With the departure of Dr. Clay McDonald, Dr Michael Mestan has been named New York Chiropractic College’s Interim Executive Vice President of Academic Affairs. McDonald now serves as Palmer College of Chiropractic’s new Assistant to the Chief Executive Officer. Mestan arrived in upstate New York in 2002 having previously worked at Parker Chiropractic College chairing the college’s Department of Radiology and directing its Diagnostic Imaging Residency program. Bearing impressive credentials, Mestan came with a Bachelor Degree in Human Anatomy and has earned Diplomate status with the American Chiropractic Board of Radiology and eight years administrative experience. Dr. Mestan says of his work at NYCC, “It is exciting to be able to work at a College with such a rich history as NYCC and serve as part of an administration that provides such a clear and progressive vision.” A national search is being conducted for the Dean of Chiropractic position to oversee academic planning, curriculum development, faculty hiring and associated budgets as they relate to the chiropractic program.

American Chiropractic Association (ACA) member Michael Minardo, DC, was recently featured in a video clip on the popular news Web site MSNBC.com. The story – which was arranged by ACA communications staff – offered advice on how women can avoid back, neck and shoulder pain when carrying a heavy or oversized handbag. The segment, which appeared prominently on the MSNBC.com homepage, was also broadcast on WNBC- 4 of New York City and NBC-5 Dallas, Texas. MSNBC.com is a leader in breaking news and original journalism on the Internet. Serving 4 to 5 million site visitors daily, the news site typically handles 50,000 simultaneous users, with as many as 400,000 site visitors during major breaking news events. This latest television segment is just one of the many media relations efforts conducted by the ACA on behalf of its members. ACA’s public relations team works to increase demand for chiropractic care and ensure that chiropractic receives accurate and favorable exposure in the media. Through proactive news releases, letters to the editor, and other vehicles, the ACA has reached millions of consumers with pro-chiropractic messages. Click here to watch the video. To view additional excerpts of media stories that mention doctors of chiropractic and/or chiropractic care, click below to visit the ACA web site.

Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD ABSTRACT Context: Proton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps. Objective: To determine the association between PPI therapy and risk of hip fracture. Design, Setting, and Patients: A nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed. Main Outcome Measure: The risk of hip fractures associated with PPI use. Results: There were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; PConclusion: Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture. JAMA. 2006;296:2947-2953. Author Affiliations: Division of Gastroenterology (Drs Yang, Lewis, and Metz), Center for Clinical Epidemiology and Biostatistics (Drs Yang and Lewis), Department of Biostatistics and Epidemiology (Drs Yang and Lewis), and Division of Endocrinology (Dr Epstein), University of Pennsylvania School of Medicine, Philadelphia; and Department of Medicine, Doylestown Hospital Research Center, Doylestown, Pa (Dr Epstein).

Since Aug. 1, Palmer College of Chiropractic added three experienced administrators from outside the institution to its administrative team. These administrators are filling key roles as dean of Clinics, assistant to the chief executive officer and executive director of the Palmer Center for Chiropractic Research (PCCR). Dean of Clinics, Davenport Campus In August, Kurt Wood, D.C., was hired as dean of Clinics at Palmer College of Chiropractic’s Davenport Campus in Davenport, Iowa. Dr. Wood comes to Palmer after a 20-year career at Northwestern Health Sciences University in Bloomington, Minn. During his tenure at Northwestern, he was a professor in the College of Chiropractic, and served as department chair, program chair, associate dean of academics, associate dean of clinical services, and as Northwestern’s compliance, privacy and security officer. In 2000, he was voted Teacher of the Year by the chiropractic program students. He has presented multiple times at professional conferences and has been published in the Journal of Manipulative and Physiological Therapeutics and other professional journals. Prior to graduating from Palmer College of Chiropractic’s Davenport Campus in 1979, Dr. Wood completed Bachelor of Science degrees in biology and chemistry at Upper Iowa University. He is credentialed as a Diplomate of the American Academy of Pain Management, a senior analyst and Diplomate of the American Board of Disability Analysts, and also is certified in healthcare compliance by the Health Care Compliance Board. Dr. Wood has maintained a private practice since 1979, for many years in a multi-doctor, family chiropractic practice in Wisconsin, and more recently in a consulting, forensic practice. A member of the Upper Iowa University board of trustees for 15 years, he currently serves as chair of that board’s residential university committee. In announcing Dr. Wood’s appointment, Palmer’s Vice President for Academic Affairs Dennis Marchiori, D.C., Ph.D., remarked: “We welcome Dr. Wood to this leadership role and look forward to his contribution to our educational program. As dean, Dr. Wood will lead an experienced faculty that is dedicated to the Palmer Clinics’ dual mission of quality patient care and clinical education, and in cooperation with Clinic Department coordinators and directors, will manage, plan, develop and continually improve Palmer’s academic health centers.” Assistant to the Chief Executive Officer In early November, Palmer College of Chiropractic Chief Executive Officer Larry Patten announced that Clay McDonald, D.C., would join Palmer College on Jan. 3, 2007, as assistant to the chief executive officer. In this newly created role, he will work directly with Mr. Patten and the College administrative team to develop and implement operational systems and a program of continual improvement. He also will assist with lobbying for chiropractic education issues at various government levels. “I’ve known Dr. McDonald for many years and I greatly value his perspective and approach to chiropractic education,” said Mr. Patten. “With his diverse and successful background as an administrator, clinician and practitioner, Dr. McDonald’s return to Palmer will continue to strengthen the College leadership team and our commitment to chiropractic education.” Dr. McDonald earned his Doctor of Chiropractic degree from Logan College of Chiropractic in 1982. He also earned a Master of Business Administration degree from St. Ambrose University in 1997, and a Juris Doctorate from Valparaiso University School of Law in 2001. He maintained a private practice in Eureka, Mont., from the time of his graduation until 1990. That year, Dr. McDonald joined Palmer College faculty and spent nearly a decade in service to the College. During that time, he served as an associate professor, faculty clinician and director of Ancillary Procedures. He went on to serve as dean of Clinics before being named special advisor to the president under Dr. Guy Riekeman. Since 2002, he has served New York College of Chiropractic, as dean of Academic Affairs and most recently as executive vice president of Academic Affairs. He currently serves on the Board of Trustees and as secretary/treasurer for the Council on Chiropractic Education. Executive Director for the Palmer Center for Chiropractic Research In late November, Mr. Patten announced that William Meeker, D.C., M.P.H., who had been serving as vice president for Research and executive director of the Palmer Center for Chiropractic Research (PCCR), had been named president of Palmer College of Chiropractic’s West Campus in San Jose, Calif. Concurrently, with Dr. Meeker assuming his role on the West Campus, the College announced the hiring of Christine Goertz Choate, D.C., Ph.D., to succeed Dr. Meeker as executive director for the Palmer Center for Chiropractic Research. Beginning January 3, 2007, she will oversee the College’s research efforts from a new office that Palmer will establish in Washington, D.C. Through this office, Dr. Goertz Choate also will monitor and coordinate government relations activities. “Dr. Goertz Choate has research and administrative experience of tremendous breadth and depth,” Mr. Patten noted. “I look forward to having her on board to lead our research efforts, as well as work through Palmer’s new Washington, D.C., office with federal sources of research funding and on governmental relations efforts.” Dr. Goertz Choate comes to Palmer College from the Samueli Institute for Information Biology in Alexandria, Va., where she served as director of clinical research from 2003 to 2005, until being named deputy director in 2005. Prior to joining the Samueli Institute, Dr. Goertz Choate was the first chiropractor hired by the National Institutes of Health as a health sciences administrator at the National Center for Complementary and Alternative Medicine in Bethesda, Maryland. Dr. Goertz Choate earned her Ph.D. from the University of Minnesota School of Public Health in 1999. In 1991, she earned her Doctor of Chiropractic degree from Northwestern College of Chiropractic in Bloomington, Minn. Among her many honors and accomplishments, Dr. Goertz Choate was named George B. McClelland Researcher of the Year in 2006 by the American Chiropractic Association.

The Food and Drug Administration (FDA) today proposed to amend the labeling regulations on over-the-counter (OTC) Internal Analgesic, Antipyretic, and Antirheumatic (IAAA) drug products to include important safety information regarding the potential for stomach bleeding and liver damage and when to consult a doctor. OTC IAAA drug products, commonly known as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen and ketoprofen, are used to treat pain, fever, headaches, and muscle aches. To help ensure safe use of OTC products, and to provide consumers with the labeling necessary for them to make more informed medical decisions, FDA is proposing the following label changes: For Products Containing Acetaminophen • To require new warnings which would highlight the potential for liver toxicity, particularly when using acetaminophen in high doses, when taking more than one product with acetaminophen, and when taken with moderate amounts of alcohol; • To require that the ingredient acetaminophen be prominently identified on the product's principal display panel (PDP) of the immediate container, and the outer carton (if applicable). For Products Containing NSAIDs • To require new warnings for products that contain an NSAID which would highlight the potential for stomach bleeding in persons over age 60, in persons who have had prior ulcers or bleeding, in persons who take a blood thinner, when taking more than one product containing an NSAID, when taken with moderate amounts of alcohol, and when taking for longer time than directed; and • To require that the name of the NSAID ingredient and the term "NSAID" be prominently identified on the product's PDP of the immediate container and the outer carton (if applicable). The new labeling would be required for all OTC drug products that contain only an IAAA ingredient, as well as for products that contain an IAAA ingredient with other ingredients, such as cold symptom relievers. Consumers may also be taking IAAA ingredients in their prescription medications, which makes it important to alert them of the contents of their OTC medications, so they do not take too much of an IAAA ingredient. FDA based its proposal for labeling changes on previous Advisory Committee discussions, recommendations, and public comments (see http://www.fda.gov/ohrms/dockets/ac/cder02.htm#NonprescriptionDrugs) and a review of the scientific literature. A number of manufacturers of OTC internal analgesic drug products already have voluntarily implemented labeling changes to identify these potential safety concerns.

Arlington, Va. – Congress, in one of the final acts of the session, passed legislation that halts a 5 percent cut in Medicare physician fees. The reduction would have gone into effect on Jan. 1, 2007, in addition to the 8 percent cut doctors of chiropractic will incur in February 2007. Instead, the Tax Relief and Health Care Act of 2006, the omnibus bill that contained the physician fee provision, provides no increase in the congressionally mandated sustainable growth rate (SGR) mechanism which works to hamper spending in the Medicare program. The president is expected to sign the bill. “The ACA is pleased that Congress has halted this portion of the upcoming cuts in physician Medicare payments,” said ACA President Dr. Richard G. Brassard. “It is completely unreasonable to expect providers to take on further financial constraints when they are already being hit from all sides with fee decreases. We applaud this move as a significant recognition of the increasingly stressful environment for physicians in Medicare.” Although the Tax Relief and Health Care Act of 2006 provides some measure of relief, providers in Medicare still face many types of fee cuts for 2007. Under a final rule—issued by CMS per the congressionally mandated five-year review of the work values of billing codes—doctors of chiropractic will face an average 8 percent cut starting in February 2007. This rule also imposes significant cuts to radiological and imaging services. The bill also includes a provision that will allow for a 1.5 percent increase in reimbursement for providers who report on existing quality measures established by CMS. Quality measures are developed by several different organizations through a rigorous process grounded in evidence-based medicine. The measures, approved by CMS, are geared toward primary care practices and have been utilized in the Physician Voluntary Reporting Program. “The ACA will continue to lobby on behalf of its members for fair reimbursement of Medicare services. It is imperative that Congress and the Department of Health and Human Services develop a permanent solution to the physician fee schedule because those most affected by this annual dilemma are not doctors, but patients,” Dr. Brassard said. Because the fee schedule has many different components, including a geographic consideration, doctors of chiropractic should contact their local Medicare carriers/contractors for information on what their fees will be in 2007. The 8 percent decrease is only an average and percentages may vary depending on location. Therapy Caps For most chiropractors—with the exception of those participating in the Medicare Demonstration Project—coverage of chiropractic services is specifically limited to treatment by means of manual manipulation of the spine. However, the ACA has received numerous questions concerning therapy caps. Also included in the Tax Relief and Health Care Act of 2006, the President authorized CMS to continue an exception process for Medicare beneficiaries to apply for medically necessary therapy services if their treatment is expected to exceed the cap in 2007. The ACA will provide more information as it becomes available.

New York Chiropractic College conferred the Doctor of Chiropractic degree upon 96 graduates on Saturday, December 2, 2006, during a commencement ceremony held in the Athletic Center Gymnasium of the college’s Seneca Falls campus. Dr. Frank J. Nicchi, president of NYCC, expressed his pride for the new graduates. “It gives me a great sense of satisfaction that this class of new doctors will soon be administering quality care to the many patients in need of chiropractic.” Jennifer Marie Conway and Patricia Marie West were co-valedictorians and had the honor of addressing their class at the commencement ceremony. Tiffany Anne Grace was salutatorian. The commencement address was delivered by Peter D. Ferguson, D.C., past chairman and current member of the NYCC Board of Trustees, whose son, Brian was among the graduates. Dr. Ferguson is a graduate of National College of Chiropractic, has been in practice for 32 years in Ohio, and is licensed in 10 other states. He has served on the Ohio State Board of Chiropractic Examiners, the National Board of Chiropractic Examiners, the Executive Board of Directors of the Federation of Chiropractic Licensing Boards, and the Council of Chiropractic Education Board of Directors. He also sits on the U.S. Department of Defense Chiropractic Health Care Oversight Advisory Committee, which has facilitated the setting up of chiropractic practices at military bases across the United States. In addition, Ferguson is a member of the Advisory Committee on Interdisciplinary, Community Based Linkages for the U.S. Department of Health and Human Services, has served as the chiropractor to the Professional Football Hall of Fames since 1995, and has lectured on various sports chiropractic topics around the country. For further information about New York Chiropractic College’s degree programs in chiropractic, acupuncture and Oriental medicine, and applied clinical nutrition, visit the college’s Web site at:

Abstract Objective: To examine the effects of smoking on cartilage loss and pain at the knee in those with knee osteoarthritis (OA). Methods: We examined 159 men with symptomatic knee OA who participated in a 30-month, prospective, natural history study of knee OA. The more symptomatic knee was imaged using MRI at baseline, 15- and 30-months follow-up. Cartilage was scored using the WORMS semi- quantitative method at the medial and lateral tibiofemoral joint and at the patellofemoral joint. At baseline and follow-up visits, the severity of knee pain was assessed using a visual analogue scale (VAS) pain score (0-100 mm). Results: Among the 159 men, 19 (12%) were current smokers at baseline. Current smokers were younger (mean age ± SD: 62 ± 9 vs. 69 ± 9 years) and leaner (mean body mass index (BMI): 28.9 & [plusmn] 3.2 vs. 31.3 ± 4.8 kg/m2) than men who were not current smokers. Adjusted for age, BMI and baseline cartilage scores, we found that men who were current smokers had an increased risk for cartilage loss, at the medial tibiofemoral joint (odds ratio (OR): 2.3, 95% CI: 1.0 to 5.4) and the patellofemoral joint (OR: 2.5, 95% CI: 1.1 to 5.7). Current smokers also had higher adjusted pain scores at baseline (60.5 vs. 45.0, p<0.05) and follow-up (59.4 vs. 44.3, p <0.05) compared with men who were not current smokers. Conclusions: Men with knee OA who smoke sustain greater cartilage loss and have more severe knee pain than men who do not smoke. Source reference: Amin, S, et al "Cigarette Smoking and the Risk for Cartilage Loss and Knee Pain in Men with Knee Osteoarthritis" Ann Rheum Dis 2006: online: 2053-2060 Shreyasee Amin 1*, Jingbo Niu 2, Ali Guermazi 3, Mikayel Grigoryan 3, David J Hunter 2, Margaret Clancy 2, Michael P LaValley 2, Harry K Genant 3 and David T Felson 2 1 Mayo Clinic College of Medicine, United States 2 Boston University School of Medicine, United States 3 University of California, San Francisco, United States

Many are now aware that the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is creating a chiropractic best practices process entitled the "Chiropractic Clinical Compass". In May of 2006 the CCGPP released the initial draft of the Introduction and Low Back evidence stratification and synthesis. This document has generated considerable commentary and concern throughout the profession. The purpose of presenting the initial draft document on the internet was to generate just such feedback. The CCGPP Council and Commission members wanted to promote the best practices concept as an iterative process. We have been monitoring all the responses and thank everyone who has presented constructive criticism and creative suggestions to enhance the document. The CCGPP also recently held a spirited forum at the COCSA annual meeting. The focus of that forum was additional clarification of the "Compass" process. This additional feedback will also be considered for use in the final document. However, the intent of this article is to dispel some confusion that has arisen regarding the best practices process. Most importantly, the initial low back draft document that many have reviewed is NOT the "Chiropractic Clinical Compass" (See Figure 1). What you have seen to date is merely the evidence stratification for the most common low back conditions seen in the average chiropractic clinic. The Council understands that this evidence stratification is a dry, difficult to understand and implement document. From the outset, the CCGPP has recognized and planned for translating the science to the field for ease of application in the treatment room with the patient. This is the nature of the DIER (Dissemination, Implementation, Evaluation, and Revision) process. It is this process that will ultimately become the Chiropractic Clinical Compass. Studies indicate that it takes 17 years for today's research to become common practice in the treatment room. They also indicate that the body of healthcare research is doubling every 3.5 years and quickly overwhelming even the most diligent reader. This is why the Bush administration has made Evidence Based Medicine/Care and Knowledge Translation national priorities. These were contributing factors as to why the CCGPP adopted the best practices model. Our DIER committee has reviewed 41 case studies of the evidence based care procedures to learn what has and has not worked in order to get doctors to utilize the latest research in their practices. The common denominator in virtually every study has been a lack of enthusiasm and confidence in the information by stakeholder populations, particularly providers. Therefore, to ensure its credibility the CCGPP adopted the internationally renowned AGREE instrument as the template for our best practices process. The synthesis of the aforementioned review indicated that the most promising approach to changing provider behavior was the use of a variety of interventions including audit and feedback, reminders, patient mediated intervention and educational outreach. The CCGPP intends to utilize those proven knowledge translation strategies to maximize the successful adoption of the best practices process for the chiropractic profession. Some of these tools will include: * Educational CD * Literature searches * Online Survey * Clinical Vignettes * Development of Evidence based online course * Development of Evidence based test * Development of Certification Course * Development of Certification Test * Development of interactive website * Development of Rapid Response Team * Development of full version BP document * Development of Clinician Quick Reference Guide * Development of Patient Version of BP * Harvesting of newly released literature * Pre and post release surveys Best practices dissemination needs to be planned, active, sustainable and ensure high accessibility. This is the mission of the CCGPP DIER committee. Best practices should also target multiple audiences (professionals, patients and policymakers) and be available in suitable formats for the different groups. Among existing chiropractic providers the successful introduction of chiropractic evidence based care needs to be patient-centered, easy to adopt and validate the doctor's clinical judgment and skills. The best way to introduce evidence based care is through the training of future chiropractors. Currently, our chiropractic colleges are adopting best practices curricula in varying degrees. CCGPP hopes the "Chiropractic Clinical Compass" will become the resource for that curriculum. Facilitating the use of the best practices document as a valuable and valid decision-making tool for healthcare administrators and policymakers will be vital in order to promote sound healthcare industry decisions, both for the good of the overall healthcare system and to protect chiropractic providers from inappropriate punitive external administrative abuse. Chiropractic patients are the stakeholders who stand to benefit the most from the chiropractic best practices initiative. As the primary decision makers in health care, they represent a very important stakeholder population. Therefore, the best practices document needs to get directly to them such that they begin to ask their doctors about how evidence based care applies to their individual cases. After the full "Chiropractic Clinical Compass" process has been implemented the CCGPP will evaluate its impact on clinical practice. The literature will also be reevaluated for relevant enhancements, whether new research on existing topics and/or topic expansion. This will lead to the revision portion of the DIER process. CCGPP is committed to review the literature every two years to ensure its efficacy. It is through this iterative process that the "Chiropractic Clinical Compass" will improve into the useful, dynamic database that the CCGPP envisions doctors using every day in their treatment rooms to the benefit of their patients. At that point the chiropractic profession as a whole will realize the evidence based care equation: Science + Doctor's Clinical Experience + Patient Values = Chiropractic Best Practices 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 Vice Chair of the CCGPP

In support if its mission to provide positive press for the chiropractic profession, the Foundation for Chiropractic Progress is excited to announce that a testimonial on the benefits of chiropractic will air on the Fox Network in January 2007. More than 150 million households will have the opportunity to see Sarah Harding, Ms. Fitness USA 2006, share a message about how chiropractic has allowed her to maintain an active lifestyle. “We believe that as the reigning Ms. Fitness USA, Sarah will have a tremendous impact on the viewing audience,” said Kent S. Greenawalt, President of the Foundation. This commercial, a first for this widely successful campaign, will be seen on the Fox Network during the Ms. Fitness USA contest during the weekend of January 6th and 7th. It will also air during the contests’ reruns including a national viewing on January 15, 2007. The Foundation is also preparing a commercial of Sarah Harding that will be made available to state associations that are partners of the F4CP’s positive media campaign. If you wish to make a pledge and/or contribution to the Foundation, please visit www.foundation4cp.com. Contributions are also received at P.O. Box 560, Carmichael, California 95609-0560

A new study published in the Journal of the British Medical Journal, reports that patients taking folic acid supplements may reduce the risk of heart attacks. This study reaffirms previous studies, which reported the benefit of folic acid as a daily supplement. Using folic acid can be an economical way of reducing the risk of strokes and heart disease. To learn more click on the link below:

State chiropractic leaders gathered in Baltimore over November 8-12, 2006 for the annual meeting of the Congress of Chiropractic State Associations. Set to the theme "Sailing into the Future with a New Vision," over 120 delegates from 50 state chiropractic associations participated in round table discussions and workshops aimed at improving their operations and overall effectiveness in serving their members and advancing the chiropractic profession. In addition to providing association management training for state elected leaders and staff, the meeting covered chiropractic's hottest issues, the introduction of new COCSA programs and policies, and the election of COCSA leaders for 2007. Sponsors of the 2006 meeting were Airpacks, Breakthrough Coaching, CBG, ChiroCode, Chiropractic America, Chiropractor Monthly, Foot Levelers, Interactive Health, Lippincott Williams and Wilkins, Maryland Chiropractic Association, NCMIC, Now You Know, Palmer College of Chiropractic, Parker Chiropractic College, Standard Process, Texas Chiropractic College, Dr. Terry Yochum, and Voice for Health. Following is a brief summary of the primary activities and issues of the 2006 Congress. CCGPP Best Practices Recommendations Over eight hours of the program was spent in intense discussion with CCGPP about their efforts to develop a best practices document. Despite heated debate and disagreement, the meeting was conducted very professionally and allowed for a true exchange of ideas with the final outcome being that COCSA members unanimously approved the following recommendations to CCGPP: • Consider the written recommendations received and make the appropriate revisions to the current draft to allow for the concerns, additions and omissions to be considered and follow this procedure for future drafts. • Change the name of the document to truly reflect the intent and use of the document. • Ensure expanded input allowing the duly elected CCGPP representatives to truly act as liaisons between the member associations and the CCGPP Board. • Consider redrafting the document's overview and introduction to make it easier to read and understand, including a shorter more concise narrative, written in non-academic language with bullet points for better understanding. • The process will remain open to allow other organizations and researchers and concerned stakeholders to be included in the process. • Consider rewriting the research compilation to make it more user-friendly to those affected. • Ensure that the commentary process will be well advertised in advance so that the stakeholders will be fully engaged. • In the absence of higher levels of evidence and research, consider the use of the clinical experience and case studies/course studies. In response, CCGPP unanimously agreed to "resubmit the low back draft to stakeholders for comment on the 'user-friendly' status, format and for consideration of responses to stakeholder comments." The chiropractic profession, as well as all other stakeholders, will receive 45 days notice before release of this new draft and an additional 45 days to respond to the draft when it is released. Furthermore, CCGPP agreed to adopt the title "Chiropractic Clinical Compass" for the CCGPP Best Practice process and defined the process as follows: "The Chiropractic Clinical Compass, which is an iterative process, shall include but not be limited to the research literature synthesis and stratification, the application of and utilization of this process in practice, and the dissemination, implementation, evaluation, and revision process applied to the various aspects of our profession: to include the experiential, experimental and clinical orientation of practitioners in order to promote Best Practices and improve the quality of patient care within our profession." Mr. Russ Leonard, executive director of the Wisconsin Chiropractic Association, an outspoken critic of the initial CCGPP draft prefaced the COCSA vote by applauding the CCGPP's patient-centered model. "The willingness of CCGPP to consider this broad set of recommendations should be commended. This is a significant step towards producing a practice document that reflects a broad consensus within the profession. Should that occur, the chiropractic profession will take a giant leap forward in its ability to attract new patients to the profession". Similarly, Dr. Don Hirsh, President of the Maryland Chiropractic Association and one of the more vocal participants in the debate, praised those involved on both sides of the discussion for their professionalism and willingness to work together towards a common goal. COCSA President Dr. Jerry DeGrado applauded the efforts of everyone involved. "Our profession took a huge step forward. We did not circle the wagons but instead chose the high road and ended the weekend with mutual concessions and respect for one another. There were points throughout the weekend at which both sides had to agree to disagree, but we did not let those disagreements kill the spirit of unity or prevent us from reaching an acceptable conclusion. I have tremendous hope for the future of our great profession---that we can, even in the midst of disagreement, move forward." However, he warned, "We must be mindful that this is only the first chapter in the book, and the rest of our story is yet to be told. As the plot thickens, it is imperative that we continue to consider the destiny of the chiropractic profession and work together for the betterment of our chiropractic family. " Resolution on Proper Documentation and Record Keeping As a participating member of the OIG Task Force, COCSA approved the following resolution emphasizing COCSA's support of the OIG Task Force Action Plan. Other members of the Task Force are the Association of Chiropractic Colleges, the American Chiropractic Association, and the Federation of Chiropractic Licensing Boards: RESOLUTION ON DOCUMENTATION AND RECORKEEPING Whereas, the 2005 report from the US Office of Health and Human Services= Office of the Inspector General extrapolates from a review of records from 2001 that a number of chiropractic claims submitted to Medicare were flawed, and Whereas, the same report noted 2/3 of all chiropractic claims failed to document medical necessity, and Whereas, the public interest is best served by all health care providers maintaining accurate records of patient visits, including appropriate documentation of medial necessity; and Whereas, chiropractic state associations are empowered to provide appropriate training on documentation and recordkeeping practices for their member doctors of chiropractic, and Whereas, it is anticipated that chiropractic colleges may soon add documentation and recordkeeping to the chiropractic curriculum, and Whereas, it is anticipated that chiropractic licensing board may soon require approved continuing education in documentation and recordkeeping as a condition for relicensure; and Whereas, the Congress of Chiropractic State Associations (COCSA) is participating in the OIG Task Force with the Association of Chiropractic Colleges, the American Chiropractic Association, and the Federation of Chiropractic Licensing Board on developing appropriate documentation and recordkeeping curriculum; and Whereas, the OIG Task Force will also develop and offer "train the trainer" sessions to familiarize instructors on appropriate documentation and recordkeeping curricula; now therefore be it Resolved, that COCSA encourages member state associations to provide approved training seminars for their member doctors; and be it Further resolved, that COCSA will work with state associations to ensure proper training of their documentation and recordkeeping instructors, and be it Further resolved, that COCSA will continue to work with the OIG Task Force to represent the interests of all state associations to ensure that their member doctors develop proper documentation and recordkeeping practices. Focus on COCSA Programs COCSA leaders reviewed the successes of the past year and announced several new programs for 2007. Among those introduced were World Class Conferencing, CERV Team, the new National Backpack Safety Program offered in affiliation with Core Products, and the development of implementation kits for the Quit for Life smoking cessation program. During the Saturday luncheon, Yolanda Davis of Foot Levelers presented a $14,250 check to Drs. Steve Simonetti and Jerry DeGrado, representing state association use of the Foot Levelers Speakers Grant Program. Checks were also presented to COCSA from NCMIC, Eclipse/Chiromatic, and TPK Backsaver Wallet. Congress members also received an update on the advances and successes during the past year of the Straighten Up America program. Information on all these programs can be found on the COCSA website. COCSA's New Mission, Vision and Leaders During the planning meeting held earlier in the year, the COCSA board approved changes to its mission statement and adopted a vision statement. At the Baltimore meeting, the board presented and received unanimous approval from the COCSA membership for the following policy statements: Mission Statement: The mission of the Congress of Chiropractic State Associations is to provide an open, nonpartisan forum for the advancement of the chiropractic profession through service to member state associations. Vision Statement: The Congress of Chiropractic State Associations is the forum for unifying the profession and inspiring the achievement of universal understanding and utilization of chiropractic. Elected to lead the Congress in 2007 are: • President - Dr. Jerry DeGrado of Kansas • 1st Vice President - Dr. Jeff Fedorko of Ohio • 2nd Vice President - Dr. John Galbreath of Illinois • Treasurer - Dr. Kate Rufalo of Pennsylvania • Secretary – Dr. Walt Engle of Pennsylvania • Past President – Dr. Stephen Simonetti of New York • District 1 Director - Dr. Don Hirsh of Maryland • District 2 Director - Dr. Ken Hughes of Michigan • District 3 Director - Ms. Lili Montoya of Florida • District 4 Director - Dr. David Kassmeier of Nebraska • District 5 Director – Mr. Bill Howe of California • At Large Director – Ms. Kathy Chittom of Louisiana Dr. Kevin Donovan of Rhode Island, the outgoing Past President, was voted an Honorary Member of the Congress for his many years of service on the COCSA board. Several districts elected representatives to serve on the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). COCSA representatives to CCGPP for 2007 are: • District 1 – Dr. Tom Augat, Maine Chiropractic Association • District 2 – Dr. David Radford, Ohio State Chiropractic Association • District 3 – Dr. Robert Hayden, Georgia Chiropractic Association • District 4 – Dr. Jeff Askew, North Dakota Chiropractic Association • District 5 – vacant • At Large – Dr. Len Suiter, Missouri State Chiropractors Association. The next meeting of the Congress will be held on November 7-11, 2007 in Nashville, Tennessee. For additional information about the Congress, visit:

The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial

One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government's annual, comprehensive report of Americans' health, Health United States, 2006, released today by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics. "We chose to focus on pain in this report because it is rarely discussed as a condition in and of itself - it is mostly viewed as a byproduct of another condition," said lead study author Amy Bernstein. "We also chose this topic because the associated costs of pain are posing a great burden on the health care system, and because there are great disparities among different population groups in terms of who suffer from pain." Low back pain is among the most common complaints, along with migraine or severe headache, and joint pain, aching or stiffness. The knee is the joint that causes the most pain according to the report. Hospitalization rates for knee replacement procedures rose nearly 90 percent between 1992-93 and 2003-04 among those 65 and older. Some of the other pain statistics include: One-fifth of adults 65 years and older said they had experienced pain in the past month that persisted for more than 24 hours. Almost three-fifths of adults 65 and older with pain said it had lasted for one year or more. More than one-quarter of adults interviewed said they had experienced low back pain in the past three months. Fifteen percent of adults experienced migraine or severe headache in the past three months. Adults ages 18-44 were almost three times as likely as adults 65 and older to report migraines or severe headaches. Reports of severe joint pain increased with age, and women reported severely painful joints more often than men (10 percent versus 7 percent). Between the periods 1988-94 and 1999-2002, the percentage of adults who took a narcotic drug to alleviate pain in the past month rose from 3.2 percent to 4.2 percent. The report also finds that the United States spent an average of $6,280 per person on health care in 2004. Seven percent of adults under 65 said they passed up getting needed care in the past 12 months due to costs. The report also notes a number of other significant health findings: Life expectancy at birth reached a record 77.9 years in 2004, up from 77.5 in 2003 and from 75.4 in 1990. Since 1990, the gap in life expectancy between men and women has narrowed from seven to just over five (5.2) years. At birth, life expectancy for females is just over 80 years and nearly 75 for males. The gap in life expectancy between white and black Americans also has narrowed from seven years in 1990 to five years in 2004. Infant mortality fell to 6.8 deaths per 1,000 live births in 2004, down from 6.9 deaths per 1,000 live births in 2003. Heart disease remains the leading killer, but deaths from heart disease fell 16 percent between 2000 and 2004, and deaths from cancer - the No. 2 killer - dropped 8 percent. The age-adjusted death rate for heart disease was 217 deaths per 100,000 in 2004; for cancer the rate was 186 per 100,000. Diabetes poses a growing threat, especially among older adults. Eleven percent of adults aged 40-59 years, and 23 percent of those 60 and older have diabetes. Health United States, 2006 is available at:

Superintendent of Insurance Howard Mills today announced that the New York State Insurance Department has levied fines totaling $310,300 against 21 health insurers and health maintenance organizations (HMOs) for violations of New York’s Prompt Pay Law. The violations and subsequent fines stemmed from complaint files that were closed by the Insurance Department between Oct.1, 2005 and March 31, 2006. New York’s Prompt Pay Law requires health insurers and HMOs to pay undisputed health insurance claims within 45 days of receipt, ensuring timely payment. Since Governor Pataki signed this measure into law in 1997, the Insurance Department has levied nearly $6.8 million in fines against health insurers and HMOs for Prompt Pay Law violations. By agreeing to pay the fines imposed by the Insurance Department, the companies are acknowledging that they failed to pay certain claims within the state-mandated timeframe. Moreover, health insurers and HMOs are also required to pay interest on undisputed claims in which payments were delayed. "New York’s Prompt Pay Law has been extremely effective in ensuring that consumers and healthcare providers are paid in a timely fashion and remains an excellent deterrent against entities slow to pay undisputed claims," Superintendent Mills stated. The fines announced today, by company, are: Health Ins. -- Fine Aetna -- $8,400.00 Affinity -- $5,000.00 Americhoice -- $30,100.00 Careplus -- $1,900.00 Centercare -- $3,400.00 CIGNA -- $2,100.00 Empire -- $5,000.00 Excellus -- $3,200.00 Fidelis -- $1,200.00 GHI HMO Select -- $2,300.00 Group Health, Inc. -- $13,800.00 Guardian -- $1,400.00 Health Plus -- $65,300.00 HealthNet -- $58,800.00 HealthNow -- $3,100.00 (includes Community Blue) HIP -- $7,400.00 Horizon -- $1,800.00 MDNY -- $22,900.00 Oxford -- $19,100.00 United Healthcare -- $16,300.00 Vytra -- $37,800.00 Consumers and healthcare providers with prompt pay complaints should call the New York State Insurance Department’s toll-free hotline at 1-800-358-9260.

Influenza vaccination: Policy versus evidence Each year enormous effort goes into producing influenza vaccines and delivering them to appropriate sections of the population. But a review of the evidence in this week's BMJ suggests that they may not be as effective as we think. So is this effort justified, asks vaccine expert Tom Jefferson? Public policy worldwide recommends the use of inactivated influenza vaccines (vaccines that contain dead viruses) to prevent seasonal outbreaks. But because influenza viruses mutate (change) and the number doing the rounds varies from year to year, it's difficult for scientists to study the precise effects of vaccines. The most reliable way to judge their effects is to use systematic reviews – impartial summaries of evidence from many different studies. Evidence from systematic reviews in this field shows that inactivated influenza vaccines have little or no effect on many influenza campaign objectives, such as hospital stay, time off work, or death from influenza and its complications. Furthermore, most studies are of poor quality (especially in the elderly) and show evidence of bias. And there is surprisingly little evidence on the safety of these vaccines. The large gap between policy and what the data tell us is surprising, writes Jefferson. Reasons for this are not clear, but may stem from the confusion between influenza and influenza-like illness (the acute respiratory infection which looks like influenza but is not), a lack of accurate and fast surveillance systems, and the fact that vaccines are available. The optimistic and confident tone of some predictions of viral circulation and of the impact of inactivated vaccines, which are at odds with the evidence, is striking, he says. But given the huge resources involved, a re-evaluation should be urgently undertaken. "The problem is that the UK has no transparent process for evaluating the effectiveness or cost effectiveness of vaccines," adds BMJ Editor, Fiona Godlee. "NICE would like to take this on. The government should let it."

Kent Greenawalt, President and CEO of Foot Levelers, joined New York Chiropractic College President, Dr. Frank J. Nicchi as they dedicated the Foot Levelers Biomechanics Research Laboratory housed on the NYCC campus in Seneca Falls, NY. Foot Levelers’ generous funding for equipment and research enabled establishment of the nation’s first biomechanical laboratory in a chiropractic setting. Dr. Nicchi expressed his pride and gratitude, remarking, “Foot Levelers’ unwavering support of chiropractic and its commitment to ongoing research has once again been demonstrated through this generous contribution.” Research at the College will address how Foot Leveler’s orthotics "facilitate proprioceptive feedback pathways and alleviate pain in individuals who suffer from various musculoskeletal pain disorders” according to Dr. Jeanmarie Burke, NYCC Dean of Basic Sciences and Research. She further noted that the new laboratory would provide the opportunity to objectively measure clinical changes that accompany neuromuscular disabilities and orthopedic conditions. It is hoped that research data may reveal how health professionals may better treat patients with complementary and alternative therapies. Essentially, the laboratory will measure combined effects of foot orthotics and chiropractic adjustments on posture, balance and gait. Established protocols will assess body symmetry within the lower extremities, spine and upper extremities in subjects as they, run, walk, and perform other physical activities. The means by which the spine and other body components are impacted by such actions will be determined through a number of means including kinematics, kinetics and electromyography. Detected misalignments in the lower extremities will be viewed to see how they influence functioning in the upper body and how chiropractors can better treat patients. "Only when research is used to help treat patients more competently and is incorporated into examinations does it find its true value,” stated Greenawalt. He saw creation of the laboratory as, as he put it, “an unparalleled opportunity to help fund important research that has the potential to help all doctors of chiropractic.” Foot Levelers, a well known industry leader in custom orthotics, has grown into one of chiropractics most respected companies. More than half a century ago Dr. Monte Greenawalt invented technology that balances the body by balancing the feet, thereby enhancing the patient’s structural integrity. Throughout the years, Foot Levelers has had a positive impact on nearly every facet of chiropractic and has demonstrated its support through donations to chiropractic colleges such as NYCC and research foundations and through substantial financial support to local, state and national chiropractic associations.

Congress has passed legislation requiring the Pentagon to conduct a study on providing chiropractic care to all members and former members of the Armed Forces, their families, and reservists. The legislation was included as a provision in HR 5122, the National Defense Authorization Act for Fiscal Year 2007, which passed the House on Sept. 29 and the Senate on Sep. 30. The study must be completed and submitted to Congress by March 31, 2008. The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) worked jointly with key allies in Congress to secure passage of the legislation. “Both ACA and ACC believe that guaranteeing access to chiropractic care is paramount, especially to our troops overseas in harm’s way,” said ACA President Richard Brassard, DC. “I am confident that upon further review, the Pentagon will not only find chiropractic care cost effective and essential, but will move to expand chiropractic care to Tricare beneficiaries and reservists as well.” “The passage of this language is a victory for our men and women in uniform who deserve no less than the best health care this country can offer,” added ACC President Frank Zolli, DC, Ed. D. "The chiropractic profession extends a sincere thank you to the Chairs and ranking members of the House and Senate Armed Services committees, and especially to Senator Jim Talent and Representatives Jeb Bradley, John McHugh, Mike Rogers and others who were instrumental in advancing this important legislation.” Congress expects the study mandated by the legislation to consider any relevant findings of an upcoming Navy research report designed to assess progress of the military chiropractic program and the efficacy and application of chiropractic health care services in reducing musculoskeletal disabilities among active-duty personnel. Currently, only 42 medical treatment facilities in the military health system, all within the continental United States, offer chiropractic health care services. Last year in a step toward full implementation, Congress directed the Air Force to place a doctor of chiropractic at 11 additional bases in the United States. The Air Force has yet to act on that order. HR 5122 has been sent to the White House, where the president is expected to sign the legislation. Click here for a copy of the bill. Go to section 712 (page 205), which deals specifically with the chiropractic benefit.

A new federal study published in the Journal of the American Medical Association, revealed that more than 700,000 ER visits each year are caused by the harmful reactions to some of the most frequently used medicines. Allergic reactions and accidental overdoses related to prescription drugs were the most common cause of serious illnesses. The worst offenders were the blood-thinner warfarin, the diabetes drug insulin and the heart medicine digoxin along with Amoxicillin, aspirin and trimethoprimsulfamethoxazole, an antibiotic. The study also revealed that ER visits for those over 65 were twice that of younger people. ABSTRACT National Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events Daniel S. Budnitz, MD, MPH; Daniel A. Pollock, MD; Kelly N. Weidenbach, MPH; Aaron B. Mendelsohn, PhD, MPH; Thomas J. Schroeder, MS; Joseph L. Annest, PhD Context: Adverse drug events are common and often preventable causes of medical injuries. However, timely, nationally representative information on outpatient adverse drug events is limited. Objective: To describe the frequency and characteristics of adverse drug events that lead to emergency department visits in the United States. Design, Setting, and Participants Active surveillance from January 1, 2004, through December 31, 2005, through the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project. Main Outcome Measures: National estimates of the numbers, population rates, and severity (measured by hospitalization) of individuals with adverse drug events treated in emergency departments. Results: Over the 2-year study period, 21 298 adverse drug event cases were reported, producing weighted annual estimates of 701 547 individuals (95% confidence interval [CI], 509 642-893 452) or 2.4 individuals per 1000 population (95% CI, 1.7-3.0) treated in emergency departments. Of these cases, 3487 individuals required hospitalization (annual estimate, 117 318 [16.7%]; 95% CI, 13.1%-20.3%). Adverse drug events accounted for 2.5% (95% CI, 2.0%-3.1%) of estimated emergency department visits for all unintentional injuries and 6.7% (95% CI, 4.7%-8.7%) of those leading to hospitalization and accounted for 0.6% of estimated emergency department visits for all causes. Individuals aged 65 years or older were more likely than younger individuals to sustain adverse drug events (annual estimate, 4.9 vs 2.0 per 1000; rate ratio [RR], 2.4; 95% CI, 1.8-3.0) and more likely to require hospitalization (annual estimate, 1.6 vs 0.23 per 1000; RR, 6.8; 95% CI, 4.3-9.2). Drugs for which regular outpatient monitoring is used to prevent acute toxicity accounted for 41.5% of estimated hospitalizations overall (1381 cases; 95% CI, 30.9%-52.1%) and 54.4% of estimated hospitalizations among individuals aged 65 years or older (829 cases; 95% CI, 45.0%-63.7%). Conclusions: Adverse drug events among outpatients that lead to emergency department visits are an important cause of morbidity in the United States, particularly among individuals aged 65 years or older. Ongoing, population-based surveillance can help monitor these events and target prevention strategies. Author Affiliations: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Coordinating Center for Infectious Diseases (Drs Budnitz and Pollock and Ms Weidenbach), Office of Statistics and Programming, National Center for Injury Prevention and Control (Dr Annest), Centers for Disease Control and Prevention, Atlanta, Ga; Office of Drug Safety, Center for Drug Evaluation and Research, US Food and Drug Administration, Rockville, Md, and Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention (Dr Mendelsohn); and US Consumer Product Safety Commission, Bethesda, Md (Mr Schroeder). Dr Mendelsohn is now director of epidemiology, Product Safety, MedImmune, Gaithersburg, Md. JAMA. 2006;296:1858-1866.

The most comprehensive annual study of hospital quality in America examines 41 million hospitalization records at 5,000 hospitals over three years; shows mortality rates decline. The largest annual study of hospital quality in America, issued today by HealthGrades, finds a typical patient, on average, has a 69 percent lower chance of dying at the nation's 5-star rated hospitals compared with the 1-star hospitals. This "quality chasm" between the best and poorest-performing hospitals has grown by approximately 5 percent since last year's study, even as overall mortality rates have improved by nearly 8 percent. The ninth annual HealthGrades Hospital Quality in America Study analyzes 40.6 million Medicare hospitalization records, from the years 2003 through 2005, to rate the quality of care at each of the nation's more than 5,000 nonfederal hospitals. To help consumers compare the quality of local hospitals, HealthGrades posts its ratings free of charge on its consumer Web site, HealthGrades.com, and in its suite of decision-support tools that major employers and health plans offer as a benefit to employees and plan members. "This year's study finds that mortality rates among Medicare patients continues to decline, however the differences in patient outcomes between 5-star and 1-star hospitals remains large and is getting larger, a concerning finding," said Samantha Collier, MD, the author of the study and the vice president of medical affairs at HealthGrades, the leading independent healthcare ratings organization. "But these are more than numbers. According to the study, more than 300,000 Medicare lives could have been saved during the three years studied if all hospitals performed at the level of hospitals rated with 5 stars." For example, the study shows that a typical patient having coronary bypass surgery has a 72.9 percent lower risk of mortality, on average, if they have the procedure at a 5-star rated hospital compared with a 1-star rated hospital. If all Medicare coronary bypass surgery patients from 2003 to 2005 went to 5-star hospitals, 5,308 lives could have been saved. The annual HealthGrades study rates every nonfederal hospital with a 1-, 3- or 5-star rating indicating poor, average or excellent outcomes in each of 28 medical categories. Taken together, the individual hospital ratings produce the following findings: • The nation's in-hospital risk-adjusted mortality rate improved, on average, 7.89 percent from 2003 to 2005. But the degree of improvement varied widely by procedure and diagnosis studied. • Five-star rated hospitals had significantly lower risk-adjusted mortality rates across all three years studied and improved, over the years 2003 to 2005, 19 percent more than the U.S. hospital average and 57 percent more than 1-star rated hospitals. • A typical patient would have, on average, a 69 percent lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital, and a 49 percent lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average. If all hospitals performed at the level of a 5-star rated hospital across 18 of the procedures and diagnoses studied, 302,403 Medicare lives could have potentially been saved from 2003 through 2005. Fifty percent of the potentially preventable deaths were associated with just four diagnoses: Heart Failure, Community Acquired Pneumonia, Sepsis and Respiratory Failure. The full study, along with its methodology, can be found at: HealthGrades