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Help Commission Doctors of Chiropractic in the U.S. Public Health Service

(Arlington, Va.) -- The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) today commended Rep. Gene Green (D-Texas) and Rep. Lee Terry (R-Neb.) for introducing legislation in the U.S. House of Representatives that calls for the appointment of doctors of chiropractic (DCs) as officers in the U.S. Public Health Service (USPHS) Commissioned Corps.

The bill, H.R. 6032, would include DCs in the Regular Corps and the Ready Reserve Corps, and would require the president, in consultation with the Surgeon General and the U.S. Secretary of Health and Human Services, to appoint no fewer than six DCs to the Commissioned Corps. Although the Commissioned Corps includes representatives from many diverse health care professions, no doctors of chiropractic have ever been appointed to serve—ACA and ACC have been working diligently with Reps. Green and Terry to advance this legislation, which specifically addresses this long-standing deficiency. 

The Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Officers in the Corps provide health care services in a variety of locations and venues, including care to members of the U.S. Coast Guard and at community health centers. 

“Both Rep. Green and Rep. Terry have been champions for improving access to quality health care, and are long-time supporters of the chiropractic profession’s role in delivering vital health services to our nation’s citizens,” said ACA President Rick McMichael, DC. “The services of doctors of chiropractic will be a tremendous value to the Commissioned Corps, and enacting this legislation will be another important milestone in the mission to fully integrate chiropractic care into the nation’s health care delivery system.”

"Doctors of chiropractic already serve our nation's active-duty military and veterans with distinction and success,” said ACC President Frank Nicchi, DC. “H.R. 6032 will allow doctors of chiropractic to join forces with other health care providers in the fight against disease, poor health conditions and other threats during both non-emergency and emergency periods for our country. We extend our appreciation to Rep. Green and Rep. Terry for their bipartisan effort to introduce this long-overdue legislation.”

H.R. 6032 has been referred to the House Committee on Energy and Commerce, which has jurisdiction over the USPHS. Reps. Green and Terry serve as senior members of that committee. ACA and ACC will soon initiate a range of grassroots activities to build support for this important legislation. 

To contact your Representative and urge them to cosponsor H.R. 6032, please visit the ACA Legislative Action Center.

The American Chiropractic Association, based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients.

The Association of Chiropractic Colleges represents accredited chiropractic colleges in North America and seeks to advance chiropractic education, research and service.















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2010 ACC-RAC: Most Highly Attended

With a focus on looking ahead to chiropractic’s future role in the evolving health care system, this year’s Association of Chiropractic Colleges Educational Conference and Research Agenda Conference (ACC- RAC) was held at Caesar’s Palace in Las Vegas, March 17 to 20, and attracted a record number of participants. ACC president, Frank J. Nicchi, DC, was pleased with the event: “I feel like we accomplished a great deal this year, attendance was robust and important issues in chiropractic education were addressed.  I should also add that the papers, posters and panel discussions presented at the conference were outstanding.”

The conference’s theme, Chiropractic and Public Health in the 21st Century, was advanced by keynote speakers, best-selling author, Nortin M. Hadler, MD, who discussed the personal, social and policy consequences of low back pain in a thought provoking presentation and Georges C. Benjamin, MD, executive director of the American Public Health Association, who spoke to the challenges and opportunities associated with improving population health and providers’ roles in reaching society’s goals. The resoundingly successful conference that included 200 scientific papers submitted for peer review from which 66 were selected for poster presentation and 92 for platform presentation concluded with a lively panel discussion, Subluxation Theory as a Component of Public Health.

During the business meeting, the ACC presidents’ group deliberated on a number of issues including the implementation of action steps related to several strategic directives developed at a July 2009 board retreat. Among those strategic directives are: to achieve consensus among member institutions as to how the chiropractic academic community may contribute to integration within the existing and emerging health care systems; promote collaboration in research efforts among member institutions; increase the quantity, quality and diversity of applicants pursuing chiropractic education; review the ACC Paradigm from an educational perspective; develop relationships with other chiropractic and allied health institutions globally that complement ACC’s mission, vision and values and to look at the possibility of developing clinical residencies as part of the doctor of chiropractic program training. Additionally, ACC working groups , consisting of the chief academic officers, chief financial officers,  directors of clinic, development, institutional assessment, research, libraries, admissions and postgraduate education, met to discuss common challenges facing member institutions.

The ACC-RAC planning committee was chaired by ACC vice-president Fabrizio Mancini, D.C. and included Richard Brassard, D.C. (ACC secretary-treasurer), Cheryl Hawk, D.C., Ph.D., Claire Johnson, D.C., William Meeker, D.C., David O’Bryon (ACC executive director), Robyn Patkus and Rodger Tepe, Ph.D.  Dr. Claire Johnson, Peer Review Chair for the scientific platform and poster sessions for the ACC-RAC conference said, “The 2010 program had the largest turn out of chiropractic research in the history of the conference and remains the premiere scientific venue for which all forms of chiropractic research are presented – which is essential to the future development of the chiropractic profession.”    

Event sponsors included renowned maker of whole food nutritional supplements premier sponsor Standard Process, Inc., and platinum sponsors Foot Levelers and NCMIC.   Next year’s conference, themed integration, will also be held at Caesar’s Palace.  For more information, please visit
www.chirocolleges.org.








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National Guidelines Clearinghouse Publishes CCGPP Documents

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is very pleased to announce that the literature syntheses published in JMPT have now been accepted for inclusion in the National Guideline Clearinghouse (NGC) and are available at www.guideline.gov. The NGC is a comprehensive database of evidence-based clinical practice guidelines and related documents. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.

This important recognition represents the culmination of a three-year effort by the best and brightest of chiropractic researchers reviewing and analyzing thousands of research articles in an effort to compile the most valid available clinical evidence. The CCGPP Scientific Commission is composed of dozens of doctors of chiropractic from around the United States and Canada and chaired by Dr. Cheryl Hawk. These doctors have donated thousands of hours of their time in this effort and deserve a resounding thank you from each and every doctor of chiropractic in this country. We would also like to recognize the countless number of people who logged in to the CCGPP site and provided valuable stakeholder input. Additionally, Dr. Claire Johnson, editor of JMPT, also deserves special recognition for the extraordinary assistance she provided in guiding CCGPP through the listing process.

“The CCGPP is very excited about the literature syntheses being accepted for inclusion by the National Guideline Clearinghouse”, said Dr. Mark Dehen, CCGPP Immediate Past Chair. “To have the CCGPP’s literature syntheses and treatment recommendations listed is a significant and historic step in our long-term Dissemination, Implementation, Evaluation and Revision (DIER) process. This level of acknowledgment will make these literature syntheses broadly available to all of our stakeholders, better educating them about the chiropractic profession and encouraging collaborative opportunities. More importantly, it will provide another avenue to make this information available to our chiropractic practitioners as they seek to continue to increase the quality of care they provide their patients.

According to the agency’s website, the NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.
The spectrum of evidence utilized ranged from randomized controlled trials to case series and consensus opinion. The draft documents were made available for stakeholder review and comment on the internet in an effort to improve the transparency and promote profession-wide input before these documents were published in a peer reviewed journal.

The chiropractic profession owes a tremendous debt of gratitude to Dr. Cheryl Hawk, current Commission Chair; Low Back Cochairs, Drs. Dana Lawrence and William Meeker; Low Back Consensus Chair, Dr. Gary Globe; Myofascial and Fibromyalgia Cochairs, Drs. Howard Vernon and Michael Schneider; Tendinopathy Chair Dr. Mark Pfefer; Lower Extremity Cochairs Drs. James Brantingham and Gary  Globe; as well as all of their teams and research assistants.  We also thank our previous Commission Chairs, Drs. Skip Lantz, Jay Triano and Al Adams, as well as our current and former Council members. We also would like to acknowledge our tremendous debt to all of our benefactors, most especially our former Vendor Representative, the late ChiroCode founder, D. Henry Leavitt.









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ACA names William K. O’Connell executive vice president

March 16, 2010 — The American Chiropractic Association (ACA) Board of Governors today announced the hiring of William K. O’Connell as its new executive vice president. Connell succeeds Kevin Corcoran, who left the association in May 2009.

"After an exhaustive search, I am pleased to announce the appointment of Bill O’Connell as the association's next EVP. His extensive background in association leadership makes him a natural fit at the helm of ACA,” said Dr. Mario Spoto, chairman of ACA’s Board of Governors.

Most recently, O’Connell served as executive director of government affairs at the National Safety Council. His achievements there include gaining the support of congressional staff for authorization bills and appropriation initiatives, managing issues and key relationships with executive branch staff and appointees, and forging partnerships in coalitions of like-minded organizations to advance shared legislative interests.

Additionally, O’Connell has served as a senior executive with the American Board of Anesthesiology, the American Osteopathic Association and the American Dietetic Association, which has prepared him to face the challenges and opportunities that the chiropractic profession must address in the changing health care environment.

"I am very excited to welcome Mr. O’Connell to ACA and the chiropractic community,” said ACA President Dr. Rick McMichael. “His successful track record of creating partnerships and coalitions and working with legislators on the Hill will be a real asset to the ACA.”








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ELLIOTT ELECTED TO ACCAHC BOARD OF DIRECTORS

The Academic Consortium of Complementary and Alternative Medicine (ACCAHC) recently elected Horace Elliott to its board of directors.  The ACCAHC was formed in 2004 as part of a broad coalition of health care professionals and organizations driving public policy to ensure that all Americans have access to safe, high quality, integrated health care.
 
Elliott has been Executive Vice President of the National Board of Chiropractic Examiners (NBCE) since 1986.  Reporting to an 11-member board of directors, Elliott is responsible for the daily operations and finances of the NBCE, as well as the goals and policies of the organization.  Prior to the NBCE, Elliott held several executive management positions at companies such as the Bendix Corporation, and Price Waterhouse/Coopers in Houston. 
 
Elliott is a graduate of Lamar University in Beaumont, Texas.  He has received numerous awards including two honorary doctorate degrees, one from Texas Chiropractic College and another from the American College of Chiropractic.  Elliott is a fellow of the International College of Chiropractic.  In 2004, he received the George Arvidson Award for Meritorious Service to Chiropractic Licensure from the Federation of Chiropractic Licensing Boards.  
 
Elliott is actively involved in his hometown community of Greeley, Colorado, where he lives with his wife, Sue.  He has been an active member of the Greeley Chamber of Commerce, serving as Chamber representative to the Greeley Planning Commission, and the Greeley Rotary Club, where he previously served on the board of directors.






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Study Expert Validates Chiropractic Standard of Care

“The most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a study sanctioned by the United Nations and the World Health Organization) indicates neck manipulation is a safe and effective form of health care,” according to Matt Pagano, DC, chiropractic profession spokesperson.

Respected researcher and epidemiologist J. David Cassidy, DC, PhD, DrMedSc, testified as a key witness last week at the hearings on informed consent before the Connecticut Board of Chiropractic Examiners in Hartford, Conn. Speaking as an expert witness and consultant to the International Chiropractors Association (ICA)—and with the support of all chiropractic organizations involved in the process, including the American Chiropractic Association, Association of Chiropractic Colleges, Foundation for Chiropractic Progress, Life West, New York College of Chiropractic, Parker College of Chiropractic, Palmer College of Chiropractic, and the University of Bridgeport College of Chiropractic—Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor. The objective of his testimony was to bring the discussion from an emotional issue back to science and the objective research record.

Dr. Cassidy joined an extensive list of witnesses representing the chiropractic profession, including William J. Lauretti, DC; James J. Lehman, DC, MBA; J. Clay McDonald, DC, JD, MBA; Gerard W. Clum, DC; Stephen M. Perle, DC, MS; Gina Carucci, DC, MS, DICCP, who appeared on behalf of the Connecticut Chiropractic Association (CCA); and George Curry, DC, FICA, who appeared on behalf of the Connecticut Chiropractic Council (CCC).

“The chiropractic profession unequivocally supports a patient’s right to be informed of the material benefits and risks of any type of health care treatment – not just chiropractic. Legislation or regulatory mandates governing informed consent should apply to all health care providers and all treatments in equal measure. However, a new law, regulation or mandate highlighting one specific treatment by a specific health care profession, which carries with it an extremely rare association and no causal link identified in the research, is simply not good public health policy. It would set an unnecessary precedent for all health care providers, procedures and products that would be virtually impossible to implement,” said Pagano.

The existing informed consent standards in Connecticut allow for the best opportunity for shared decision making between a patient and his or her health care provider. Further, the chiropractic organizations participating in the hearing process all believe informed consent is more than a piece of paper; it is a process. It should occur in the context of a discussion between a doctor and a patient, and it should be appropriately documented.

In a finding highly relevant to the issue before the Connecticut Board of Chiropractic Examiners, the Neck Pain Task Force study demonstrated that patients suffering from headache and neck pain are no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician. This implies that there are factors involved other than the type of care provided by doctors of chiropractic.  It’s important to note that millions of patients safely benefit from chiropractic care every year—they are able to return to their normal activities and enjoy a better quality of life.

Dr. Cassidy was an investigator with the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The work of this international task force affirms the safety and benefits of chiropractic care for people with neck pain—a condition frequently treated by doctors of chiropractic. The Task Force initiated this new population-based, case-control and case-crossover study, which appeared in the Feb. 15, 2008 edition of the journal Spine.

The study, which analyzed nine years’ worth of data from a population of 110-million person years, concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke following a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician (PCP).

The study goes on to say that any observed association between VBA stroke and chiropractic manipulation—as well as its apparent association with PCP visits—is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke.

Over the years, popular media has all too often sensationalized the association between chiropractic cervical manipulation and cerebral vascular accidents—even though the evidence would strongly indicate that this assertion is incorrect. The organizations representing the chiropractic profession believe this most recent evidence should help to dispel any myths on this issue, as well as provide more data to support the safety and effectiveness of chiropractic procedures.

As a profession, doctors of chiropractic remain committed to expanding the research and clinical understanding of VBA injuries, because even one cerebral vascular incident that could have been prevented or detected early is one too many.




















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NJ Passes Scope of Practice Awaits Governor Corzine Signature

 

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NBCE BREAKS GROUND ON NEW MEETING FACILITY

Greeley, Colo. – On Friday, October 16, the National Board of Chiropractic Examiners (NBCE) broke ground on a 15,000 square foot, $2.5 million dollar building. The target completion date is May 27, 2010. NBCE President Dr. Vernon Temple along with members of the NBCE Executive Committee Drs. Edwin Weathersby, Richard Cole and Ted Scott, and Daniel Saint-Germain, President of the Federation of Chiropractic Licensing Boards and Chair of the NBCE Developmental Committee, were on hand to welcome special guests, including Larry Steel, Architect. Opening remarks were made by Horace Elliott, NBCE Executive Vice President, Greeley Mayor Ed Clark, Greeley Chamber of Commerce President Sarah MacQuiddy, and Terry Drahota representing Drahota Construction of Fort Collins, Colorado. Other special guests recognized were County Commissioner Sean Conway and Greeley City Council member Maria Seacrest, Greeley City Manager Roy Otto, Bruce Biggi of the City Economic Development office, and several academic vice presidents of chiropractic colleges. According to President Temple, “The new building represents the growth and expansion necessary for the NBCE and its international component, the International Board of Chiropractic Examiners, to maintain the high standard we have set for testing in the health care community.” He continued, “In the last 46 years, this organization has set the standard in testing—not just in chiropractic, but in the general standardized testing community. NBCE has gained the recognition and confidence of the general public and state regulatory boards as well as unified the profession by providing standardized testing that assesses the ability of each doctor of chiropractic." The new building will house state-of-the-art audiovisual and teleconferencing equipment that will enhance the ability of test committee members to develop future examinations testing basic science and clinical knowledge and the demonstration of clinical competency. Each year more than 300 visitors, representing state licensing boards, chiropractic college faculty, and subject matter experts meet at the NBCE to develop standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. The organization has been headquartered in Greeley, Colo., since 1978 and moved to its current campus in west Greeley in 1990.

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Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

A report, prepared by a global leader for trusted human resources and related financial advice, products and services, finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at: (Full Report) Executive Summary: Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment. The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations. High quality randomized cost-effectiveness studies have to date only been performed in the EU. To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU. The results of the researchers’ analysis are as follows: Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain. Total cost of care per year: -For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care. -For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care. Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds. These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve. Accordingly, this report was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US. Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and president of Life Chiropractic College West, says, “While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.” About F4CP A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) embraces a singular mission to promote positive press for the profession in national, regional and local media. Through effective and ongoing initiatives, the Foundation’s goal is to raise awareness to the many benefits provided by doctors of chiropractic. The F4CP relies upon strategic marketing campaigns that span prominent spokespersons, monthly press releases, public service announcements, and advertisements in high-profile media outlets. To learn more about the Foundation, please visit us on the web at www.foundation4cp.com or call 866-901-f4cp.

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ACA, Coalition Support Bill Repealing 'Flawed' Medicare Payment Formula

(Arlington, Va.) -- The American Chiropractic Association (ACA) has joined with other provider groups to support legislation, S. 1776, introduced in Congress on Oct. 13 by Sen. Debbie Stabenow (R-Mich.) that would permanently repeal the “flawed” formula that determines Medicare reimbursement rates. Current federal law mandates that Medicare payments to physicians be modified annually using the Sustainable Growth Rate (SGR) formula. The SGR formula ties payments to the national gross domestic product, and many in health care have expressed concerns that this system is neither accurate nor appropriate. Acknowledging problems associated with tying payments to the SGR, Congress for the past seven years has voted to overturn proposed fee cuts based on the formula. On Oct. 16, ACA joined other health care provider organizations in the Patients’ Access to Responsible Care Alliance (PARCA) to voice its strong support of ending the system that has for too long proposed unfair reimbursement rates. By joining with other providers, ACA underscores its belief that the current system is unacceptable for any health care professional. To read the PARCA letter to Sen. Stabenow, click here. “ACA is committed to supporting S. 1776, and any other legislation that addresses problems associated with the flawed SGR formula,” said ACA President Rick McMichael, DC. “Health care services to our nation’s Medicare beneficiaries should not be undervalued.” Look for updates on S. 1776, and ACA’s efforts to address the Medicare payment system, in upcoming ACA publications and on ACA’s Web site:

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New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders

(Arlington)-- A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care. “The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added. Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days. The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark. Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes: • A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. • A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms. • A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.

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Patient Survey Finds Chiropractic Offers Most Satisfaction in Back Pain Treatment

According to a newly released patient survey by a leading consumer group, chiropractic is the top rated treatment for back pain. Of the 14,000 survey respondents who suffered from back pain in the past year, 58 percent rated chiropractic/spinal manipulation as helping a lot. When asked how satisfied they were with practitioners, 59 percent of respondents said they were “highly satisfied” with the back pain treatment received from their doctors of chiropractic whereas only 34 percent said the same about their primary care physicians. Most survey respondents had, on average, tried five or six different treatments for their back pain. Click on the link below to watch a report from CBS News:

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Hands-on Therapies for Relief of Aching Backs Rated Top

The May 2009 issue of Consumer Reports Magazine reports the results of its recent survey of more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. About 80 percent of U.S. adults have at some point been bothered by back pain. The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers who had lower-back pain in the past year but had never had back surgery. More than half-said pain severely limited their daily routine for a week or longer and 88 percent said it recurred through the year. Many said the pain interfered with sleep, sex, and efforts to maintain a healthy weigh… This article is the archived version of a report that appeared in May 2009 Consumer Reports Magazine. Read the entire Consumer Reports Magazine report by clicking on the link below: Consumer Reports Magazine Reports on Aching Backs

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NBCE SUPPORTS CHIROPRACTIC POSITION AT THE WORLD HEALTH ORGANIZATION

The National Board of Chiropractic Examiners (NBCE) Board of Directors recently voted to help sponsor a position in chiropractic at the headquarters of the World Health Organization (WHO) in Geneva, Switzerland. The position is the first chiropractic appointment ever established at the WHO and has been offered to Dr. Molly Meri Robinson as a mid-level technical officer, a non-treating physician. The NBCE joins the National Chiropractic Mutual Insurance Company, Foot Levelers, Standard Process and the World Federal of Chiropractic in financially supporting the first year of Dr. Robinson’s appointment. Dr. Robinson, a graduate of Northwestern Chiropractic College, previously served as National Legislative Chair for the Students of the American Chiropractic Association, as well as regional representative of the World Congress of Chiropractic Students. She was the first chiropractic intern to serve at the WHO, a position that resulted in the development of a permanent chiropractic position. NBCE President Dr. Vernon Temple announced the NBCE’s support, saying, “We are extremely proud of the dedication and prudent judgment shown by Dr. Robinson during her internship. The doors she has opened will help to lead the major paradigm shift currently taking place worldwide in chiropractic health care. Dr. Robinson’s presence in Geneva will serve as a constant reminder of the excellent education of chiropractors and their ability to serve as portal of entry physicians.” He said, “This is an excellent match for the NBCE as we develop the International Board of Chiropractic Examiner’s role in including chiropractic in national health care delivery systems.” The World Health Organization is the central clearinghouse for information on health care for 193 countries around the world. Because of the WHO’s importance in defining future health care policy, the NBCE Board of Directors chose to endorse and support the appointment of Dr. Robinson. She will represent the chiropractic profession in crafting policy that will consider non-pharmaceutical treatment, especially chiropractic, among treatment modalities. Headquartered in Greeley, Colo., 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. For more information, please contact Joanne Monath, Director of Professional Relations and Communications at [email protected] or 970-356-9100 ext 119.

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According to a New Government Survey, 38 Percent of Adults and 12 Percent of Children Use Complementary and Alternative Medicine

Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey(1). This survey marks the first time questions were included on children's use of CAM, which is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine. The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation. "The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans' use of CAM," said Josephine P. Briggs, M.D., director of NCCAM. "These statistics confirm that CAM practices are a frequently used component of Americans' health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care." The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS—the first was done as part of the 2002 NHIS(2). CAM Use Among Adults Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases. The most commonly used CAM therapies among U.S. adults were --Nonvitamin, nonmineral, natural products (17.7 percent) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng(3) --Deep breathing exercises (12.7 percent) --Meditation (9.4 percent) --Chiropractic or osteopathic manipulation (8.6 percent) --Massage (8.3 percent) --Yoga (6.1 percent) Adults used CAM most often to treat pain including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007). Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among: --Women (42.8 percent, compared to men 33.5 percent) --Those aged 30-69 (30-39 years: 39.6 percent, 40-49 years: 40.1 percent, 50-59 years: 44.1 percent, 60-69 years: 41.0 percent) --Those with higher levels of education (Masters, doctorate or professional: 55.4 percent) --Those who were not poor (poor: 28.9 percent, near poor: 30.9 percent, not poor: 43.3 percent) --Those living in the West (44.6 percent) --Those who have quit smoking (48.1 percent) CAM Use Among Children Overall, CAM use among children is nearly 12 percent, or about 1 in 9 children. Children are five times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar—factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use. Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and Attention Deficit/Hyperactivity Disorder (ADD/ADHD). The most commonly used CAM therapies among children were --Nonvitamin, nonmineral, natural products (3.9 percent) --Most common: echinacea, fish oil/omega 3/DHA, combination herb pill, flaxseed oil or pills, and prebiotics or probiotics --Chiropractic or osteopathic manipulation (2.8 percent) --Deep breathing exercises (2.2 percent) --Yoga (2.1 percent) "The survey results provide information on trends and a rich set of data for investigating who in America is using CAM, the practices they use, and why," said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM's Division of Extramural Research and co-author of the National Health Statistics Report. "Future analyses of these data may help explain some of the observed variation in the use of individual CAM therapies and provide greater insights into CAM use patterns among Americans." Inclusion and development of the 2007 supplement was supported, in part, by seven National Institutes of Health components: NCCAM; National Heart, Lung, and Blood Institute; National Institute of Allergy and Infectious Diseases; National Institute of Mental Health; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Office of Dietary Supplements; and Office of Behavioral and Social Sciences Research. 1.--Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 10, 2008. 2.--Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004. 3.--While the reference period for overall use of nonvitamin, nonmineral, natural products was for the past 12 months, the reference period for the use of specific nonvitamin, nonmineral, natural products was reduced from 12 months in 2002, to 30 days in 2007 in order to be more congruent with other national surveys of dietary supplement use, such as the National Health and Nutrition Examination Survey.

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ACA Rolls Out Chiropractic Advocacy Network

(Arlington, Va.) -- The American Chiropractic Association (ACA) today announced that it has rolled out the pilot phase of its patient advocacy network enabling an initial group of nearly 400 doctors of chiropractic to introduce their patients to a specially-designed Internet portal. This preliminary phase will ensure the network’s full functionality prior to its official launch on Jan. 5, 2009. The advocacy network is one piece in an ambitious campaign to mobilize chiropractic patients and supporters in a coordinated effort to lobby Congress and the new Obama administration in support of Americans' expanded access to services provided by doctors of chiropractic. The national grassroots campaign will utilize modern electronic methods to quickly and effectively deploy chiropractic’s voice when needed on Capitol Hill. In making the announcement to ACA’s House of Delegates, association President Glenn Manceaux, DC, said the best way to ensure a positive outcome for chiropractic in national health care and Medicare reform is to mobilize the grassroots power and influence of chiropractic patients. “Strengthening the voice of chiropractic will positively impact not only our patients, but all aspects of our profession,” Dr. Manceaux said. “ACA recognizes that there are many stakeholders in the profession: practitioners and their staff members, students, faculty, product and service vendors, trade media, and especially, our patients. Using ACA’s advocacy network, we hope to engage as many of these groups as possible because each has a constituency that responds uniquely to its respective call to action. “To ensure that the profession’s goal of full-scope inclusion becomes a reality, ACA is not only providing leadership to this initiative but is also collaborating with those organizations involved in the Chiropractic Summit,” he continued. All doctors of chiropractic will receive special instructions and information about ways they and their patients can participate in the campaign via the January issue of ACA News. Further, the ACA will promote the program through ongoing conference calls with state chiropractic associations, and in January will host a series of teleseminars open to all doctors of chiropractic to share additional information and answer questions. ACA officials assure doctors that data collection efforts will be fully HIPAA compliant and that patient information will not be shared with any third parties. Association leaders laid the groundwork for this project nearly two years ago when the House of Delegates approved a new association management system, capable of housing a national database of patient contact information that can be matched with individual members of Congress. The patient mobilization campaign was developed over the last several months by the ACA Board of Governors, Legislative Commission, and Political Action Committee (PAC) Board. Details were finalized during a joint Legislative Commission-PAC meeting at ACA headquarters Nov. 14-15, 2008.

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Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients

ABSTRACT Objective: The objective of this study was to gather descriptive information concerning the clinical outcomes of patients with cervical and lumbar radiculopathy treated with a nonsurgical, chiropractic treatment protocol in combination with other interventions. Methods: This is a retrospective review of 162 patients with a working diagnosis of radiculopathy who met the inclusion criteria (312 consecutive patients were screened to obtain the 162 cases). Data reviewed were collected initially, during, and at the end of active treatment. The treatment protocol included chiropractic manipulation, neuromobilization, and exercise stabilization. Pain intensity was measured using the numerical pain rating scale. Results: Of the 162 cases reviewed, 85.5% had resolution of their primary subjective radicular complaints. The treatment trial was 9 (mean) treatment sessions. The number of days between the first treatment date and the first symptom improvement was 4.2 days (median). There were 10 unresolved cases referred for epidural steroid injection, 10 unresolved cases referred for further medication management, and 3 cases referred for and underwent surgery. Conclusion: The conservative management strategy we reviewed in our sample produced favorable outcomes for most of the patients with radiculopathy. The strategy appears to be safe. Randomized clinical trials are needed to separate treatment effectiveness from the natural history of radiculopathy. Christensen KD, Buswell K. Journal of Chiropractic Medicine. September 2008; Vol. 7, No. 3, pp. 115-125.

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Translating Research Into Practice

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

REPORT FROM THE NBCE EXECUTIVE VICE PRESIDENT – July 2008

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

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ACA Targets 16,000 Neurologists with Latest Research on Neck Pain

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

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