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Senate Bill to Expand Veterans’ Access to Chiropractic Care Introduced


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Conservative Pain Management a First-Line Defense Against Prescription Drug Abuse Crisis

(Arlington, Va.) -- The American Chiropractic Association (ACA) applauds federal efforts to curb prescription drug abuse following the U.S. government’s announcement in late April that the problem has reached crisis level. ACA encourages patients and health care providers to explore drug-free, conservative approaches to pain management as a first-line defense against painkiller abuse.
The government’s report, “
Epidemic: Responding to America’s Prescription Drug Abuse Crisis,” notes that while the use of some illegal drugs has diminished, the abuse of prescription medications has sharply increased, particularly prescription opioid pain relievers such as Oxycontin and Vicodin. It points out unintentional opioid overdoses—once almost exclusively the fate of heroin abusers—are today increasingly caused by prescription painkiller abuse.
“This new report shows that while sometimes the use of these powerful drugs may be necessary, their overuse and abuse can lead to deadly consequences. The chiropractic profession offers non-drug interventions for pain relief,” said ACA President Dr. Rick McMichael. “We urge health care providers, whenever possible, to recommend drug-free conservative care interventions for their patients before prescribing medications that may be associated with harmful side effects. It’s critical that patients know their options.”
The government report outlines a four-part strategy to reduce the incidence of overdose caused by painkiller abuse, including increased education; monitoring of “doctor-shoppers” who obtain multiple prescriptions; the safe disposal of prescription medications; and cracking down on “pill mill” clinics that dispense hundreds of pills per patient. ACA believes prevention is also key and that increased use of conservative approaches for pain management may curb the need for painkillers and thereby reduce the likelihood of patient dependency, overuse and possible overdose.
Chiropractic care is best known for its effectiveness in treating painful conditions such as back pain, neck pain, and headaches—which are serious causes of disability in the United States. According to the U.S. Bone and Joint Decade, the number of prescription medications has increased in the past 10 years. Chiropractic care may lessen or eliminate the need for medications in some cases and help patients avoid unnecessary surgery. Chiropractic physicians treat the whole person, promote wellness and strive to address the underlying cause of patients’ ailments, not just their symptoms.
Current evidence-based guidelines support the use of conservative care such as chiropractic for conditions such as chronic lower back pain. In 2007, the Annals of Internal Medicine published low back pain guidelines developed by the American Pain Society and the American College of Physicians recommending that, for patients who do not improve with self-care, doctors should consider non-pharmacologic therapies such as chiropractic care, massage therapy and acupuncture.

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Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure

Abstract (provisional)

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Ethics and Boundaries Examination Introduction and Retake Policy


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Record Breaking Attendance at ACC/RAC 2011 Conference

ACC/RAC combines the ACC’s annual business meeting and working group sessions along with the educational and research or RAC’s (Research Agenda Conference’s) focus on scientific knowledge - a powerful combination intended to cultivate an increasingly intimate relationship between chiropractic scholarship and education. Chiropractic research, fittingly held to serve as the backbone for chiropractic’s successful progression, is appropriately highlighted at the conference known to attract high caliber educators and scientists. The theme this year was “Integration: Chiropractic Education and Practice in Integrative Healthcare.”

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The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain

Background context
Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.
To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician–directed usual care (UC) in the treatment of AM-LBP.
Study design/setting
A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.
Patient sample
Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).
Outcome measures
Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.
Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician–directed UC, the components of which were recorded.
Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).
This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician–directed UC in the treatment of patients with AM-LBP. Compared to family physician–directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.
The Spine Journal (December 2010) Volume 10, Issue 12 Pages 1055-1064

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Back Pain, Complementary and Alternative Medicine

Complementary and Alternative Medicine in Back Pain Utilization

Structured Abstract

This systematic review was undertaken to evaluate which complementary and alternative medicine (CAM) therapies are being used for persons with back pain in the United States.

Data Sources: MEDLINE®, EMBASE®, CINAHL® and Cochrane Central®
and a variety of CAM specific databases were searched from 1990 to November 2007. A grey literature search was also undertaken, particularly for clinical practice guidelines (CPG) related to CAM.

Review Methods: Standard systematic review methodology was employed. Eligibility criteria included English studies of adults with back pain, and a predefined list of CAM therapies.

Results: A total of 103 publications were evaluated; of these 29 did not present CAM therapy use stratified for back pain. There were a total of 65 utilization studies, 43 of which were American. Four publications evaluated the concurrent use of four or more CAM therapies and these suggest that chiropractic/manipulation is the most frequently used modality followed by massage and acupuncture. A limited number of publications evaluated utilization rates within multiple regions of the back and show that CAM was used least for treating the thoracic spine and most for the low back. However, rates of use of massage were similar for neck and lower back regions. Concurrent use of different CAM or conventional therapies was not well reported.

From 11 eligible CPG, only one (for electro-acupuncture) provided recommendations for frequency of use for low back pain of all acuity levels.

Eighteen cost publications were reviewed and all but one publication (cost-effectiveness) were cost identification studies. There is limited information on the impact of insurance coverage on costs and utilization specific to back pain.

Conclusions: There are few studies evaluating the relative utilization of various CAM therapies for back pain. For those studies evaluating utilization of individual CAM therapies, the specific characteristics of the therapy, the providers, and the clinical presentation of the back pain patients were not adequately detailed; nor was the overlap with other CAM or conventional treatments.

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Health Care Costs for Back Pain Much Higher when Care Initiated with an MD vs DC

A new study finds that low back pain care initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), the American Chiropractic Association (ACA) announced today. The study, featuring data from 85,000 Blue Cross Blue Shield beneficiaries, concludes that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.

Low back pain is a significant public health problem. Up to 85 percent of Americans have back pain at some point in their lives. In addition to its negative effects on employee productivity, back pain treatment accounts for about $50 billion annually in health care costs—making it one of the top 10 most costly conditions treated in the United States.

The study, “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer,” which is available online and will also be published in the December 2010 issue of the Journal of Manipulative and Physiological Therapeutics, looked at Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year span. The insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays.

Results show that paid costs for episodes of care initiated by a DC were almost 40 percent less than care initiated through an MD. After risk-adjusting each patient’s costs, researchers still found significant savings in the chiropractic group. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.

“As doctors of chiropractic, we know firsthand that our care often helps patients avoid or reduce more costly interventions such as drugs and surgery. This study supports what we see in our practices every day,” said ACA President Rick McMichael, DC. “It also demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”

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.


Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.

OBJECTIVE: The primary aim of this study was to determine if there are differences in the cost of low back pain care when a patient is able to choose a course of treatment with a medical doctor (MD) versus a doctor of chiropractic (DC), given that his/her insurance provides equal access to both provider types.

METHODS: A retrospective claims analysis was performed on Blue Cross Blue Shield of Tennessee's intermediate and large group fully insured population between October 1, 2004 and September 30, 2006. The insured study population had open access to MDs and DCs through self-referral without any limit to the number of visits or differences in co-pays to these 2 provider types. Our analysis was based on episodes of care for low back pain. An episode was defined as all reimbursed care delivered between the first and the last encounter with a health care provider for low back pain. A 60 day window without an encounter was treated as a new episode. We compared paid claims and risk adjusted costs between episodes of care initiated with an MD with those initiated with a DC.

RESULTS: Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient's costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD.

CONCLUSIONS: Beneficiaries in our sampling frame had lower overall episode costs for treatment of low back pain if they initiated care with a DC, when compared to those who initiated care with an MD.

Journal of Manipulative and Physiological Therapeutics (JMPT) 2010 Nov-Dec;33(9):640-3. Epub 2010 Oct 18.

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Association for the History of Chiropractic to Meet in Rhode Island

The 31st Annual Meeting and Conference of the Association for the History of Chiropractic will be May 20-22, 2011, at the Crowne Plaza Hotel, 801 Greenwich Avenue, Warwick, Rhode Island. Hotel reservations can be made by calling 401-732-6000. Be sure to mention the Association to get the $135 conference rate.

Registration fee for the conference is $100, which includes the Lee-Homewood Recognition Luncheon. Registration forms are available on the AHC website [] and should be sent to the AHC, 4430 8th Street, Rock Island, IL, 61201.

Submissions for the Lee-Homewood Award are due by December 31, 2010 and should go to the above address. The Award is made annually to a person who has made a lifetime contribution of lasting significance toward the advancement of chiropractic in the scientific and academic communities, and the public acceptance of the profession.

The deadline for paper submission for presentation at the conference is January 15, 2011. Those also go the AHC office, address above.

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Chiropractic Associations Describe Chiropractic Care Using Conventional Terminology

(Arlington, Va.) -- The Council on Chiropractic Guidelines and Practice Parameters (CCGPP), with assistance from the American Chiropractic Association (ACA), has established terminology that describes chiropractic care using conventionally recognized terminology across the accepted continuum of care. The terminology was established by a formal consensus process conducted in early 2009.

The chiropractic profession is making great strides with integration among health care providers and insurers. Doctors of chiropractic now practice in many military and Department of Veterans Affairs (VA) sites, in hospital settings and in a variety of integrated practice models. As our nation’s health care landscape changes and the primary care shortage becomes more acute, the stage will be set for even more integration of doctors of chiropractic among other health care providers—traditional and alternative. Therefore, it is vital that the scope of appropriate chiropractic care be clearly defined relative to overall patient case management.

The terminology that was established by the CCGPP consensus process relates to levels of care across the spectrum from acute care, to chronic/recurrent care and on to wellness care. The process specifically defined the following:

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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

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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 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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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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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 ( 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 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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