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:

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 .

Late yesterday, the U.S. House of Representatives passed H.R. 5658, (Sec. 704. Chiropractic health care for members on active duty) the National Defense Authorization Act for FY2009, which includes language declaring chiropractic care a standard benefit for all active-duty military personnel. The bill—supported by the American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC)—also contains language allowing for chiropractic demonstration projects at overseas military locations and clarifies that chiropractic care at U.S. military facilities is to be performed only by a doctor of chiropractic. According to ACA’s department of government relations, this most recent legislation strengthens current law and, if enacted, will increase access to chiropractic care at more facilities worldwide. To date, there is a doctor of chiropractic at 49 military bases around the United States; however, servicemen and women serving overseas do not have access to the chiropractic benefit.

Abstract Background Back problems are often recurring or chronic. It is therefore not surprising that chiropractors wish to prevent their return or reduce their impact. This is often attempted with a long-term treatment strategy, commonly called maintenance care. However, some aspects of maintenance care are considered controversial. It is therefore relevant to investigate the scientific evidence forming the basis for its use. Objectives: A review of the literature was performed in order to obtain answers to the following questions: What is the exact definition of maintenance care, what are its indications for use, and how is it practised? How common is it that chiropractors support the concept of maintenance care, and how well accepted is it by patients? How frequently is maintenance care used, and what factors are associated with its use? Is maintenance care a clinically valid method of approach, and is it cost-effective for the patient? Results Thirteen original studies were found, in which maintenance care was investigated. The relative paucity of studies, the obvious bias in many of these, the lack of exhaustive information, and the diversity of findings made it impossible to answer any of the questions. Conclusion There is no evidence-based definition of maintenance care and the indications for and nature of its use remain to be clearly stated. It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial. Chiropractic & Osteopathy 2008, 16:3doi:10.1186/1746-1340-16-3

The National Board of Chiropractic Examiners (NBCE) reports on the latest events at NBCE. The National Board of Chiropractic Examiners (NBCE) hosted a number of meetings including Practice Analysis Advisory Committee, Part IV Case Development Committee workshop, and Part IV Standardized Patient Trainers Workshop. To view the full report click on the link below.

GREELEY, Colo.—The National Board of Chiropractic Examiners (NBCE) re-elected officers during the Board’s organizational meeting May 2, 2008 in Atlanta, GA. These officers form the NBCE Executive Committee. Dr. Vernon R. Temple, D.C., (VT) was re-elected to serve as president of the National Board. Dr. Temple is a graduate of Palmer College of Chiropractic in Davenport, Iowa, and has been in practice in Vermont since 1978. He is a diplomate of the American Board of Chiropractic Orthopedists. He is a former chairman of the Federation of Chiropractic Licensing Boards and has also served as president of the Vermont Board of Chiropractic Examination and Regulation. Dr. N. Edwin Weathersby, D.C., (AZ) was re-elected as NBCE vice president. Dr. Weathersby is a graduate of Western States Chiropractic College and currently owns a multi-disciplinary practice in Glendale, Ariz. He is the past president of the Federation of Chiropractic Licensing Boards. He is a past chair of the Arizona Board of Chiropractic Examiners and former vice president and president of the Arizona Association of Chiropractic. In 1993, Theodore J. Scott, D.C., of Kaysville, Utah, was re-elected to serve a second term as District IV director and was re-elected as treasurer of the National Board of Chiropractic Examiners (NBCE) during the Annual Meeting on May 2, 2008, in Atlanta, GA. Dr. Scott will serve three years as District IV director, which includes the states of Arizona, California, Colorado, Hawaii, Kansas, Nevada, New Mexico, Oklahoma, Texas and Utah. Dr. Scott has served as chairman of the Utah State Chiropractic Physicians Licensing Board, and was reappointed to this position in 2004 for a four-year term. In addition to his NBCE responsibilities, Dr. Scott maintains a private practice in Layton, Utah. Dr. Scott is a 1978 doctor of chiropractic graduate from Texas Chiropractic College. He served as chairman of the Utah State Professional Standards Committee from 1989 to 2001. Dr. Scott is a past member of the Utah Chiropractic Physicians Association and the past convention chairman for the Utah Chiropractic Association. Dr. Mary-Ellen Rada, D.C., (NJ) was re-elected as secretary for the NBCE. Dr. Rada is a graduate of Sherman College of Straight Chiropractic in Spartanburg, S.C., and has been in practice in New Jersey since 1990. She is the former president and a current member of the New Jersey State Board of Chiropractic Examiners, where she has served since 2000. 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.

The American Chiropractic Association today announced that it has sent a letter to state chiropractic licensing boards urging them to ramp up continuing education programs aimed at improving Medicare documentation and reducing the number of claims errors. In a letter dated April 4, ACA President Glenn Manceaux, DC, noted that the Centers for Medicare and Medicaid Services (CMS) is scheduled to issue a special report to the U.S. Congress in 2009 detailing the results of the Medicare Chiropractic Demonstration Project. ACA fears that continued high claims error rates will be used as an argument to thwart efforts to allow chiropractors to provide additional services under Medicare, even if results from the demonstration project are favorable. “It is abundantly clear that unless we can convincingly demonstrate that our profession has put into place various educational and training programs, along with policies and requirements that will collectively lead to a significant reduction in Medicare claims errors, then the U.S. Congress will likely reject any proposals allowing DCs to provide additional services within Medicare,” Dr. Manceaux wrote. ACA is also anticipating the Department of Health and Human Services Office of the Inspector General (OIG) to soon issue a follow-up to its 2005 report on chiropractic documentation. The 2005 OIG Report, which was based on a random sampling of claims data from 2001, concluded that 67 percent of the claims examined as part of the study contained documentation errors or omissions that led to what the OIG considered to be inappropriate reimbursement under Medicare. “ACA is fully prepared to wage an intensive battle to secure expanded and permanent chiropractic benefits under the Medicare program; however, we need the support of every chiropractic organization and every chiropractic office across the country,” Dr. Manceaux said. To read ACA’s letter to the state chiropractic licensing boards, click on the link below:

Over the last few years many of you have heard the cries of our fellow chiropractic practitioners in California over the revisions in their Workers Compensation system. In 2004 the California legislature adopted the American College of Occupational and Environmental Medicine (ACOEM) guidelines for use in that system. Only those interventions recommended in the ACOEM guidelines are now reimbursable under California law. The only exception available under this law is that the ACOEM guidelines may be supplemented by other nationally published guidelines. In December of 2007 Gary Globe, DC, MBA, PhD, who is serving as the California Chiropractic Association (CCA) representative on the California Workers Compensation Advisory Board, contacted the CCGPP for assistance. Dr. Globe indicated that there was a brief window of opportunity for the chiropractic profession to provide a nationally published supplemental guideline to clarify weaknesses in the ACOEM guidelines as it pertains to chiropractic care for low back and chronic pain conditions. However, for this opportunity to be realized, that supplement had to be available for the next regularly scheduled meeting of the California Workers Compensation Advisory Board on March 19, 2008. As many of you are aware, in September, 2007 the CCGPP's Rapid Response Team initially penned a letter to United Healthcare demonstrating the inappropriateness of their newly adopted policy of non-coverage for chiropractic care of pediatrics and headaches. That letter was subsequently endorsed by the ACA, ICA, FCER, COCSA, ACC, etc. In response to that letter, in October, 2007 United Healthcare suspended both policies for additional review. They have recently announced they have retracted the pediatric policy altogether and have reworked the headache policy. Due to the rapidity and success of this response, Dr. Globe was prompted to contact the CCGPP for assistance with the California Workers Compensation situation. The CCGPP at its inception was charged with the evaluation of any guidelines, parameters, protocols, best practices, and standards of practice. This also means taking a stand for the profession when a problem or potential assault is noted. Therefore, the CCGPP accepted the California challenge and has undertaken a new initiative. We are currently involved in a Delphi process to generate consensus opinion of Doctors of Chiropractic from across the country regarding the care of low back pain, especially chronic pain. After conducting its extensive literature synthesis on low back conditions initially posted on the Internet in May of 2006, the CCGPP is acutely aware that there is inadequate literature on various areas of common chiropractic practice. Many of those studies that do exist have a medical bias that needs to be tempered with a chiropractic lens, as provided by the CCGPP's team of low back experts. The purpose of the Delphi technique is to elicit information and judgments from participants to facilitate problem-solving, planning, and decision-making. It does so without physically assembling the contributors. Instead, information is exchanged via mail, FAX, or email. It is structured to capitalize on the merits of group problem-solving and minimize the liabilities of group problem-solving. Consensus derived from a rigorous Delphi process is considered to be expert evidence, and while not as highly valued as some forms of research, it is nevertheless widely used and accepted, particularly in addressing areas where high quality research is lacking. Indeed, other national guidelines have used medical expert opinion to address issues of chiropractic care when more definitive literature was not available. The purpose of the CCGPP conducting the present Delphi process was to look at the same literature base others have, through a chiropractic expert perspective. The Delphi technique requires a Coordinator to organize requests for information, information received, and to be responsible for communication with the participants. The Delphi technique requires an efficient communication channel to link the Coordinator with each of the participants. Therefore, this Delphi process is being undertaken in an effort to clarify the role of chiropractic in these areas of care, especially as they are impacted by the Workers Compensation system and their incorporation of external guidelines, e.g. ACOEM, ODG, etc. CCGPP solicited seed panelists from chiropractic's national organizations, e.g. ACA, ICA, etc., and from the state associations through COCSA. These 39 panelists are all actively involved in chiropractic practice from across the country with a diverse variety of philosophy, technique and practice situations. As background material, those panelists were provided the CCGPP's Low Back literature synthesis, along with Dr. Gert Bronfort's recent study published in the Spine Journal. After reviewing the ACOEM guidelines, the CCGPP's Seed Committee then developed 27 seed statements defining areas of concern within those guidelines. Those seed statements were then submitted to the panel for review and comment. After the first round of review, there was greater than 80% consensus on 24 of the 27 seed statements. On the 3 outstanding seed statements, the panelist's comments were reviewed by the Seed Committee and utilized to revise those statements. Those revised seed statements were then submitted to the panelists for a second round of review and comment. After the second round, the 3 remaining outstanding seed statements again achieved greater than the 80% threshold for consensus that the Seed Committee had required at the outset of the project. The Seed Committee is currently in the process of incorporating the acquired commentary into a final consensus report. The CCGPP is hopeful of having the final version available by the beginning of June for use in the California Workers Compensation process. That consensus report will also be posted on the CCGPP's website when it is available. The CCGPP Scientific Commission Chair, Dr. Cheryl Hawk, also has a verbal commitment from the Journal of Manipulative and Physiological Therapeutics to publish the available literature syntheses chapters, inclusive of this consensus report, in the November/December 2008 issue. CCGPP has studiously avoided entering into the "guidelines" development process for a number of years, especially following the furor raised over the "Mercy" guidelines. They were widely condemned, particularly by those who never took the time to read them or learn how to properly apply them to obtain the care their patients needed. However, "Mercy" was a long time ago, given the pace of change in health care over the last decade and a half, and the literature needed to be updated. Third party payors, government agencies, other guideline organizations, patients, and yes, even DC's now want to know what kind of care is supported by evidence. Our profession's refusal to address this issue has led to the inevitable result that MD's, insurers and bureaucrats are now deciding what reasonable chiropractic care should be, based on their interpretation of the currently available scientific literature. We must remember that we exist as a profession to provide a service our patients need and want and not to advocate for what is best for our own benefit. Need proof? Our market share has not increased (and some would argue it has declined) despite the greatest increase in the use of CAM in recent history. We continue to have little cultural authority, meaning in part that the public still does not clearly understand our role and areas of expertise in the health care market. Physical therapists are publishing widely accepted papers on indications for manipulation of the low back, and have made it clear that they intend to take over chiropractic's traditional place in the health care market. The good news is that there is a great deal of evidence for what we do, as revealed by the CCGPP Low Back Literature Synthesis, as well as the subsequent CCGPP condition related chapters. The crisis in California (where nearly one-quarter of US doctors of chiropractic practice) has provided an opportunity to address what many of us consider to be mis-interpretation of the scientific literature, and to instead re-interpret the scientific literature viewed through a chiropractic lens. This Delphi process was in part developed by the CCGPP in response to what we heard at COCSA in Baltimore in 2006, where one of the primary concerns voiced by our critics during our round table discussion was that not every aspect of chiropractic practice had yet been subjected to randomized controlled trials. Now some of those same critics have already begun to naively criticize this effort as "unscientific." Nothing could be further from the truth. CCGPP conducted a multi-year, scientific evaluation of the current literature based on internationally accepted standards and resulting in the aforementioned Low Back Literature Synthesis. We also included additional, newly released research, published in interim since the completion of the Low Back Literature Synthesis. This formed the framework for the subsequent Delphi consensus process, which is widely viewed as an appropriate, defensible and scientific methodology for addressing areas where scientific literature is lacking. The issue of "dosage" is a perfect example of the need for a scientific consensus process. Patients, insurers, DC's and others want to know what reasonable parameters of chiropractic care are for a given condition. Is it short trials of treatment to see if it helps, or 75 visits and year-long contracts? Most published literature on this subject is based on treatment restrictions which do not realistically reflect actual practice, but reflect necessary limitations imposed by clinical study protocols. Accordingly, the most appropriate and valid methodology for addressing the gaps between scientific studies and clinical practice is a rigorous consensus process. We chose to use the Delphi process because of its economy in terms of both costs and timeliness. We chose to ask every state association and national organization in the country to provide participants who were conversant with using published literature, represented a wide variety of practice styles, philosophies and locals, and who were willing to work collegially to try to reach accord. Is the end result what we wanted? No, if the goal was the ability of the individual chiropractor to practice unfettered by any constraints (and we are unaware of any other health care profession with such a privilege). But if the goal was to draft a guideline which reflects the mainstream of chiropractic practice, provides advice and benchmarks for extending trials of treatment, and most importantly safeguards our patients' rights to demonstrably effective, conservative chiropractic care, then we believe this is a good start. We anticipate that this type of consensus process will eventually have national impact, as New York, Ohio and other states are also incorporating the ACOEM or other guidelines into their Workers Compensation systems. As an example, the CCGPP was contacted in early March by the ACA to participate in their recently established Guideline Review Task Force. This task force has been established in response to a request by the ACA Delegate in Tennessee, Dr Michael Massey. BCBS of Tennessee has requested a critique of the Milliman Care Guideline, 12th Edition, as it applies to chiropractic care. Once that review has been completed, the task force members are hoping to again put together an intraprofessional coalition to sign onto the review, such as was done with the successful effort to convince United Healthcare to change its Pediatric and Headache Guideline. It is the hope of the involved parties that this review will be used to enter into a collaborative effort with Milliman and Robertson to improve their product, beyond its application to BCBS of Tennessee. For further information or if you are interested in assisting with this process, please visit the CCGPP website at www.ccgpp.org Ultimately, the CCGPP views this type of consensus development as one of the next phases of the progression from the literature syntheses to the "best practices" development process we have dubbed the "Chiropractic Clinical Compass". This is also another example of the CCGPP's Rapid Response Team model, where the fluidity of our organization is able to mobilize our teams of experts and effectively address an immediate issue. However, we were only able to conduct this process due to the generous donation of time by all participants, or the generosity of the institutions at which they are employed. ABOUT THE AUTHOR: Dr. Mark D. Dehen is a second generation Doctor of Chiropractic practicing in North Mankato, MN. He does ergonomic consulting and injury prevention for local industries. Dr. Dehen is a past president of the MN Chiropractic Association and recipient of the MN Chiropractor of the Year award. Currently, he serves as Chair of the CCGPP.

In a report to accompany legislation reauthorizing the National Health Service Corps (NHSC), the Senate Committee on Health, Education, Labor and Pensions made it abundantly clear that doctors of chiropractic are eligible to qualify for inclusion in the NHSC Loan Repayment program. The report language, which will accompany bill S.901, is supported by both the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC). “For more than 35 years, doctors of chiropractic were excluded from the National Health Service Corps because we were not mentioned explicitly as eligible providers,” said ACA President Glenn Manceaux, DC. “Many areas of the country are experiencing shortages of qualified health professionals, and doctors of chiropractic are uniquely positioned to provide high-quality, cost-effective care to the nation’s underserved communities. I applaud the Senate committee for taking this action and I look forward to chiropractic inclusion in the program.” “This is a great victory, particularly for chiropractic students who are ready, willing and able to serve in the NHSC,” said ACC President Carl Cleveland III, DC. “Chiropractic graduates enter the profession well-qualified, prepared and most eager to serve, but many are positioned to enter practice with considerable student loan indebtedness. Thanks to the Committee’s action, doctors of chiropractic—especially the next generation of doctors graduating from our colleges—will soon have an opportunity to participate in this important loan forgiveness program.” Originally enacted in 1970, NHSC allows selected health care professionals engaged in the delivery of primary care services to be reimbursed for student loans in return for establishing and maintaining their practices in geographic areas designated as “medically underserved” by the federal government. Unfortunately, the NHSC Loan Repayment program has not included doctors of chiropractic as eligible providers. In 2002, at the request of ACA and ACC, Congress enacted language that authorized a two-year demonstration program intended to explore the feasibility of opening the program to doctors of chiropractic. The demonstration program began in 2003 and was later extended through 2007. The demonstration results are now being evaluated by the federal Health Resources and Services Administration. Report language accompanying S. 901 becomes effective once the bill has been passed by the full Senate. S. 901 has not yet been scheduled for further consideration. Watch ACA publications and the association’s Web site for more information as it becomes available. To access the full committee report Click on the link below. The information regarding inclusion of doctors of chiropractic can be found on page 19.

GREELEY, Colo.—Salvatore D. LaRusso, D.C., of Wellington, Fla., was elected on March 8 by the board of the National Board of Chiropractic Examiners (NBCE) to fill a vacancy in the roll of Director-At-Large. The vacancy was created by the untimely death of Dr. Earl L. Wiley who passed away in November 2007. Dr. LaRusso will complete the unexpired term of Dr. Wiley which will end in May 2009. At that time, Dr. LaRusso will be eligible for re-election. Dr. LaRusso is a graduate of New York Chiropractic and obtained his undergraduate degree in business administration from Seton Hall University. He has been active in many international, national, state and local organizations. In 1998, Dr. LaRusso was a gubernatorial appointee to the Florida Board of Chiropractic Medicine, serving as board chair in 2005, 2006 and 2007. From 2005 to present, he serves as chairman of the Florida Board’s Certified Chiropractic Physicians Assistant Committee. Dr. LaRusso is a long-standing member of both the Florida Chiropractic Association and the Florida Chiropractic Society (FCS) serving as president of the FCS from 1992-1993 and chairman from 1993-1997. The FCS named Dr. LaRusso Chiropractor of the Year in 1994, awarded him the Gavel Award in 1993 and honored him the Distinguished Service to the FCS in 1992. 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.

The American Medical Association (AMA) has announced that it will issue a correction to all purchasers of its Guides to the Evaluation of Permanent Impairment, Sixth Edition, after ACA’s legal team questioned the legality of restrictive language related to evaluations by doctors of chiropractic and accused the AMA of violating the permanent Wilk injunction. In a Feb. 20 letter to ACA, AMA’s legal counsel writes that the text in question "is incorrect and warrants immediate correction."

Abstract of Study Study Design: Population-based, case-control and case-crossover study. Objective: To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to compare this with visits to primary care physicians (PCP) and the occurrence of VBA stroke. Summary of Background Data: VBA stroke is a rare occurrence. Neck pain and headache are common symptoms of VBA dissection and typically precede VBA stroke. Chiropractic care is popular for neck pain and headache, but has been associated with an increased risk for VBA dissection and stroke. People experiencing headache and neck pain may also choose to consult a primary care physician. Methodology: The cases studied comprise eligible incidents of VBA stroke admitted to Ontario hospitals over a nine year period from April 1993 to March 2002. Four controls were age and gender matched to each case. Visits to chiropractors and primary care physicians during the year before the stroke date were determined from Ontario Health Insurance Plan (OHIP) billing records. In the case cross-over analysis, cases acted as their own controls. Results: Over the nine year study period, there were 818 cases of VBA stroke admitted to Ontario hospitals in a population of more than 100 million person-years. Among those under 45 years of age, cases were about three times more likely to visit a primary care physician or a chiropractor prior to their stroke compared to controls. A strong association was found between primary care physician visits and VBA strokes in all age groups. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Conclusions: VBA stroke is a very rare event in the population. 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 an MD’s office. The incidence of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. The study found no evidence of excess risk of VBA stroke associated with chiropractic care compared to primary physician care. J David Cassidy, DC, PhD, et al. Spine. Vol. 33, No. 4S, pp. S176-S183.

(Arlington, Va.) -- Following an unprecedented profession-wide campaign led by the ACA, UnitedHealthcare (UHC) has announced it will rescind its recent policy declaring chiropractic manipulative treatment for headaches and pediatric patients as unproven, and therefore, not a covered service. “We are pleased that UHC has decided not to implement this policy,” said ACA President Glenn Manceaux, DC. “We strongly believe that through the actions of ACA, along with the other chiropractic organizations, the profession made a compelling argument as to why this policy should have been rescinded. We feel that our members, the profession and our patients will be well served by UHC’s recent decision.” Since September 2007, ACA has maintained a line of communication with UHC to emphasize its members’ concerns over the proposed policy change. Furthermore, ACA joined forces with ACC, CCGPP, COCSA, FCER and ICA to issue a joint letter opposing the "flawed" and "unconscionable" policy and supporting a detailed CCGPP analysis and critique of UHC's stance. The ACA Council on Chiropractic Pediatrics also submitted a separate response to UHC. In October, UHC delayed implementation of its flawed policy pending additional review of research and information provided by the ACN Chiropractic Professional Advisory Committee (CPAC) and other chiropractic organizations. “The ACA is proud to have led this effort, which serves as a very important reminder that there is strength in numbers. When all corners of the profession work together with a single vision and a single voice, there is no limit to what we can accomplish. It also underscores the critical role research and evidence play in the reimbursement world and the need for insurers to consult with the chiropractic profession before implementing changes that negatively affect our patients,” said Dr. Manceaux. Click below for the full text of UHC’s policy update.

Increasingly the New York State Board for Chiropractic has been receiving questions and concerns about certain types of advertising. The information provided in this brief article may help clarify some of the responsibilities we have as practitioners when we advertise. Beyond those rules and regulations we have that are specific to our profession in New York, we must also comply with the general Rules of the Board of Regents which are applicable to all licensed professionals in the state of New York. If you do not have a copy of these regulations you can view them online at www.op.nysed.gov or call the New York State Board for Chiropractic at 1-518-474-3817 ext. 190. The specifics of advertising are discussed in Part 29 "Unprofessional Conduct". As described in Part 29 Advertising or soliciting not in the public interest shall include, but not be limited to, advertising or soliciting that: 1. "is false, fraudulent, deceptive or misleading" 2. "guarantees any service" 3. "makes any claim relating to professional services or products or the cost or price therefore which cannot be substantiated by the licensee, who shall have the burden of proof" 4. "makes claims of professional superiority which cannot be substantiated by the licensee, who shall have the burden of proof" 5. "offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product". This list is for the most part pretty self explanatory. However, item number three may deserve a little more attention. If in the course of your advertising you state that your technique is effective a certain percentage of the time, it is up to you to be able to prove it. If some of the information in your advertising program is being provided to you from an outside source, then please verify that it is true and accurate because you, the practitioner, are ultimately held accountable for the accuracy of your advertising. If you have any questions on these rules and regulations or any other questions you may have, please contact the New York State Board for Chiropractic office at: NY State Education Department Office of the Professions State Board for Chiropractic 89 Washington Ave. Albany, NY 12234-1000 1-518-474-3817 ext.190 NYSBC Information Committee

CLINICAL GUIDELINES Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence). Annals of Internal Medicine 2 October 2007 | Volume 147 Issue 7 | Pages 478-491 Related articles in Annals: Clinical Guidelines Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Roger Chou AND Laurie Hoyt Huffman Annals 2007 147: 492-504. [Full Text] Clinical Guidelines Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline Roger Chou AND Laurie Hoyt Huffman Annals 2007 147: 505-514. [Full Text] Summaries for Patients Diagnosis and Treatment of Low Back Pain: Recommendations from the American College of Physicians/American Pain Society Annals 2007 147: I-45. [Full Text]

Abstract: Study Design. Prospective national survey. Objective. To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors. Summary of Background Data. The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. Methods. We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment. Results. Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse [almost equal to]1 per 10,000 treatment consultations immediately after cervical spine manipulation, [almost equal to]2 per 10,000 treatment consultations up to 7 days after treatment and [almost equal to]6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse [almost equal to]16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse [almost equal to]4 per 100, numbness/tingling in upper limbs in, at worse [almost equal to]15 per 1000 and fainting/dizziness/light-headedness in, at worse [almost equal to]13 per 1000 treatment consultations. Conclusion. Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low. Spine. 32(21):2375-2378, October 1, 2007. (C) 2007 Lippincott Williams & Wilkins, Inc.

As was announced in August, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is posting the evidence synthesis on "CHIROPRACTIC MANAGEMENT OF UPPER EXTREMITY PAIN– DRAFT" for review and commentary at www.ccgpp.org on October 10, 2007. The CHIROPRACTIC MANAGEMENT OF UPPER EXTREMITY PAIN chapter was written by CCGPP Commission member, Thomas Souza, DC and his team. It is the third chapter to be released in the ongoing best practices initiative of the CCGPP, as commissioned by its founding organizations. This latest chapter utilizes the improved format developed by the Commission to make the information more user-friendly for the profession; however, it should be noted that this chapter represents only the literature synthesis. Future projects are planned to translate this evidence into useful information for the DC practice to be published in its final form as the Clinical Chiropractic Compass. The 60-day comment period on this "Upper Extremity" chapter draft begins October 10, 2007 and will end December 10, 2007. Comments should be submitted in an electronic format to [email protected] and include a discussion of the conclusions, submission of additional literature for review, and editorial suggestions. "CHIROPRACTIC MANAGEMENT OF PREVENTION AND HEALTH PROMOTION; NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS OF THE ELDERLY, CHILDREN AND PREGNANT WOMEN—DRAFT" was the second chapter released on September 1, 2007. The 60-day comment period on this "Wellness" chapter draft will remain open until November 1, 2007. Comments should be submitted in an electronic format to [email protected] and include a discussion of the conclusions, submission of additional literature for review, and editorial suggestions. The "Low Back" evidence synthesis was the first chapter released in May 2006. That chapter has been under review based on the feedback received during its commentary period and will be re-released in two parts: Part A will consist of treatment approaches and other aspects which generated little or no comment. Part B will consist of diagnostics and related issues. The CCGPP anticipates releasing the "Low Back A" evidence synthesis before the end of the year for a 60-day review and comment period. Low Back B will be deferred pending additional literature review and synthesis.

Laying the groundwork for an expanded footprint on the chiropractic profession, the Foundation for Chiropractic Education and Research (FCER) has elected a new foundation president, an expanded Board of Trustees, and appointed a new Executive Committee. Dr. Charles R. Herring, currently a trustee, was elected FCER president at the FCER Board of Trustees meeting held recently in Orlando, Florida. Dr. Herring succeeds Vincent P. Lucido, DC, who had been board president for the past 10 years. Dr. Lucido remains on the board. “This is one of the most exciting and productive times in FCER’s 60-plus year history,” Dr. Herring, said. “This election was important since new trustees have joined FCER from careers outside or ancillary to chiropractic. Joining our current hard-working board, these new members will bring fresh new ideas to the foundation, moving it in directions that up to now, no other chiropractic organization has traveled,” he added. New trustees, all elected at-large, include Jeffrey Fedorko, DC, practicing in Canton, Ohio, and an active member of the Ohio State Chiropractic Association (OSCA) and the Congress of Chiropractic State Associations (COCSA); Mitchell Haas, DC, MA, the dean of research at Western States Chiropractic College (WSCC) in Portland, Oregon, and FCER’s 2006 Researcher of the Year; Fabrizio Mancini, DC, FICC, FACC, president of Parker College of Chiropractic (PCC) in Dallas, Texas, and an Association of Chiropractic Colleges (ACC) board member; and, David M. Rubin, PhD, Maplewood, New Jersey, who has more than 10 years of experience as a designer and executive in bioinformantics services as well as business development experience in the commercial marketplace. Re-elected to the board, in addition to Dr. Herring, was Thomas E. Hyde, DC, DACBSP, of Miami, Florida, a well-respected practitioner, author and speaker on the applications of chiropractic methods in the sports and fitness area. Dr. Herring, who practices in Baton Rouge, Louisiana, has been instrumental in helping to develop FCER’s new Evidence-Based Resource Center, the online research and education web site which will be launched later this year. In addition to his practice, Dr. Herring has served in the Louisiana House of Representatives, and has been appointed to numerous health care boards and commissions over the years. The trustees’ Executive Committee, also recently appointed, includes: • FCER President Charles R. Herring, DC, DABCC, FICC, who is also a popular chiropractic lecturer • FCER Vice President Reed B. Phillips, DC, PhD, MSCM, DACBR, former president of Southern California University of Health Sciences and current resident of Pocatello, Idaho. In addition, Dr. Phillips has served on numerous chiropractic and health care boards and commissions. He also is a renowned chiropractic researcher and author • FCER Secretary/Treasurer D. Michael Kelly, Esq., a practicing attorney in Columbia, South Carolina, where he is a well-known community activist. His firm specializes in providing legal services to those who have been injured by the conduct of another • George B. McClelland, DC, DABCC, who practices in Christiansburg, Virginia, and is a former FCER president. In addition, Dr. McClelland has served on many chiropractic and health care boards and commissions, and is known as a chiropractic lecturer and author • R. Reeve Askew, DC, of Easton, Maryland, who has been on the Board of Governors for the American Chiropractic Association as well as its Executive Committee. He also has a long history of serving on non-profit boards Other trustees include Evon Barvinchack, DC, of Greencastle, Pennsylvania; David A. Herd, DC, of Geneva, New York; Vincent P. Lucido, DC, of Lakeland, Florida; Frank H. McCarty, PE, of Portsmouth, Rhode Island; and, Mario Spoto, DC, of Downington, Pennsylvania. FCER is the chiropractic profession’s oldest not-for-profit foundation, serving the profession since 1944. Based in Norwalk, Iowa, FCER 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.

As was announced earlier this month, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) has posted the evidence synthesis on “CHIROPRACTIC MANAGEMENT OF PREVENTION AND HEALTH PROMOTION; NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS OF THE ELDERLY, CHILDREN AND PREGNANT WOMEN—DRAFT” for review and commentary at www.ccgpp.org. The CHIROPRACTIC MANAGEMENT OF PREVENTIONAND HEALTH PROMOTION; NONMUSCULOSKELETAL CONDITIONS; AND CONDITIONS OF THE ELDERLY, CHILDREN AND PREGNANT WOMEN chapter addresses issues of achieving and maintaining wellness through care by chiropractic doctors. It was written by the CCGPP Commission Chair, Cheryl Hawk, DC, PhD, CHES and her team. The chapter covers the special populations most commonly treated by doctors of chiropractic. It is the second chapter to be released in the ongoing best practices initiative of the CCGPP, as commissioned by its founding organizations. This latest chapter utilizes an improved format developed to make the information more user-friendly for the profession; however, it should be noted that this chapter represents only the literature synthesis. Future projects are planned to translate this evidence into useful information for the DC practice to be published in its final form as the Clinical Chiropractic Compass. The 60-day comment period on this “Wellness” chapter draft begins September1, 2007. Comments should be submitted in an electronic format to [email protected] and include a discussion of the conclusions, submission of additional literature for review, and editorial suggestions. The CCGPP anticipates releasing the "Upper Extremity" evidence synthesis on October 1 2007, for its 60-day review and comment period. Additional chapters will follow thereafter. The "Low Back" evidence synthesis was the first chapter released in May 2006. That chapter is currently being revised based on the feedback received during its commentary period, and it will be re-released for review later this year. Thank you for your participation in the comment period, as well is your continued support of the CCGPP's iterative best practices process.