where the research shows that regular chiropractic care including nutrition and exercise help keep patients healthy and mobile. Scenario 2—Downward Spiral The cost squeeze in healthcare pushes many chiropractors to the brink. Consumer demand falls and managed care removes even more chiropractic coverage from their plans. Standards of care fall, insurance fraud is common, and many chiropractors turn to unethical behavior to sustain their practices. Simultaneously, serious malpractice cases involving missed and ignored diagnosis of serious illnesses by super straight chiropractors become major media stories. By 2015, the evidence base for chiropractic effectiveness advances little over the limited indications where chiropractors had been proven effective in 2005. Other providers offer spinal manipulation for lower back, neck, and chronic pain. DPTs and massage therapists take over a large percentage of the cash market for back pain. The remaining chiropractors fight over the declining number of “true believer” patients who have had positive previous experiences with chiropractic and can afford to pay out-of-pocket. Scenario 3—Evidence Based Collaboration Manipulation is found to be both efficacious and cost effective for a variety of NMS conditions including back and neck pain, headache and some types of chronic pain. Chiropractors expand their education and training to include more NMS conditions and they push for limited prescription rights. This allows them to fill a broader role as NMS specialists. Clinical experience for chiropractors in integrated settings becomes a standard part of chiropractic education and recertification. This, combined with new authoritative studies showing the benefits of chiropractic for NMS conditions, increases the rates of referrals from medical doctors to chiropractors. Consumer-directed healthcare grows dramatically. Patients who manage their own care favor those chiropractors who score well on “report cards” which compare health care providers in their area. By 2015, the few large managed care plans that remain require patients to undergo a course of manipulation for back or neck pain before considering authorization of expensive surgery or medicines. Chiropractors have very sophisticated office information systems which include electronic patient records, the ability to link genomic information, and “patient coaching” with different chiropractic techniques. Scenario 4—Healthy Life Doctors A mindshift takes place in the US, particularly among individuals and health care systems. Chronic diseases can be forecast years in advance, and lifestyle approaches are often the most effective way to prevent disease or to reverse it in its early stages. A “healthy life” is viewed as powerful medicine and many types of providers, such as chiropractors, medical doctors, naturopathic doctors, and doctors of physical therapy, commit to build practices as “healthy life doctors”. There is increasing evidence that spinal manipulation is effective for many types of neuromuscular problems. But lifestyle or wellness approaches are effective for many of the same conditions, as well as for most viscerosomatic conditions. Many chiropractors argue that they have always included a lifestyle component in their practice -- yet only a small fraction actually did so. As the mindshift takes place in the larger society, thousands of DCs shift their practices to become “healthy life doctors”. By 2015, advances in prospective medicine allow accurate predictions of very specific risk factors for disease. Health information systems forecast health conditions by analyzing a person’s genes and sophisticated biomonitoring on all patients. Healthy life doctors specialize in providing targeted health management plans for their patients to avoid the onset of disease. Consumer-directed health plans give individuals significant choice and proactive consumers who are willing to pay for wellness/preventative care drive changes in the healthcare system. Managed care follows when it becomes apparent that preventing disease is more cost effective than treating it. INSIGHTS & RECOMMENDATIONS Chiropractic is a series of enigmas. • It is the largest and most well established complementary and alternative medicine (CAM) in the United States, but in practice many chiropractors are barely holistic or integrative. • Chiropractic is still well positioned to take advantage of newfound interest in complementary and alternative care by providing more integrative care themselves, developing better interdisciplinary teams, and doing more consistent referrals. But since we made that recommendation in 1998 DCs have done relatively little to make this integration more real. • Patient satisfaction with chiropractic care is generally high. But it is not clear if this is from spinal manipulation or the broader aspects of chiropractic care as it is delivered, including the personal attention of the chiropractor. • The acceptance of chiropractic in the Department of Veterans Affairs (VA) and Department of Defense (DoD) represent major advances. Yet wide parts of the health care provider establishment are still neutral or hostile to chiropractors and major insurers are further cutting coverage. IAF identified a number of opportunities for chiropractic profession. The inclusion of chiropractors in the VA and DoD will generate more demand and it will create better relations between conventional medical providers and chiropractors. Consumer driven healthcare with Health Savings Accounts will give consumers more choice. However, chiropractic still faces significant challenges. Healthcare cost controls, especially in managed care plans, will continue. Although patient satisfaction with chiropractic is high, the broader public has an indifferent or negative attitude to chiropractic. The efforts of chiropractors to integrate with the medical community have been hampered by the lack of internal unity in the chiropractic field. Also, the evidence for spinal manipulation is promising, but is far from conclusive. Chiropractors will face more competition, especially from the growing numbers of physical therapists who are pursuing direct patient access in all 50 states and are upgrading their educational programs to graduate Doctors of Physical Therapy. IAF’s recommendations for the most important activities the chiropractic field should pursue include: 1. Accelerate Research,: Chiropractic needs more research demonstrating the efficacy and cost-effectiveness of chiropractic for NMS conditions. Beyond NMS conditions, research on the efficacy and cost-effectiveness of chiropractic care on somatovisceral conditions is needed. The chiropractic community should aggressively promote data collection by chiropractors in their practices. The data could then be used for well-designed scientific studies. 2. Continue to Strive for High Standards of Practice: In the years ahead empowered consumers and managed care plans will demand better information on their health care providers. They will look for healthcare providers who generate good outcomes for their patients, and provide good value. The chiropractic profession should define and ensure the use of high standards of practice. 3. Develop Greater Integration with Mainstream Healthcare: Greater integration with mainstream healthcare will create many opportunities for the profession. DCs in practice need to enhance their ability to network with doctors and other health care providers, and make appropriate referrals to them. The clinical experience of chiropractic students should be improved and graduating students should have some clinical experience in settings with healthcare providers other than chiropractors. 4. Anticipate and Engage Consumer Directed Care: Consumer Directed Healthcare will be an important force shaping the future of healthcare. Chiropractic’s high patient satisfaction rates are important, but not sufficient for becoming the treatment of choice for patients. Chiropractic will also have to improve outcome measures and communicate the benefits of chiropractic care to the public through the media and consumer advocacy groups. 5. Create Greater Unity within the Profession: Creating greater unity within the profession remains a major challenge. Since we made this recommendation in 1998 there have been significant efforts towards unity, although with mixed success, and they should continue. One way to enhance unity is a shared chiropractic vision of health, health care and chiropractic. Part of this effort was made in 2000. It should be continued. 6. Enhance Individual DC’s Contribution to Public Health: Public and community health objectives are often not addressed by individual chiropractors (just as they are usually not addressed by MDs and other treatment focused health care providers). We recommend that each DC understand what contribution they can make to public/community health and do this. We recognize that many already are doing this, but most chiropractors do not. 7. Prepare for the Future of Prevention & Wellness: Scenario 4 forecasts a “healthy life doctor”. No aspect of health care has invented the business model for prevention and wellness. Chiropractors argue that they are closer to prevention and wellness than MDs and other providers. Some, but only some, chiropractors do practice prevention. But the chiropractic field will need to be inventive in defining the economics of success in this realm. 8. Develop Geriatric Chiropractic: One of the largest growth areas in healthcare will be geriatrics. The retiring Baby Boomers will look for alternative medicine that can help them to remain active and healthy. Developing better evidence for geriatric chiropractic and more in-depth postgraduate programs in geriatric chiropractic will help chiropractic expand. There is much overlap between prevention and wellness approaches for the general population and what elders need. The NYSCA and the IAF thank you for participating in this forum and poll regarding the IAF Future of Chiropractic. The link to the IAF survey page is: Expert Survey The link to the survey tool is: Survey Tool . The results of this expert canvass tabulated thus far can be accessed at: Results thus far The results are filterable, that is, they can be filtered to show only the results of a select population of “experts.” The IAF is also going to allow the survey instrument to be used a part of a school or class project. By using a unique group name on question 4 of the instrument, the responses can be filtered to highlight the inclinations of persons located in the same vicinity, within a particular school or class, or with a particular instructor. IAF is providing you with an opportunity that should not be missed. Enter YOUR expert opinion today. Sincerely, Craig Bettles Futurist Institute for Alternative Futures

ABSTRACT Background There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy’s effects in this population. Objective To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. Design Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). Setting Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. Patients Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. Interventions Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. Main Outcome Measure The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. Results At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. Conclusion Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. Arch Gen Psychiatry. 2005;62:409-416. Author Affiliations: Departments of Psychology (Dr DeRubeis), and Psychiatry (Drs Amsterdam, Young, O’Reardon, and Gladis), University of Pennsylvania, Philadelphia; Departments of Psychology (Dr Hollon), and Psychiatry (Drs Shelton, Salomon, Lovett, and Brown), Vanderbilt University, Nashville, Tenn; Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pa (Dr Gallop).

Each year, an estimated 200,000 to 600,000 Americans will suffer from deep-vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs usually in the lower limbs, when a blood clot forms in a deep vein. Pulmonary embolism a complication of DVT can occur when a clot breaks loose from the wall of the vein and travels to the lungs, blocking a pulmonary artery or one of its branches. PE will be fatal in 60,000 to 200,000 individuals who develop this condition. According to a national survey conducted on behalf of the American Public Health, almost three-quarters (74 percent) of adults have little or no awareness of DVT. Click here to assess your risk for DVT LEARN MORE ABOUT DEEP-VEIN THROMBOSIS AND PULMONARY EMBOLISM For additional information click on the link below.