• Exceptional speakers headline May 2004 NYSCA Leadership Meeting at New York Chiropractic College. Field doctors invited. Twelve hours of CE offered at no charge to members; $59 to non-members. • Healthcare system about to change . . . again! How will chiropractic cope? Given the professional press lately and the scientific discussion taking place in referred journals, members probably have heard something of the latest buzzwords in health care – evidence-based medicine (EBM) and best practices. These terms have the potential to be a double-edged sword in health care practice. Used appropriately, EBM and best practices hold the potential for advancing the quality of care patient’s receive in that EBM and best practices champion patient-centered care that is scientifically-based and individualized, and refined through quality improvement measures and clinical experience. For chiropractic, EBM and best practices provide an opportunity to advance the integration of chiropractic with mainstream healthcare. Used inappropriately, however, EBM and Best Practice could also turn out to be the newest cudgel used to batter chiropractic. Indeed, as Allan Korn, MD, Chief Medical Director of the National Association of Blue Cross and Blue Shield Plans warned attendees at the ACA National Chiropractic Legislative Conference in Washington, DC, March 4, squeezed by the surging health care inflation employers have put insurers on notice that employers are no longer willing to pay insurance premiums for care that is not evidence-based. This sentiment was echoed by ACC-RAC keynote speaker, Murray Goldstein, DO, MPH a week later at the Association of Chiropractic Colleges-Consortia sponsored Research Agenda Conference convened in Las Vegas, March 11, more then 2,000 miles away. The question is, how will evidence-based, best practice information be used and what does all this mean to the average field doctor? Come to the May 22, meeting of the NYSCA House of Delegates to find out. At the same time, members should be aware that the health care system, if it can be called a “system” at all, is on the threshold of a major overhaul, provided that some action is taken on the 2003 recommendations of the Institute of Medicine (IOM), National Academies of Science (NAS or the “National Academies”). Following a thorough, multi-year study by separate interdisciplinary committees examining all of the ills that prevail in the health care system, the IOM has called for a complete overhaul of the disorganized health care system. The import of these recommendations lies in the fact that the IOM is one of the National Academies of Science (NAS) and the NAS was chartered by Congress during the Civil War in 1863 and charged with the responsibility of advising Congress on scientific matters. Unfortunately, it appears, chiropractic has been participated in these deliberations. In the most recent studies of three IOM Studies Quality Chasm Series – “Health Professions Education: A Bridge to Quality,” the IOM convened a 150 member Task Force in July 2003 under the command and direction of the IOM Health Professions Education Summit Committee, to grapple with reshaping the disorganized health care system to make it more sensible and system-like. The Committee and Task Force developed a new vision for clinical education, one that is centered on a commitment to meeting patients’ needs, not the needs of the providers, and offered the following overarching vision: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.”(1) The committee proposed a set of five core competencies that all clinicians should possess, regardless of their discipline. These include: • Provide patient-centered care -- identify, respect, and care about patients' differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness and promotion of healthy lifestyles, including a focus on population health. • Work in interdisciplinary teams -- cooperate, collaborate, communicate, and integrate in teams to ensure that care is continuous and reliable. • Employ evidence-based practice -- integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. • Apply quality improvement -- identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality. • Utilize informatics -- communicate, manage knowledge, mitigate error, and support decision making using information technology. To advance the IOM vision, the Committee called on “leaders across the professions to work together on the cross-cutting changes that must occur to effect reform in clinical education and related training environments.” (2) Furthermore, the Committee recommended integrating a core set of competencies – competencies shared across the professions – into the health professions oversight spectrum (state and federal licensure and regulatory bodies and private accreditation and certification entities) that would provide the most leverage in terms of reform for health professions education.(3) The IOM report listed ten (10) different recommendations to achieve the foregoing vision and goals including: 1• An interdisciplinary effort to develop and adopt a common language, with the ultimate aim of achieving consensus across the health professions on a core set of competencies that includes patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement and informatics. 2• A recommendation that DHHS should provide a forum and support for a series of meetings involving a spectrum of oversight organizations across and within disciplines charging attendees with developing the necessary strategies for incorporating a core set of competencies into oversight activities, based on definitions shared across the professions following consultations with health profession associations and the education community. 3• A recommendation that accreditation bodies should move forward expeditiously to revise their standards so that programs are required to demonstrate – through process and outcome measures – that they educate students in both academic and continuing education programs in how to deliver patient care using a core set of competencies.. In doing so, these bodies should coordinate their efforts. 4• All health professions boards should move toward requiring licensed health professionals to demonstrate periodically their ability to deliver patient care – as defined by the five competencies identified by the committee – through direct measures of technical competence, patient assessment, evaluation of patient outcomes, and other evidence-based assessment methods. These boards should simultaneously evaluate the difference assessment methods. 5• Certification bodies should require their certificate holders to maintain their competence throughout the course of their careers by periodically demonstrating their ability to deliver patient care that reflects the five competencies, among other requirements. 6• Foundations, with support from education and practice organizations, should take the lead in developing and funding regional demonstration learning centers, representing partnerships between practice and education. These centers should leverage existing innovative organizations and be state-of-the-art training settings focused on teaching and assessing the five core competencies. 7• Through Medicare demonstration projects, the Centers for Medicare and Medicaid Services (CMS) should take the lead in funding experiments that will 3enable and create incentives for health professionals to integrate interdisciplinary approaches into educational or practice settings, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies. 8• The Agency for Healthcare Research and Quality (AHRQ) and private foundations should support ongoing research projects addressing the vie core competencies and their association with individual and population health, as well as research related to the link between the competencies and evidence-based education. Such projects should involve researchers across two or more disciplines. 9• AHRQ should work with a representative group of health care leaders to develop measures reflecting the core set of competencies, set national goals for improvement, and issue a report to the public evaluating progress toward these goals. AHRQ should issue the first report, focused on clinical educational institutions, in 2005 and produce annual reports thereafter. 10• Beginning in 2004 , a biennial interdisciplinary summit should be held involving health care leaders in education, oversight processes, practice, and other areas. This summit should focus on both reviewing progress against explicit targets and setting goals for the next phase with regard to the five competencies and other areas necessary to prepare professionals for the 21st - century health system. The NYSCA has accepted the proposition that there cannot exist two scientific standards – one for medicine and a separate standard for chiropractic. (4, 5) It is the Association’s goal to be a proactive catalyst for change in the profession by championing professional accountability, promoting clinical and educational excellence, and fostering the development of a multidisciplinary/interdisciplinary team approach to the treatment of common neuromusculoskeletal conditions using evidence-based outcomes measures, best practices, and scientifically-based, multidisciplinary treatment guidelines derived by consensus processes. Fortuitously, the profession is working on the next generation of evidence-based chiropractic practice parameters and best practices through the efforts of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Committee underwritten by the Congress of Chiropractic State Associations (COCSA). But the profession must also be a participant in the ongoing IOM/National Academies efforts to transform healthcare and healthcare education along the principles noted above. To address these issues and more, the NYSCA has enlisted the following speakers who will examine chiropractic’s role in an integrated healthcare system; the steps the profession would need to take in order to bring about chiropractic’s participation in multidisciplinary/interdisciplinary endeavors, including the integration of the profession with the mainstream healthcare. These persons represent some of the most knowledgeable individuals and strategic elites in chiropractic and the health care system. Strategic Elite # Lewis J. Bazakos, MS, DC earned his chiropractic qualifications from the New York Chiropractic College in 1978, a Master of Science Degree from the University at Bridgeport in 1980 and his baccalaureate degree from St. John’s University in 1975. He is a former Board Member, Treasurer, Vice President, and Past President of the New York State Chiropractic Association and served as a District Officer in NYSCA District 6 and represented District 6 in the NYSCA House of Delegates and served on several NYSCA committees, particularly the NYSCA Legislative Committee. After completing his service with the NYSCA, Dr. Bazakos served as District 1 Governor of the Congress of Chiropractic State Associations (COCSA) for two years. He started serving as a delegate to the American Chiropractic Association (ACA) House of Delegates in 1991 and was elected as a Governor on the ACA Board of Governors three years ago. For the last year and a half, Dr. Bazakos has been a member of the ACA Executive Committee and is slated to be the next Chair of the ACA Board of Governors. Throughout his tenure at ACA, Dr. Bazakos has served the ACA in a variety of capacities but most notably as chair of the ACA Legislative Committee. In 1997, Dr. Bazakos filled the Alumni seat on the Board of Trustees of the New York Chiropractic College. Subsequent to his initial appointment, Dr. Bazakos has co-chaired the NYCC Board of Trustees. He is the current chair of the College Advancement Committee. Strategic Elite # Mark R. Chassin, MD, MPH, MPP, is the Edmond A Guggenheim Professor of Health Policy and Chair of the Department of Health Policy at the Mount Sinai School of Medicine. He is also Senior Vice-President for Clinical Quality at the Mount Sinai Medical Center in New York City. Dr. Chassin received his undergraduate and medical degrees from Harvard University and a master's degree in public policy from the Kennedy School of Government at Harvard. He received a master's degree in public health from the University of California at Los Angeles. Dr. Chassin is a former Commissioner of Health in New York under Governor Mario Cuomo. Dr. Chassin has also served as a senior project director at the RAND Corporation, where he led several major health services research studies and participated as co-investigator in several others including the 1991 series of RAND studies on the “Appropriateness of Spinal Manipulation for Low Back Pain. He was a co-investigator for the 1992 meta-analysis on “Spinal manipulation for low back pain” study that appeared in the Annals of Internal Medicine (October 1992). He was Senior Vice President and Co-Founder of Value Health Sciences, a private sector firm that developed software and systems for quality assessment and utilization review; and Deputy Director and Medical Director of the Office of Professional Standards Review Organizations of the Health Care Financing Administration. Dr Chassin is a renowned expert in the area of performance measurement, clinical indicators and continuous quality improvement. In 2001, he was recognized for his contributions to the fields of quality measurement and improvement with several honors. He was in the first group honored with a lifetime membership of the National Associates of the National Academies, a new program of the National Academy of Sciences. He also received the Founders' Award of the American College of Medical Quality and the Ellwood Individual Award from the Foundation for Accountability. Recently, Dr. Chassin co-chaired the IOM Quality Health Care in America Committee, which issued two reports, in the IOM Quality Chasm Series, “To Err Is Human: Building a Safer Health System released in 1999, and “Crossing the Quality Chasm: A New Health System for the 21st Century,” released in 2001. This committee was responsible for laying the groundwork that lead to the Institute’s call for a dramatic change in the way the health care providers are trained and the way the health care system functions and operates. Dr. Chassin is a member of the Board of Directors of the National Committee for Quality Assurance (NCQA) and the Association for Health Services Research (AHSR). Strategic Elite # Cynthia Laks is the Executive Secretary of the New York State Board for Chiropractic, Office of the Professions, State University of New York, New York State Education Department (SED) in Albany. She was appointed by the Board of Regents to be the Executive Secretary for the NYS Board for Chiropractic on March 1, 2003. In addition to administering the State Board, she also is responsible for reviewing all curricula of foreign professional schools and all endorsement requests for licensure; developing regulations for the chiropractic profession; participating in program registration; coordinating and monitoring disciplinary proceedings; and providing information to the Board, the Department and the public. Secretary Laks received her Master of Arts from Columbia University Teachers College, her Bachelor of Science from New York University and has taken advanced post-graduate credits in public administration at the Nelson A. Rockefeller College of Public Affairs and Policy and Russell Sage Graduate School. Not surprisingly, Secretary Laks has been intimately involved with the State Board, the State Associations and New York Chiropractic College in coordinating the development of the regulations governing mandatory continuing education for chiropractors in New York State. She was also responsible for the oversight and management of the revisions to the Guide to Chiropractic, the Application Packet for Licensure and the Office of the Professions (OP) website dedicated to chiropractic. In addition to her Executive Secretary responsibilities, Ms. Laks is also the legislative coordinator for the Office of the Professions, coordinating legislative comments provided in response to a multitude of bills that affect the 44 licensed professions under the authority of the Board of Regents. She also organizes and contributes to meetings with legislators, lobbyists and professional organization leaders. Most of the members of the State Boards know her best as the primary coordinator of the Board Member Discipline Seminars as well as the Discipline Process Resource Guide. She also has been a lead person in implementing improvements to the professional discipline hearing process and coordinates the scheduling of all first-time hearing dates for the professions. Before coming to the Office of the Professions in 1997, Secretary Laks was the Chief of the Bureau of Continuing Education Program Development within the Office of Elementary, Middle, Secondary and Continuing Education. Strategic Elite # Dana Lawrence, DC is an Associate Professor at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic. Dr. Lawrence earned his chiropractic degree from the National College of Chiropractic, a Bachelor of Science Degree from Michigan State University and a Bachelor of Science Degree in Human Biology also from National. He is licensed to practice chiropractic in Illinois, Michigan and Iowa. Dr. Lawrence is the former Professor in the Department of Chiropractic Practice a post he held from 1987 through 2003 at the National College of Chiropractic and he served in a variety of posts at National for more than twenty-five (25) years. For the last 17 years, Dr. Lawrence has been the editor of the Journal of Manipulative and Physiological Therapeutics (JMPT), and Associate editor of JMPT two years prior to that. JMPT is the only chiropractic journal to be indexed in Index Medicus maintained by the National Library of Medicine, Current Contents/Clinical Medicine, and other international databases as well. Dr. Lawrence also edits the Journal of Chiropractic Medicine and the Journal of Chiropractic Humanities. He also held the post of Director/Associate Director of the National College Department of Editorial Review and Publication from 1986 through 2003. Dr. Lawrence is a past member of the Alternative Medicine Program Advisory Council of the Office of Alternative Medicine (OAM) and the National Center for Complementary and Alternative Medicine (NCCAM). He was responsible for drafting the chiropractic entry in “Alternative Medicine: Expanding Medical Horizons.” In 1998, Dr. Lawrence was honored as “Researcher of the Year” by the Foundation for Chiropractic Education and Research (FCER) in 1998. He received numerous faculty awards while at National College, including several Professor of the Year Awards from National students. Dr. Lawrence also received a Distinguished Service Award from the American Chiropractic Association. Over the years, Dr. Lawrence has served as a consultant to more than 75 entities including stints as peer reviewer and editorial advisory board member to the Journal of Allied Health, Clinical Chiropractic, Journal of the American Chiropractic Association, Topics in Clinical Chiropractic, the Back Pain Society, The Back Letter, the Journal of the Neuromusculoskeletal System, the Journal of Chiropractic Technique, The Chiropractic Report and the Journal of Back and Musculoskeletal Rehabilitation. As editor of JMPT, Dr. Lawrence is affiliated with the World Association of Medical Editors, the Association for Continuing Higher Education, the Hastings Center for Biomedical Ethics, the Council of Science Editors, the American Medical Writer’s Association, and the Society for Scholarly Publishing. Dr. Lawrence has written or co-authored more than 80 papers and 14 book chapters and several books. Strategic Elite # Frank Nicchi, MS, DC earned his chiropractic degree from the New York Chiropractic College (NYCC) in 1978, a Master of Science Degree from the Roberts Wesleyan College, and a Bachelor of Arts Degree from the St. John’s University in 1973. Dr. Nicchi served as the Dean of Postgraduate and Continuing Education at NYCC for five of his nearly twenty-five years of services to NYCC just prior to ascending to the post of President of the College in September 2000. Since 1980, Dr. Nicchi has been an instructor at NYCC in clinical sciences and technique, and as a clinician at the college's Levittown outpatient facility. He was a member of the New York State Chiropractic Association (NYSCA), and served on the NYSCA Board of Directors from 1984-1988. Presently, Dr. Nicchi serves on the Board of Directors of the Association of Chiropractic College’s. Dr. Nicchi was an influential advocate for promoting New York State legislation in areas such as diagnostic and laboratory testing by chiropractors. More recently, as a representative of New York Chiropractic College, he has encouraged legislation for mandatory continuing education for chiropractors, and equality of education requirements for chiropractors to obtain certification status in acupuncture. Dr. Nicchi has presented at numerous chiropractic meetings, state conventions, and interdisciplinary venues on topics ranging from chiropractic management of clinical conditions to chiropractic's role in the health care system. Strategic Elite # Stephen Perle, MS, DC earned his chiropractic degree from the Texas College of Chiropractic, a Masters of Science Degree in Exercise Science from the Southern Connecticut State University and Bachelor Degrees in Biology from Excelsior College in Albany, Cellular & Molecular Biology from the University at Buffalo, and Biomedical Electrical Engineering from the Rensselaer Polytechnic Institute. He is licensed to practice chiropractic in the states of Connecticut, California and New York. He is a Certified Chiropractic Sports Physician, certified by The American Chiropractic Board of Sports Physicians. Dr. Perle is a Associate Professor of Clinical Sciences in the College of Chiropractic, a post he has held since 1991. He is also Adjunct Professor of Mechanical Engineering in the School of Engineering at the University of Bridgeport, Bridgeport, Connecticut. Dr. Perle is the first chiropractor in the United States to receive a tenure-tracked appointment from a university to teach chiropractic. Dr. Perle serves on the steering committee of the University of Bridgeport Institute for the Study of Values and Ethics and is chair of the University’s Institutional Review Board. He also serves on the post-graduate faculty or adjunct faculty at the Southern California Health Sciences University, the Royal Melbourne Institute of Technology, the Texas Chiropractic College, the New York Chiropractic College and the Northwestern College of Chiropractic. He serves as on the editorial boards of the American Running and Fitness Association’s Running & FitNews Training & Conditioning; the Journal of Sports Chiropractic and Rehabilitation and Chiropractic Sports Medicine. He was the principal investigator or co-investigator on several federally funded research grants and has authored/co-authored more than thirty articles in trade publications more than six book chapters. In the course of his career, Dr. Lawrence has presented more than 32 times in different convocations and venues. He is a regular consultant to the State of Connecticut, Department of Public Health, Division of Health Systems Regulation. He also served, as did Dr. Triano, as an Expert Panel Member to the NYSCA Long Range Planning Committee for the Profession, in September 2002. He also served the NYSCA as a former District officer and delegate in the NYSCA House of Delegates. Strategic Elite # Gregory Stewart, DC earned his doctor of chiropractic degree in 1986 from the Canadian Memorial Chiropractic College in Toronto, Ontario, Canada and a Bachelor’s Degree in Physical Education in 1982 from the University of Manitoba, Winnipeg, Manitoba. Dr. Stewart is licensed to practice chiropractic in Manitoba and Ontario. Presently, Dr. Stewart is Chairman of the Canadian Chiropractic Association. He served as President of the Canadian Chiropractic Association from 2002-2003, as a member of the CCA Board of Governors from 1997-1999; as President of the Manitoba Chiropractors’s Association from 1994-1992 and a member of the Manitoba Chiropractor’s Association Board of Directors from 1992 - 1997. Dr. Stewart is a member of the Manitoba Chiropractor’s Association; the Canadian Chiropractic Association, the Canadian Memorial Chiropractic College and the American Back Society. Dr. Stewart also is a professional service provider in Canada providing chiropractic treatment to Canadian Sports Centers, Manitoba 1999 - present; Athletics Canada 1999 Canadian Senior Championships; and Pan-American Games 1999. He is a co-participant with NYSCA President, E. Daniel Quatro on the World Chiropractic Federation Task Fore on chiropractic’s Professional Identity. It is the NYSCA’s understanding that the Canadian Chiropractic Association (CCA) which recently completed an extensive identity/branding process relative to the role of chiropractic in the Canadian healthcare system and the integration of chiropractic into the mainstream of healthcare in Canada. He was selected to be a participant of a 40-member Task Force representing the North American Region, Canadian chapter, assembled by the Toronto-based, World Chiropractic Federation. He was presented with a Distinguished Service Award from the Manitoba Chiropractor’s Association in 2003 as well as a Presidential Citation for Outstanding Service from the Ontario Chiropractic Association 2003. He has made several presentations – World Federation of Chiropractic, Orlando 2003 and a Presentation to Romanow Commission on the Future of Health Care in Canada Winnipeg, 2002. He represented the Canadian Chiropractic Association in the Public Policy Forum Ottawa, 2002 and at World Federation of Chiropractic Conference On the Identity of the Profession, San Francisco, 2004. And he was a speaker at the Occupational Health and Safety Conference, Winnipeg, 2004. Dr. Stewart practices in Winnipeg, Manitoba. Strategic Elite # John J. Triano, DC, PhD is the Co-Director of Conservative Medicine and Director of the Chiropractic Division at the Texas Back Institute, a multidisciplinary spine facility with several locations throughout Texas. Dr. Triano received his chiropractic degree from the Logan College of Chiropractic; his Master’s degree from Webster College and his PhD doctoral degree in biomechanics from the University of Michigan. Dr. Triano is a Fellow of the College of Chiropractic Scientists (Canada) and serves as an editorial advisor to the Journal of Manipulative and Physiological Therapeutics, Spine, The Spine Journal, The BackLetter, and the Journal of the Canadian Chiropractic Association. Dr. Triano is Research Professor in the Department of Engineering, Biomedical Engineering Program at the University of Texas in Arlington, and is an Associate Professor of Biomechanics at the Southwestern School of Medicine. To date he has authored or co-authored more than 63 scientific and clinical articles and 16 book chapters. He was one of two chiropractors who participated in the development of the Agency for Health Care Policy and Research (AHCPR) Guidelines released in 1994 on the treatment of Acute Low Back in Adults. He is the recipient of numerous awards and honors, including ICA Researcher of the Year (1987), FCER Researcher of the Year (1989), AHCPR Service Award (1993), ACA Council on Rehabilitation Doctor of the Year Award (1998), the DC Person of the Year (2002) and the ACA Chairman Award (2003). A leading participant in the Guidelines for Chiropractic Quality Assurance and Practice Parameters (GCQAPP also known as the Mercy Guidelines, Triano is currently the Commission Chair of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). References 1-Ibid. p. 4. 2-Ibid. 3-Angell M, Kassirer JP. [Editorial] Alternative medicine: the risks of untested and unregulated remedies. N Engl J Med 1998 (Sep 17); 339(12): 839-841. 4-Fontanarosa PB, Lundberg GD. [Editorial] Alternative medicine meets science. JAMA 1998 (Nov 11); 280: 1619-1619. To register click on the .PDF file:

ARLINGTON, VA -- The American Chiropractic Association (ACA) today applauded Congressman Bob Filner (D-CA) for introducing legislation to provide veterans with direct access to a doctor of chiropractic through the Department of Veterans Affairs (DVA) health care system. The ACA, the nation's largest chiropractic organization, worked closely with Congressman Filner on the direct access bill now before Congress and on other ongoing efforts to ensure unimpeded access to chiropractic care. In the past, segments of the federal bureaucracy have been reluctant to implement directives from Congress regarding chiropractic care. This new bill (HR 4051) seeks to send a message to opponents of chiropractic - inside and outside of the government - that America's veterans will not be denied the chiropractic care they need and deserve. "Congressman Filner is a powerful and effective leader on health care issues and a well-known fighter for America's veterans," said ACA President and U.S. Navy veteran Donald J. Krippendorf, DC. "He has shown time and again that he is committed to protecting the rights of doctors of chiropractic and chiropractic patients. Introduction in the U.S. House of Representatives of the "Better Access to Chiropractors to Keep our Veterans Healthy Act" by Congressman Filner is a strong statement of support for chiropractic care and its positive benefits for veterans and other patients." The Filner bill (HR 4051) seeks to amend Title 38 of the United States Code to permit eligible veterans to receive direct access to chiropractic care at Department of Veterans Affairs hospitals and clinics. Section 3 of HR 4051 states that "The Secretary [of Veterans Affairs] shall permit eligible veterans to receive needed [health care] services, rehabilitative services, and preventative health services from a licensed doctor of chiropractic on a direct access basis at the election of the eligible veteran, if such services are within the state scope of practice of such doctor of chiropractic." The measure goes on to directly prohibit discrimination among licensed health care providers by the DVA when determining which services a patient needs. Congressman Filner is a senior member of the Committee on Veterans Affairs. He represents California's 51st Congressional District, including Imperial County and a portion of San Diego County and the communities of Bonita, Brawley, Calexico, Calipatria, Chula Vista, El Centro, Heber, Holtville, Imperial, La Presa, National City, San Diego, Seeley and Westmoreland. In 2004, the ACA presented Congressman Filner with its Veterans Health Care Leadership Award.

Washington, DC - The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) commended Department of Veterans Affairs (DVA) Secretary Anthony Principi for issuing an historic and far-reaching blueprint for formalizing the full inclusion of chiropractic care into the massive veterans health care system in the United States. Secretary Principi’s decision today to implement more than three dozen recommendations made by a multi-disciplinary health care advisory panel will dramatically improve the quality of care available to millions of veterans in the U.S. and increase access to chiropractic care for every veteran who wants or needs to see a doctor of chiropractic. The Secretary’s bold action originated with legislative directives from Congress in 2002 and 2003 - passed at the urging of the ACA, the ACC and America’s veterans - to establish a permanent chiropractic benefit through the DVA system and authorize the DVA to hire and employ doctors of chiropractic as care providers. “This is a great victory for veterans and an historic new opportunity for doctors of chiropractic across America,” said ACA President and U.S. Navy veteran Donald Krippendorf, DC. “Secretary Principi always makes certain that veterans come first. He’s done so today by acting decisively to bring chiropractic care into veterans hospitals from coast-to-coast and to make doctors of chiropractic full partners in providing care to all those who answered our country’s call to serve.” Since the creation of the DVA health system, the nation’s doctors of chiropractic (DCs) have been kept outside the system and all but prevented from providing proven, cost-effective and much-needed care to veterans, including those among the most vulnerable and in need of the range of the health care services DCs are licensed to provide. In 2002, 4.5 million patients received care in DVA health facilities, including 75% of all disabled and low-income veterans. Although the DVA health care budget is roughly $26 billion, in 2002, less than $370,000 went toward chiropractic services for veterans. In issuing today’s order to his department to begin inclusion of chiropractic care, Secretary Principi specifically acknowledged that the goal is “to ensure that chiropractic care is ultimately available and accessible to veterans who need it throughout the DVA system.” Several key elements of Secretary Principi’s blueprint were strongly supported by the ACA and the ACC, including: · DVA’s endorsement of the integration of full-scope chiropractic care (under applicable state law) into all missions of the DVA health care system, including patient care, education, research and response to disasters and national emergencies, and DVA facilities across the country. · DVA’s endorsement of a successful and patient-friendly model - essentially based on the operations of Bethesda National Naval Medical Center - of full integration of doctors of chiropractic as partners in health care teams. · Inclusion of chiropractic care into the VA's funding of research into treatment of service-connected conditions. · Inclusion of chiropractic colleges and students in training programs at VA facilities. · Establishment of a goal to ensure continuity of chiropractic care for newly discharged veterans who have been receiving chiropractic care through the Defense Department health care system. Jean Moss, DC, President of the ACC, commended Principi’s decision to integrate chiropractic care into the DVA health system, saying, “The administration, faculty and students of chiropractic colleges across America are delighted that Secretary Principi has taken steps to ensure that DCs can now directly contribute to the health and well-being of veterans. I am pleased, too, that chiropractic college students will become eligible to participate in internship programs at DVA hospitals and that a fair share of federal research funding will be directed to further documenting the efficacy and cost-effectiveness of chiropractic care.” Dr. Krippendorf added, “The ACA is a membership organization that is comprised of thousands of hard-working health professionals who are pillars of their communities in all 50 states. Our advocacy for full inclusion of chiropractic care in the DVA system is part of our broader campaign to ensure that DCs and their patients are treated fairly in all of the Federal government’s health care programs and initiatives. We’ve made great progress across the board, but the fight for fairness continues and the ACA is ever vigilant.” In addition to legislation authorizing the DVA to employ chiropractors (Public Law 108-170), ACA-backed bills to test expanded access to chiropractic services under Medicare (Public Law 108-173) and to accelerate the implementation of chiropractic care in the military (Public Law 108-136) were also signed into law by President Bush in 2003. In 2004, the ACA will make it a priority to ensure that Secretary Principi’s recommendations are speedily implemented, and work with Congress on new legislation to ensure that chiropractic patients are never wrongly denied access to care. There are about 60,000 DCs in the U.S. and an estimated 25 million chiropractic patients. “Today’s historic action involved the hard work and determined efforts of several members of the DVA’s Chiropractic Advisory Committee, including Drs. Reed Phillips, Cynthia Vaughn and Rick McMichael,” said ACA Chairman and Army veteran George McClelland, DC. “These outstanding leaders have helped improve America’s veterans health care system, eliminated discriminatory practices against their fellow DCs and won meaningful protections for a most deserving group of chiropractic patients.”

New York State Board of Regents appointed three new Board Members to the New York State Board for Chiropractic at their March 23, 2004 meeting. Appointed were Dr. Stephen T. Eble, from Mt. Kisco, New York and Dr. Jay A. Okin from New York City, New York. Both are graduates of New York Chiropractic College. Additionally, Dr. Humayun J. Chaudhry an Osteopathic Physician from Old Westbury, New York was also appointed to the New York State Board for Chiropractic. The term of their appointment is April 1, 2004 to March 31, 2009. For more information, visit the New York State Board of Regents by clicking on the link below:

Florida Governor Jeb Bush today signed into law Senate Bill 2002, legislation creating a variety of new health care initiatives including the authorization and funding to establish the nation's first public chiropractic college at Florida State University. The bill was approved previously by both the Florida Senate and House of Representatives in the opening days of Florida's annual 60-day legislative session. Senate Majority Leader Dennis L. Jones, D.C. (R-Treasure Island) and House HealthCare Committee Chairman Rep. Frank Farkas, D.C. (R-St. Petersburg) were both on hand for the signing ceremony this morning. Jones and Farkas, both chiropractic physicians and former presidents of the Florida Chiropractic Association, were instrumental in helping steer the issue through its legislative course over the past five years. They were flanked at the signing by the bill's prime sponsors, Sen. Durell Peaden, (R-Crestview), Chairman of the Senate Appropriations Subcommittee on Health and Human Services, and Bruce Kyle(R-Ft. Myers), Chairman of the House Appropriations Committee, as well as Senate President Jim King (R-Jacksonville.) "This is certainly a momentous day for the chiropractic profession and for the citizens of our state," said Jones. "Today we are beginning a proud, new chapter in our history as we embark on an exciting new era of scientific-based education and research at one of the nation's pre-eminent research institutions." "Dream as we might, I'm not sure any of us realize how big this is going to be," added Farkas. "At a time when public demand for chiropractic care is growing, we will be training our newest generation of practitioners in a place rich with the kind of resources you can only find at a major public institution." Creation of the college has a been a twenty-year project of the Florida Chiropractic Association and a life-long dream of the association's long time CEO, now its CEO Emeritus, Ed Williams, D.C. "We always believed chiropractic students should have the same options those in other professions have always enjoyed. Finally, they now have the choice of a public education," Williams said. FCA leaders have been actively pursuing the creation of the college ever since they joined hands in the late 1990's with the Lincoln Chiropractic Education and Research Foundation (LCERF) to fund a super-endowed research chair at FSU. With seed money from LCERF, the FCA ran a two-year campaign successfully raising the million-dollar endowment, ultimately matched with another $750,000 by the state, to found the Lincoln Eminent Scholar Chair in Chiropractic and Biomechanics at the university. The university is currently in negotiations with its chosen eminent scholar, and will soon begin planning the new research facility. It is expected the research program will rely heavily on the new college and its faculty. Having established the chair, the FCA and its lobby team worked closely with legislative leadership, weathering both good and bad budget years, but never losing sight of the new college objective. "There were a few bumps along the way but we never gave up hope. Today we have a long list of legislators, staff, chiropractic leaders, educators and others to thank for helping to achieve this success," said FCA CEO Debbie Brown. "This has been one in credible group effort -- and it will be one incredible celebration heard around the world." Reprinted with permission from the Foundation for Chiropractic Education and Research (FCER). For further information on FCER, please click on the link below:

New York Chiropractic College (NYCC) has launched a study designed to quantify the effects of Graston Technique on patients with Carpal Tunnel Syndrome. Led by NYCC faculty member and researcher, Dale J. Buchberger, D.C., D.A.C.B.S.P., the study uses a three-phase approach to screen, treat and assess patients. It is expected to last for one year with results available in the Fall of 2004. This study by NYCC is one of several currently being done on the Graston Technique as researchers around the country continue to identify and study uses of the innovative soft tissue treatment for patients suffering acute and chronic connective soft tissue problems. The first phase of the study includes screening patients with suspected carpel tunnel using clinical tests to measure strength and functionality, electrodiagnostic tests to measure muscle and nerve stimulation and ultrasound to measure compression of the nerves. The study will include 20 patients who have carpal tunnel in one wrist. Patients with confirmed carpal tunnel are then randomly placed into two groups for the six-week treatment phase. All patients will be treated by Dr. Buchberger using the same treatment protocols that include soft tissue manipulation administered twice during each of the first four weeks and once during the last two weeks. The difference in treatment protocols is that patients in one group will be treated using the Graston Technique Instruments, and patients in the other group will be treated using manual manipulation. No splinting or medications will be used in either group, and all patients will receive the same icing following treatment. After six weeks of treatment, patients will be re-tested using the same clinical, electrodiagnostic and ultrasound tests to measure acute improvements. Testing will be repeated again after three months to determine what changes, if any, have occurred to the corrections. This study is an important step in better understanding the anatomy, physiology and functionality of what makes patients feel better when being treated for carpal tunnel, said Jean Burke, Ph.D. and department head of research at NYCC. By using extensive testing protocols, we hope to quantify what brings about change most effectively, and ultimately to help more patients avoid surgery. About Graston Technique The Graston Technique is an advanced form of instrument-assisted soft tissue mobilization developed more than 10 years ago by two athletes who suffered injuries that left them with limited ranges of motion. This patented technique incorporates the use of stainless-steel instruments contoured to adapt to various parts of the anatomy. Using the instruments, the clinician is better able to detect fibrotic tissue and can treat at greater depth and specificity. Reprinted with permission from the Foundation for Chiropractic Education and Research (FCER). For further information on FCER, please click on the link below:

ABSTRACT Context: Use of antibiotics may be associated with risk of breast cancer through effects on immune function, inflammation, and metabolism of estrogen and phytochemicals; however, clinical data on the association between antibiotic use and risk of breast cancer are sparse. Objective: To examine the association between use of antibiotics and risk of breast cancer. Design, Setting, and Participants: Case-control study among 2266 women older than 19 years with primary, invasive breast cancer (cases) enrolled in a large, nonprofit health plan for at least 1 year between January 1, 1993, and June 30, 2001, and 7953 randomly selected female health plan members (controls), frequency-matched to cases on age and length of enrollment. Cases were ascertained from the Surveillance, Epidemiology, and End Results cancer registry. Antibiotic use was ascertained from computerized pharmacy records. Main Outcome Measure Association between extent of antibiotic use and risk of breast cancer. Results: Increasing cumulative days of antibiotic use were associated with increased risk of incident breast cancer, adjusted for age and length of enrollment. For categories of increasing use (0, 1-50, 51-100, 101-500, 501-1000, and =" src="/math/ge.gif" border=01001 days), odds ratios (95% confidence intervals) for breast cancer were 1.00 (reference), 1.45 (1.24-1.69), 1.53 (1.28-1.83), 1.68 (1.42-2.00), 2.14 (1.60-2.88), and 2.07 (1.48-2.89) (P

Chiropractic and Massage Therapy are two distinct and separate professions whose licensure and practice are authorized in New York State Education Law. Article 132 authorizes the licensure and practice of Chiropractic; Article 155 authorizes the practice of Massage Therapy.

In 1996, the Department undertook a review of current literature in the field, practices in other states, and applicable State and Federal law and regulation.

Current statute does not authorize chiropractors to use acupuncture as part of their practice. Article 160 of the Education Law authorizes those persons licensed in acupuncture to treat “diseases, disorders and dysfunctions of the body…by means of mechanical, thermal or electrical stimulation effected by the insertion of needles.” The definition of chiropractic in Article 132, section 6551, does not include such authorization.

Objective: To investigate the effect of glucosamine sulfate on long-term symptoms and structure progression in postmenopausal women with knee osteoarthritis (OA). Design: This study consisted of a preplanned combination of two three-year, randomized, placebo-controlled, prospective, independent studies evaluating the effect of glucosamine sulfate on symptoms and structure modification in OA and post-hoc analysis of the results obtained in postmenopausal women with knee OA. Minimal joint space width was assessed at baseline and after 3 years from standing anteroposterior knee radiographs. Symptoms were scored by the algofunctional WOMAC index at baseline and after 3 years. All primary statistical analyses were performed in intention-to-treat, comparing joint space width and WOMAC changes between groups by ANOVA. Results: Of 414 participants randomized in the two studies, 319 were postmenopausal women. At baseline, glucosamine sulfate and placebo groups were comparable for demographic and disease characteristics, both in the general population and in the postmenopausal women subset. After 3 years, postmenopausal participants in the glucosamine sulfate group showed no joint space narrowing [joint space change of +0.003 mm (95% CI, −0.09 to 0.11)], whereas participants in the placebo group experienced a narrowing of −0.33mm(95% CI, −0.44 to −0.22; P < 0.0001 between the two groups). Percent changes after 3 years in theWOMACindex showed an improvement in the glucosamine sulfate group [−14.1% (95%, −22.2 to −5.9)] and a trend for worsening in the placebo group (5.4% (95% CI, −4.9 to 15.7) (P = 0.003 between the two groups). Conclusion: This analysis, focusing on a large cohort of postmenopausal women, demonstrated for the first time that a pharmacological intervention for OA has a disease-modifying effect in this particular population, the most frequently affected by knee OA. Menopause. 2004;11:138-143

The transcript of the oral arguments presented before the 4th Circuit Court in Richmond, VA, on February 24th by ACA and Trigon are now available on ACA's Web site.

Objective To evaluate the effectiveness and safety of a preparation containing echinacea, propolis, and vitamin C in the prevention of respiratory tract infections in children during a 12-week winter period. Design Randomized, double-blind, placebo-controlled study. Subjects Four hundred thirty children, aged 1 to 5 years, were randomized to an herbal extract preparation (n = 215) or a placebo elixir (n = 215). Intervention Administration of an herbal preparation (Chizukit) containing 50 mg/mL of echinacea, 50 mg/mL of propolis, and 10 mg/mL of vitamin C, or placebo (5.0 mL and 7.5 mL twice daily for ages 1 to 3 years and 4 to 5 years, respectively) for 12 weeks. Results Significant mean ± SD reductions of illnesses were seen in the Chizukit group in the number of illness episodes, 138 vs 308 (55% reduction); number of episodes per child, 0.9 ± 1.1 vs 1.8 ± 1.3 (50% reduction, P<.001); and number of days with fever per child, 2.1 ± 2.9 vs 5.4 ± 4.4) (62% reduction, P<.001). The total number of illness days and duration of individual episodes were also significantly lower in the Chizukit group. Adverse drug reactions were rare, mild, and transient. Conclusion A preventive effect of a product containing echinacea, propolis, and vitamin C on the incidence of respiratory tract infections was observed. Arch Pediatr Adolesc Med. 2004;158:217-221.

The North Central Association of Colleges and Schools (NCA) has granted accreditation status for Palmer College of Chiropractic Florida as a branch campus of Palmer College of Chiropractic in Davenport. NCA is one of six regional accrediting agencies in the United States. It accredits K-12 schools plus post-secondary educational institutions, including junior colleges, colleges, and universities in its region, which spans 19 states and about 1,200 colleges and universities. Palmer College of Chiropractic has had NCA accreditation since 1984. According to Donald Kern, D.C., interim president of Palmer College of Chiropractic, the NCA accreditation process began three years ago, even before students arrived at the Port Orange campus in October 2002. "A school with no previous NCA accreditation getting accredited for the first time is a significant accomplishment," he said. "It sends a strong message to current and prospective students. Palmer Florida also has received an annual license to operate in Florida from the Florida Commission for Independent Education. "With this second jewel for Palmer Florida, along with the state licensure, we now are setting our sights toward completing the crown with CCE (Council on Chiropractic Education) accreditation," Dr. Kern said. Dr. Kern anticipates hosting a CCE on-site visitation team shortly to determine if Palmer Florida is eligible for CCE accreditation as a branch campus. To learn more visit Palmer Chiropractic University System by clicking on the link below:

A former Palmer College of Chiropractic president will lead a Georgia chiropractic school that was a Palmer competitor and is now rebuilding after experiencing accreditation problems. Guy Riekeman ignited a furor when he resigned his post as president and chancellor of Palmer’s university system Feb. 5 in protest of decisions made by the institution’s board of trustees. He will take office immediately at Life University in Marietta, Ga., where Ben DeSpain resigned as president Tuesday. In a statement, Riekeman thanked the Life board of trustees for “this opportunity to lead a university that I have developed such affection for. As a result of your leadership, the university is now ready to face new challenges and opportunities that lie ahead of us. “I know that I have much to learn over the coming months, but I also know that I can depend on the advice and counsel of all members of the Life community, from our faculty, staff and students here on campus to the trustees, alumni and the chiropractic family around the world.” Charles Ribley, the chairman of the Life University board, said Riekeman “epitomizes Life’s fundamental commitments to chiropractic scholarship, teaching and service to others. “His character and outstanding human qualities have made Dr. Riekeman a valued colleague among chiropractic educators and an inspiration to students.” Riekeman had been president at Palmer for five years and chancellor of the university system of campuses in Davenport, California and Florida for eight months when he resigned. The board and Riekeman acknowledged that he resigned because of resolutions passed by the board, namely a requirement for board approval of hiring and salary increases and the employment of Larry Patten as a consultant to gather information for the board. Patten resigned after a 1997 vote of no confidence in the school’s administration by organizations connected with Palmer. The Palmer board also ordered an audit, which Riekeman supported. Officials said the audit may take several months to complete. Students publicly protested twice, the first time over a noon hour at the campus along Brady Street in Davenport. At the second, students marched to the office of board chairman Vickie Palmer, who is the great-granddaughter of chiropractic’s founder. Also, 759 students signed a vote of no confidence in the board. An alumni vote of no confidence gathered more than 600 signatures. Several alumni have said they either have pulled or will pull their financial support for the school and will no longer refer future students to the campus. The faculty senate, however, issued a letter of support for the board of trustees. “In this time of transition,” it said, “it is important to remember that the accomplishments of Palmer College or the entire Palmer Chiropractic University System do not rest on the shoulders of any one individual.” Palmer College, in a statement issued Thursday, said: “Life University is a fellow institution in chiropractic education, and Dr. Riekeman is a graduate of Palmer, a former employee and now a colleague. We wish him and Life University the very best and anticipate that we will be able to work together to assure the positive advancement of chiropractic as a primary health-care provider.” Life University, once the largest chiropractic school in the country with 4,000 students, lost its accreditation in June 2002, which meant its students could no longer take licensing exams. Several Life students came to finish their schooling at Palmer as enrollment plummeted at the Georgia campus. The battle resulted in several lawsuits and an injunction from a federal judge that put the accreditation temporarily on hold, according to newspaper accounts. A settlement between Life and the Council on Chiropractic education, the organization that accredits all chiropractic schools, reinstated accreditation in June 2003. Life’s president and founder, Sid Williams, is a Palmer graduate. He retired shortly after the institution lost its accreditation. An Atlanta Journal-Constitution story about his retirement said the move raised “an age-old question for the future: How will an institution so closely tied with the dynamic and visible personality of its founder survive his departure?” Riekeman, according to the statement announcing his appointment, is “renowned not only for being a powerful motivational speaker, but for his creation of several professional development seminar programs.” This information is reprinted with permission of the Quad-City Times. Copyright 2004. Ann McGlynn can be contacted at (563) 383-2336 or [email protected].

ARLINGTON, VA — With his characteristic repertoire of blistering truths and colorful analogies, ACA General Counsel George McAndrews pulled out all the stops Feb. 24 to convince a federal three-judge appellate panel that insurance giant Trigon Blue Cross Blue Shield conspired to discriminate against doctors of chiropractic. During the hearing in Richmond, VA before the U.S. Court of Appeals for the 4th Circuit, McAndrews presented oral arguments laying out the reasons why he believes the case deserves to be sent back to the district court for trial. "Once in a while, everything needs to default to common sense," McAndrews implored the judges. "To say there is no conspiracy here ignores reality." During the hearing, McAndrews and attorneys for Trigon each had a total of 20 minutes to state their cases and respond to questions from the judges. McAndrews used 14 minutes of his time to present evidence that Trigon had altered the federal government's 1994 guidelines on acute low back pain to remove reference to chiropractic-style spinal manipulation — purely for economic reasons. Trigon's new "referral" guidelines, co-authored by representatives of most of the state's medical physician trade associations and medical schools, effectively directed low back patients away from chiropractors and to pharmaceutical treatment by medical doctors, he said. McAndrews then saved his six remaining minutes to use for rebuttal following Trigon's presentation. "They changed the critical definition of manipulation," McAndrews explained. "The evidence is that they weren't trained in [manipulation]. It was panic time." During their 20-minute presentation, Trigon attorneys contended there was no evidence of a conspiracy and that doctors of chiropractic were paid less than medical doctors because they are not as highly educated. According to Trigon attorneys, a for-profit company such as Trigon has every right to make business decisions that it feels make the best business sense. During his rebuttal time, McAndrews challenged the Trigon attorneys' assertion that doctors of chiropractic are less educated and should therefore make less money than medical doctors. McAndrews explained that, while the medical doctors controlling Trigon base their decisions to discriminate against doctors of chiropractic on monetary issues, professional pride also comes into play. McAndrews quipped that medical doctors/M.D.s see themselves as "Major Deities," but they sneer at other professionals with doctoral degrees, including judges and attorneys who have J.D. degrees, as merely "Just Docs" — a statement that elicited knowing chuckles from the judges. McAndrews concluded by emphatically reiterating that Trigon's and its medical physician co-conspirators' actions constituted medical fraud and were based on "pure economic greed." He reminded the court that every person who has ever been mistreated by under-educated medical doctors for musculoskeletal problems and has had to endure unnecessary pain, surgery or work or social disablement from the mistreatment were silent witnesses to this lawsuit. After the hearing, McAndrews had positive comments about the process. "We were impressed by the depth of knowledge shown by the panel," he said. "It is clear that they carefully read our briefs and were prepared to ask knowledgeable questions about the legal conflict that exists between medical doctors and chiropractic doctors. They questioned both sides fairly and I can only hope that common sense prevails. It appeared that the court was very bothered that the chiropractic doctors were left with no apparent recourse or remedy for a rather apparent series of wrongs perpetrated by Trigon and its co-conspirator medical trade associations." A full courtroom — with many supporters from the chiropractic profession — was on hand to witness this historic event. In addition to McAndrews' legal team, spectators included ACA President Donald J. Krippendorf, DC, ACA Chairman George B. McClelland, DC, ACA Executive Vice President Garrett F. Cuneo, ACA Legal Counsel Tom Daly, ACA Media Spokesperson Jerome McAndrews, DC, Former ACA Chairman Louis Sportelli, DC and ACA Vice President of Communications Felicity Feather Clancy. A decision about the case from the appellate court could be rendered within one to six months after the oral arguments. For a full copy of the appeal brief, click here. In addition, a full transcript of the Feb. 24 oral arguments will be available on ACA's Web site in approximately one week. The National Chiropractic Legal Action Fund (NCLAF) has been established to support ACA's federal chiropractic lawsuits on behalf of the profession. Doctors, patients and other concerned individuals may contribute to the fund by making a donation online or sending a check to NCLAF, P.O. Box 75359, Baltimore, MD 21275.

Diabetes Care - February 2004 OBJECTIVE—Pharmacologic agents currently approved for use in children with type 2 diabetes (metformin and insulin) are less than optimal for some patients. We evaluated the use of a ketogenic, very-low-calorie diet (VLCD) in the treatment of type 2 diabetes. RESEARCH DESIGN AND METHODS—We conducted a chart review of 20 children (mean age 14.5 ± 0.4 years) who consumed a ketogenic VLCD in the treatment of type 2 diabetes. Several response variables (BMI, blood pressure, HbA1c, blood glucose, and treatment regimens) were examined before, during, and up to 2 years after the diet and compared with a matched diabetic control group. RESULTS—Before starting the diet, 11 of 20 patients were treated with insulin and 6 with metformin. Mean daily blood glucose values fell from 8.9 ± 1.1 to 5.5 ± 0.38 mmol/l (P < 0.0001) in the first 3 days of the VLCD, allowing insulin and oral agents to be discontinued in all but one subject. BMI fell from 43.5 ± 1.8 to 39.3 ± 1.8 kg/m2 (P < 0.0001) and HbA1c dropped from 8.8 ± 0.6 to 7.4 ± 0.6% (P < 0.005) as the diet was continued for a mean of 60 ± 8 days (range 4–130 days), and none required resumption of antidiabetic medications. Sustained decreases in BMI and insulin requirements were observed in patients remaining on the VLCD for at least 6 weeks when compared with those of the control group. CONCLUSIONS—The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, has potential as an alternative to pharmacologic therapies for this emerging subset of diabetic individuals.

BOSTON (Nov. 10, 2003)-The most important nationwide trend affecting workers compensation this year has been increases in medical costs, according to panelists speaking during the recent Business Insurance's Workers Compensation and Disability Management Conference. This "most critical" trend means that the cost of caring for injured workers' medical needs is now a larger part of each workers compensation claim dollar, said Nancy Schroeder, assistant vp-workers compensation for the National Assn. of Independent Insurers in Des Plaines, Ill., who addressed the conference late last month in Boston. According to data from the National Council on Compensation Insurance, "medical claim costs are alarming, with double-digit increases the last two years. In 2002, medical severity increased by 12%, even greater than the 2001 increase of 10.7%." Yet it is important to remember that comp care "represents only 3% to 4% of total health care expenditures," said Keith Bateman, vp and director of the Alliance of American Insurers in Downers Grove, Ill. Several factors contribute to the increasing health care costs of workers comp claims, Mr. Bateman said. While costs are up for inpatient hospital stays and specialists' fees, the increased cost and utilization of prescription drugs makes that the key contributor, he said. What's particularly troublesome for workers comp insurers is that many of the tools available to control drug spending in group health plans, such as worker co-payments and the ability to direct an employee to a particular pharmacy, are not available to them (BI, Oct. 20). In addition, employers and insurers are grappling to cope with the growing use of the painkiller OxyContin. The drug, which was originally intended for people suffering from severe long-term pain, has become one of the most popular drugs prescribed for workers comp claimants. The concern with the drug stems from its addictive nature and how some users are abusing it. Some claimants who use it become addicted while recovering from their injuries and then must go through a detoxification program before they can return to work, Ms. Schroeder said. In addition, the slow-release medication can produce a heroin-like high when consumed after being ground up. It has a street value of 10 times its cost, which may entice some workers to make money by selling it, Ms. Schroeder said. But rising medical costs are not the only national trends that have emerged this year, Ms. Schroeder said. Another trend concerns federal impingement on state workers comp programs, she said. That "is an increasing and disturbing trend," said Bruce C. Wood, assistant general counsel with the Washington-based American Insurance Assn. One of the most serious examples of that is the federal Medicare program's "far more aggressive stance" in protecting its status as "the secondary payer" of benefits to previously injured workers, he said. Consequently, Medicare is requiring employers to establish trust funds to pay the medical costs of older injured workers to help ensure that employers and their workers comp insurers primarily pay such costs, so that they are not left to Medicare, he said. The Medicare secondary-payer issue "has been increasingly disruptive" and is expected to continue because Medicare is going broke at the same time Congress is expanding the drug benefit Medicare offers under its program, Mr. Wood said. Lobbying efforts heretofore have not resolved the problem, so the next step is to get Congress to step in and define Medicare's appropriate interest in a state-based workers comp system, he said. Another example of federal impingement is a bill (H.R. 1562) approved by the House Veterans' Affairs Committee that could allow veterans to receive medical care for workers compensation claims through the U.S. Veterans' Administration. It also would permit that entity to recover full charges for any such medical care, which could increase workers comp costs, Mr. Wood said. Despite those infringement issues, some progress has been reported in resolving workers comp payers' concerns about their continued access to claimants' medical data, following enactment of the Health Insurance Portability and Accountability Act earlier this year. Payers need access to such data to resolve claims and had been concerned that physicians might respond to the privacy requirements by denying information to them, although the law's preamble expressly excludes applying those provisions in the case of workers compensation claims, Mr. Wood said. While there have been pockets of problems, the education effort appears to be succeeding, Mr. Wood said. Another national trend concerns various types of activity involving state-specific funds, which generally exist at least to provide a source of workers comp coverage, if none is available elsewhere. Developments this year include concerns about the solvency of the competitive California state fund, which, if declared insolvent, could "take down" private insurers linked to it by guaranty funds, Mr. Bateman said. Meanwhile, the Arizona state fund is suing legislators who sought to use its accumulated assets for general expenses, he said. In several states, though, there have been proposals to allow a fund to write others lines of insurance, such as medical malpractice insurance in Oregon, he said. Finally, workers comp insurers continue to be concerned about state funds that seek to write workers comp insurance outside their borders while still maintaining their federal tax exemption, he said. That exemption reduces their cost of operation relative to their private insurers, who have complained that their entry into the marketplace constitutes unfair competition. This information is reprinted with permission of the Business Insurance. Copyright 2004. To learn more visit Business Insurance website:

Eighty-five percent of the Palmer College of Chiropractic alumni who responded to a Web-based poll supported a vote of no confidence in the institution’s board of trustees. This information is reprinted with permission of the Quad-City Times. Copyright 2004. Of the 665 alumni who filled out a questionnaire at www.dc2be.com, 569 cast their ballot in favor of the vote. Twenty-three voted to support the board of trustees. Non-alumni and chiropractic students also responded the poll, which was prompted by the resignation of Palmer president and chancellor Guy Riekeman on Feb. 5. A total of 1,257 people responded. The response shows there is concern beyond Riekeman’s resignation, said Mary Flannery, the alumnus who organized the effort. Specifically, several of those who responded cited problems with the structure of the board. “A lot of the alums are saddened and unhappy about Riekeman leaving,” she said. “But the loss of Riekeman is a symptom of a much larger problem.” Palmer officials asked that alumni continue to support the school in order to maintain the school’s “107-year tradition of excellence.” “We recognize that alumni and students still have questions about Dr. Riekeman’s resignation,” a statement from the school said, noting that Palmer is conducting an audit which “may provide additional information relevant to this matter. We would again ask that all alumni continue to support Palmer both financially and by referring students.” Riekeman resigned his position as president of Palmer College and as chancellor of the Palmer University System about three weeks ago. He had been president for five years, chancellor for eight months. The board and Riekeman acknowledged that he resigned because of resolutions passed by the board, namely the requirement for board approval of hiring and salary increases and the employment of Larry Patten as a consultant to gather information for the board. Patten resigned after the 1997 vote of no confidence. The number who cast their vote of no confidence is about the same as those who cast ballots of no confidence in the school’s administration during 1997, Flannery said she was told. The 1997 vote was organized by Palmer’s alumni association. Palmer officials said the 665 who responded “represent a small percentage of Palmer’s more than 20,000 alumni worldwide.” The board and Riekeman also say he supported an audit requested by the board. They agree there was a communication problem between them. Almost 700 people said they would stop referring students to Palmer, while 45 said they would continue to do so. More than 350 said they were donors to the college and would discontinue their support, while 32 said they would continue their financial investment. Todd Spieles, a 1970 graduate who attended Palmer with Riekeman, said Palmer is the epicenter of chiropractic and “we just had a big earthquake.” “There is a firestorm brewing amongst the alumni,” he said. Two hundred of the students who responded called for a restructuring of the board to include a student representative. Seventy-seven students said they are considering transfer to another school, and five said they would transfer. Thirteen students voted in support of the board, with 16 saying there was no negative impact on their education. All of the respondents who supported the board “reviled the negative press surrounding this crisis and felt it was better to either trust the board or wait for more information to become public before judging,” the poll summary says. It continues: “Many expressed a personal distaste for Dr. Riekeman and his vision. The other comments in support of the board applaud the perceived return of less philosophy and more musculoskeletal science to the curriculum.” Those who supported the vote of no confidence, the summary says, “expressed extreme anger and incomprehension toward the board and toward (Palmer board chairman) Vickie Palmer. “A frequent comment lamented the financial damage and loss of Palmer pride likely to remain if no satisfactory statement or rectification of the situation is evident,” it continues. “Finally, many comments praised Dr. Riekeman and what was characterized as the unique leadership qualities he brought to the school.” Flannery hopes that, in the end, the vote will open communication between all parties interested in the future of the college. “One of my primary goals is to have the board, the alumni association and some people who are not in the alumni association sit down and have an open dialogue,” she said. This information is reprinted with permission of the Quad-City Times. Copyright 2004. Ann McGlynn can be contacted at (563) 383-2336 or [email protected].

RYE - On Wednesday, February 11, 2004, NYSCA District 8 Members were honored to have the Honorable Ronald Tocci, New York State Assemblyman representing the 91st Assembly District representing residents of the Sound Shore Communities, which consists of the Town of Rye (Village of Port Chester, Village of Rye Brook and Rye Neck), the City of Rye, the Town of Mamaroneck and a major portion of the City of New Rochelle be the guest speaker at their monthly meeting. Assemblyman Tocci updated members on the legislature that was passing through the Assembly now and on upcoming legislature. He discussed the recent property tax increases in Westchester County and enlightened us on his opinions as to how to make up for some of the multibillion deficit that New York State is currently facing. Mr. Tocci is a longtime proponent of chiropractic care and a friend to our profession. NYSCA District 8 members were very appreciative of Assemblyman Tocci's presence at our monthly meeting. Assemblyman Tocci was first elected to the Assembly in November 1984. On the State level, he is the prime sponsor of more than 100 Chapter laws which include: the law that increased the availability of the Tuition Assistance Program (TAP) as well as increased the amount of the awards; the law requiring home improvement contracts to be in writing and establishes a private right of action against a contractor for financial loss; and he also sponsored the law that allows residents of small cities to vote on school budgets. Born on April 19, 1941, Assemblyman Tocci is a lifelong resident of Westchester where he was educated in the public school system and at Iona Prep. He studied Architectural Engineering at the New York Institute of Technology and currently serves as a full-time legislator. Mr. Tocci is a member of many civic and fraternal organizations including the Knights of Columbus, American Legion, Disabled American Veterans, Vietnam Veterans of America, Elks, Foresters of America, Court Sons of Italy, Calabria Society, and Heritage Lodge. Assemblyman Tocci served in the U.S. Army as a paratrooper in the 82nd Airborne Division from 1966-1968. After receiving an Honorable Discharge, he returned to Westchester County where he began his public career. Assemblyman Tocci resides at 138 Emerson Avenue in New Rochelle with his wife Patricia (the former Patricia Etzler), his son Ron, and his daughter Cara. For more information on Assemblyman Ronald Tocci, click on the link below: