Abstract (provisional) Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractic as a primary care provider. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractic as a portal-of-entry provider, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles which would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession. © 2005 Nelson et al., licensee BioMed Central Ltd. Chiropractic & Osteopathy 2005, 13:9 doi:10.1186/1746-1340-13-9 Read the full version by clicking on the link below.

A new study funded by the Canadian Institute for Health Information’s Canadian Population Health Initiative shows that Old Order Mennonite children from Ontario living a similar lifestyle to that of previous generations tend to be fitter, stronger and leaner than children living a contemporary Canadian lifestyle—this despite the fact they do not have physical education classes and do not participate in organized sports. New analyses by obesity expert Dr. Mark S. Tremblay and a group of researchers from the University of Saskatchewan and University of Lethbridge found a strong link between contemporary lifestyles in Canadian children and reduced physical activity and fitness. “What this study proves is that you don’t need to do triathlons to stay fit and active,” says Dr. Tremblay, a Professor of Kinesiology at the University of Saskatchewan. “Children living traditional lifestyles have exercise embedded in their daily lives. In contrast, today’s children engage more in passive activities, such as video games. This may go a long way in explaining why they are less physically fit.” The study found that Old Order Mennonite children, on average, do up to 18 minutes more moderate or vigorous physical activity a day than urban and rural contemporary children. Researchers estimate that, all else being equal, this translates into a caloric difference between the Old Order Mennonite children and children living a contemporary lifestyle of approximately 15,000 kcal per year—or over 40 pounds of fat per person, per decade. The Old Order Mennonite children in the study also had leaner triceps than urban Saskatchewan children, a greater aerobic fitness score than rural Saskatchewan children, and greater grip strength than both rural and urban Saskatchewan children. These findings were true for girls and boys. Researchers attribute the Old Order Mennonite children’s strength and fitness to the fact they get a great deal of physical activity through walking, traditional farming activities and household chores. “Since obesity can lead to life-long health problems, including diabetes and heart disease, it may well be worthwhile to look at how aspects of modern lifestyles may contribute to childhood obesity,” says Lisa Sullivan, Manager of Research and Policy at the Canadian Population Health Initiative. “This research gives us a unique glimpse into the past that may help to explain the rising rates of obesity over the past few decades.” Approximately 30% of all the children in the study were classified as overweight—a figure that is consistent with nationally representative data. Methodology A cross-sectional study design was used to examine physical fitness and activity characteristics of three groups of children aged 8 to 13: Old Order Mennonite children from Ontario; Urban Saskatchewan children; and Rural Saskatchewan children. The data collection for this study took place from September to December 2002. Researchers assessed fitness by collecting height, weight, triceps skin fold, grip strength, push-ups, partial curl-ups and aerobic fitness measurements. Also, physical activity levels were measured for seven consecutive days using an accelerometer—an instrument that measures the intensity of body acceleration—and estimated from a self-reported physical activity questionnaire for older children. Canadian Population Health Initiative The Canadian Population Health Initiative (CPHI), which is part of the Canadian Institute for Health Information (CIHI), funded the research described in this media release. CPHI supports research to advance knowledge on the determinants of health in Canada and to develop policy options to improve population health and reduce health inequalities. Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information (CIHI) is an independent, pan-Canadian, not-for-profit organization working to improve the health of Canadians and the health care system by providing quality health information. CIHI’s mandate, as established by Canada’s health ministers, is to coordinate the development and maintenance of a common approach to health information for Canada. To this end, CIHI is responsible for providing accurate and timely information that is needed to establish sound health policies, manage the Canadian health system effectively and create public awareness of factors affecting good health. Media contacts: Leona Hollingsworth (613) 241-7860, Ext. 4140 Cell: (613) 612-3915

Today we celebrate the 229th birthday of the United States of America. On July 4, 1776, the Second Continental Congress unanimously adopted the Declaration of Independence, as we claimed our independence from Britain. On behalf of the NYSCA’s Officers, we want to wish you and your family a Happy 4th of July. To celebrate 4th of July with your own fire works show, click on the “Fire Works” below. Fire Works Also, examine the US Constitution by clicking on this link.

YONKERS, N.Y., -- Alternative medicine is no longer truly alternative. A Consumer Reports survey of more than 34,000 readers reveals that many people have tried it, and more and more doctors are recommending it. Readers gave the highest marks to hands-on treatments, which worked better than conventional treatments for conditions such as back pain and arthritis. Chiropractic was ranked ahead of all conventional treatments, including prescription drugs, by readers with back pain. (Readers said it also provided relief for neck pain, but neck manipulation can be risky and is not recommended by CR.) Deep-tissue massage was found to be especially effective in treating osteoarthritis and fibromyalgia. While readers suffering from back pain deemed acupuncture and acupressure less effective than chiropractic and massage, one-fourth of readers who had tried these therapies said they helped them feel much better. Of all the hands-on alternative therapies, acupuncture has the most scientific support. Readers also reported good results for exercise, not only for conditions such as back pain, but also for allergies and other respiratory ills, anxiety, rheumatoid arthritis, high blood pressure, high cholesterol, depression, insomnia, and prostate problems. Those results are consistent with a broad range of clinical studies of treatments for all of these conditions except allergies and respiratory ailments. On the other hand, well-known, heavily promoted herbal treatments such as echinacea, St. John's wort, saw palmetto, melatonin, and glucosamine and chondroitin didn't work as well for readers. Readers reported that alternative treatments were far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. Interpreting these results of the reader survey is somewhat difficult because the U.S. regulates alternative and conventional medicines differently. Federal laws ensure that a bottle of prescription or over-the-counter pills contains the amount and kind of medicine stated on the label, and dosages are standardized, but no such standards apply to dietary supplements. Moreover, there are no standard recommended dosages. Treating symptoms of menopause A separate Consumer Reports survey of 10,042 women who had gone through menopause or were experiencing it found that a large minority of women have turned from hormone replacement, which can be risky, to black cohosh, soy supplements, and vitamin E for relief from hot flashes. However, those alternatives were far less effective. Sixty percent of respondents who took estrogen plus progestin said it helped them feel much better, as did 53 percent of those who took estrogen by itself. The botanicals scored far lower. Black cohosh was typical. It helped 17 percent of women feel much better, but 51 percent said it did nothing at all. Some, but not all, studies have found that black cohosh is modestly helpful against hot flashes and night sweats. However, its long-term safety has not been studied. Most studies of soy supplements have suggested that they're not very helpful, and breast-cancer patients should talk with their doctor before taking large amounts of soy. For other supplements, studies show little or no evidence of benefit. For specific, free advice on how to choose an alternative treatment, visit ConsumerReports.org during the month of July. In general, CR recommends the following: -- Ask your doctor. Many doctors will refer patients to preferred alternative practitioners. And your doctor may be able to steer you away from potentially hazardous alternative treatments. -- Do your own research. Objective online references include the National Center for Complementary and Alternative Medicine (nccam.nih.gov), part of the U.S. National Institutes of Health; Medline Plus (medlineplus.gov), for plain-language medical information; and Consumer Reports Medical Guide (ConsumerReportsMedicalGuide.org), which rates treatments, including alternative treatments, for several dozen common conditions. It costs $24 per year or $4.95 per month; the others are free. -- Consult other reliable sources. If your doctor doesn't have a referral list of practitioners, check with a local hospital or medical school. You can also turn to national professional organizations, many of which have geographic search functions on their Web sites. -- Check your health plan. Many cover some alternative therapies. -- Check the practitioner's credentials. Make sure your practitioner has the proper license, if applicable, or check for membership in professional associations, which require minimum levels of education and experience. Some also make practitioners pass an exam. The August 2005 issue of Consumer Reports is on sale now wherever magazines are sold. To subscribe, call 1-800-765-1845.

Abstract: Ambulatory Care Visits for Treating Adverse Drug Effects in the United States, 1995–2001: Zhan, Chunliu; Arispe, Irma; Kelley, Edward; Ding, Tina; Burt, Catharine W.; Shinogle, Judith; Stryer, Daniel Background:: Adverse drug events (ADEs) are a well-recognized patient safety concern, but their magnitude is unknown. Ambulatory visits for treating adverse drug effects (VADEs) as recorded in national surveys offer an alternative way to estimate the national prevalence of ADEs because each VADE indicates that an ADE occurred and was serious enough to require care. Methods: A nationally representative sample of visits to physician offices, hospital outpatient departments, and emergency departments was analyzed. VADEs were identified as the first-listed cause of injury. Results: In 2001, there were 4.3 million VADEs in the United States, averaging 15 visits per 1,000 population. VADE rates at physician offices, hospital outpatient departments, and hospital emergency departments were at 3.7, 3.4, and 7.3 per 1,000 visits, respectively. There was an upward trend in the total number of VADEs from 1995 to 2001 (p < .05), but the increases in VADEs per 1,000 visits and per 1,000 population were not statistically significant. VADEs were lower in children younger than 15 and higher in the elderly aged 65–74 than in adults aged 25–44 (p < .01) and were more frequent in females than in males (p < .05). Discussion: Although methodologically conservative, the study suggests that ADEs are a significant threat to patient safety in the United States. Joint Commission Journal on Quality and Patient Safety, July 2005, vol. 31, no. 7, pp. 372-378(7)

New study confirms conclusions from earlier studies linking sleep disorders and inattention in children. Children who snore may be at greater risk of becoming hyperactive later in life than those who sleep quietly. The study, published in the journal Sleep, corroborate earlier conclusions linking sleep disorders and hyperactivity, with snoring coming first followed by hyperactivity. ABSTRACT Autonomic Dysfunction in Children with Sleep-Disordered Breathing Louise M. O’Brien, PhD; David Gozal, MD - Kosair Children’s Hospital Research Institute, and Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY Study Objectives: To measure sympathetic responses in children with and without sleep-disordered breathing. Design: Prospective, observational study. Setting: Kosair Children’s Hospital Sleep Medicine and Apnea Center. Participants: Subjects were prospectively recruited from children undergoing overnight polysomnographic assessments and were retrospectively grouped according to the results of the polysomnogram. Sleep-disordered breathing was defined as an apnea-hypopnea index >5 and children were assigned to the control group if their apnea-hypopnea index was < 1. Intervention: N/A. Measurements and Results: During quiet wakefulness, pulse arterial tonometry was used to assess changes in sympathetic activity following vital capacity sighs in 28 children with sleep-disordered breathing and 29 controls. Each child underwent a series of 3 sighs, and the average maximal pulse arterial tonometry signal attenuation was calculated. Further, a cold pressor test was conducted in a subset of 14 children with sleep-disordered breathing and 14 controls. The left hand was immersed in ice cold water for 30 seconds while right-hand pulse arterial tonometry signal was continuously monitored during immersion and 20-minute recovery periods. Signal amplitude changes were expressed as percentage change from corresponding baseline. Results: The magnitude of sympathetic discharge-induced attenuation of pulse arterial tonometry signal was significantly increased in children with sleep-disordered breathing during sigh maneuvers (74.1%±10.7% change compared with 59.2%±13.2% change in controls; P<.0001) and the cold pressor test (83.5%±7.3% change compared with 74.1%±11.4% change in controls; P=.039). Further, recovery kinetics in control children were faster than those of children with sleep-disordered breathing. Conclusion: Children with sleep-disordered breathing have altered autonomic nervous system regulation as evidenced by increased sympathetic vascular reactivity during wakefulness. Journal SLEEP Volume 28/ Issue 6, June 1, 2005, Pages 747-752

Arlington, Va. (June 23, 2005) — The American Chiropractic Association today responded to the report issued by the Office of the Inspector General with the following statement: It is the opinion of the American Chiropractic Association (ACA) that the findings stated in the report issued by the Department of Health and Human Services, Office of the Inspector General reflect a universal problem in physician documentation and do not represent a concerted effort by doctors of chiropractic to over bill the government for non-reimbursable Medicare services. As has been shown with other physician groups, the documentation process frequently presents challenges and oftentimes results in perceived errors; however, it is simply wrong to conclude, based solely on this report, that chiropractic care typically rendered to Medicare beneficiaries is not necessary or appropriate. In far too many instances, chiropractic providers are simply failing to adequately document the medically necessary care provided. The ACA is committed to working with Centers for Medicare and Medicaid Services (CMS) to develop and implement efficient mechanisms to greatly improve the documentation process and help eliminate errors. It is unfortunate that the Inspector General’s report, drawn from 2001 data, provided only a passing reference to a program initiated in October 2004 that specifically addresses the very problems mentioned in this report. In addition, the Inspector General’s analysis completely ignores ACA’s vigorous and ongoing development of a documentation manual for use by doctors of chiropractic, and its educational programs targeted at state associations, chiropractic colleges, and Medicare carriers. The solution offered by the Inspector General -- to impose arbitrary caps or limits on chiropractic services -- does not take into account the individual needs of the patient. Medicare beneficiaries have the right to receive care which is reasonable and necessary, and the solution offered by the OIG arbitrarily cuts short this right, rather than to addressing the true problem of documentation. The ACA contends that placing arbitrary limits -- or caps -- on care is not an appropriate solution. Lastly, the ACA strenuously objects to the suggestion made in the report that it, at any time, supported the notion of arbitrary caps on services. The cited letter does not support that contention. The ACA is highly confident that the chiropractic care being provided through the Medicare program is both appropriate and medically necessary. We believe access to chiropractic care in Medicare saves taxpayer dollars as it is typically far less expensive than alternative forms of treatment, which often require the use of drugs and surgery. The ACA will continue to pursue all possible means to ensure that doctors of chiropractic have access to the resources they need to help correct the documentation issues raised in this report. We will also continue to protect the rights of all Medicare beneficiaries so they may continue to receive chiropractic services.

According to the Inspector General (IG) report, the government overpaid nearly $285 million in 2001 for chiropractic services. To prevent abuses, the IG recommends that caps should be placed on the number of treatments a chiropractor could bill Medicare. The ACA said that the government instituted new procedures last year to help Doctors of Chiropractic avoid improperly billing Medicare, nothing that the IG’s data cited is four years old. To examine the IG’s report click on the link below:

Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection Paul Little, MD; Kate Rumsby, BA; Joanne Kelly, BSc; Louise Watson, PhD; Michael Moore, MRCGP; Gregory Warner, MRCGP; Tom Fahey, MD; Ian Williamson, MD ABSTRACT Context Acute lower respiratory tract infection is the most common condition treated in primary care. Many physicians still prescribe antibiotics; however, systematic reviews of the use of antibiotics are small and have diverse conclusions. Objective To estimate the effectiveness of 3 prescribing strategies and an information leaflet for acute lower respiratory tract infection. Design, Setting, and Patients A randomized controlled trial conducted from August 18, 1998, to July 30, 2003, of 807 patients presenting in a primary care setting with acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups by a factorial design: leaflet or no leaflet and 1 of 3 antibiotic groups (immediate antibiotics, no offer of antibiotics, and delayed antibiotics). Intervention Three strategies, immediate antibiotics (n = 262), a delayed antibiotic prescription (n = 272), and no offer of antibiotics (n = 273), were prescribed. Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics). Main Outcome Measures Symptom duration and severity. Results A total of 562 patients (70%) returned complete diaries and 78 (10%) provided information about both symptom duration and severity. Cough rated at least "a slight problem" lasted a mean of 11.7 days (25% of patients had a cough lasting 17 days). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed, 0.75 days; 95% confidence intervals [CI], –0.37 to 1.88; immediate, 0.11 days; 95% CI, –1.01 to 1.24) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96%, 20%, and 16%, respectively; P<.001), fewer patients were "very satisfied" (86%, 77%, and 72%, respectively; P = .005), and fewer patients believed in the effectiveness of antibiotics (75%, 40%, and 47%, respectively; P<.001). There were lower reattendances within a month with antibiotics (mean attendances for no antibiotics, 0.19; delayed, 0.12; and immediate, 0.11; P = .04) and higher attendance with a leaflet (mean attendances for no leaflet, 0.11; and leaflet, 0.17; P = .02). Conclusion No offer or a delayed offer of antibiotics for acute uncomplicated lower respiratory tract infection is acceptable, associated with little difference in symptom resolution, and is likely to considerably reduce antibiotic use and beliefs in the effectiveness of antibiotics. Author Affiliations: Primary Medical Care Group, University of Southampton, Highfield (Drs Little, Watson, and Williamson, and Mss Rumsby and Kelly); Nightingale Surgery, Romsey, Hants (Dr Warner); Three Swans Surgery, Salisbury (Drs Moore and Fahey), England; and Department of Primary Care, Dundee University, Dundee, Scotland (Dr Fahey). JAMA. 2005;293:3029-3035

ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Author Affiliations: Department of Public Health, University of Massachusetts, Amherst (Dr Bertone-Johnson); Channing Laboratory (Drs Hankinson, Willett, and Manson) and Division of Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; Departments of Epidemiology (Drs Hankinson, Willett, and Manson) and Nutrition (Dr Willett), Harvard School of Public Health, Boston; GlaxoSmithKline Consumer Healthcare, Parsippany, NJ (Dr Bendich); and Department of Obstetrics and Gynecology, The University of Iowa, Iowa City (Dr Johnson). Arch Intern Med. 2005;165:1246-1252.

IMMEDIATE ACTION REQUIRED Earlier this week, Senate Bill S.3169a and Assembly Bill A.5622a, legislation that would grant physical therapists “direct access” in New York state were amended to “A” prints and started to move. The former Senate Bill, S.3169, contained protections penned into the legislation by the NYSCA and the Medical Society in the Fall of 2002. These protections have been completely discarded in the “A” print of S.3169 – now S.3169a. The companion legislation in the state Assembly, A. 5622a, has been amended to mirror the Senate legislation making the possibility of passage of Physical Therapy Direct Access more probable. YOU NEED TO ACT NOW. For more information, click on the link below.

One of the most common disorders of premenopausal women is premenstrual syndrome (PMS) however, women that get plenty of calcium and vitamin D may prevent PMS. ABSTRACT Background Premenstrual syndrome (PMS) is one of the most common disorders of premenopausal women. Studies suggest that blood calcium and vitamin D levels are lower in women with PMS and that calcium supplementation may reduce symptom severity, but it is unknown whether these nutrients may prevent the initial development of PMS. Methods We conducted a case-control study nested within the prospective Nurses’ Health Study II cohort. Participants were a subset of women aged 27 to 44 years and free from PMS at baseline in 1991, including 1057 women who developed PMS over 10 years of follow-up and 1968 women reporting no diagnosis of PMS and no or minimal menstrual symptoms. Intake of calcium and vitamin D was measured in 1991, 1995, and 1999 by a food frequency questionnaire. Results After adjustment for age, parity, smoking status, and other risk factors, women in the highest quintile of total vitamin D intake (median, 706 IU/d) had a relative risk of 0.59 (95% confidence interval, 0.40-0.86) compared with those in the lowest quintile (median, 112 IU/d) (P = .01 for trend). The intake of calcium from food sources was also inversely related to PMS; compared with women with a low intake (median, 529 mg/d), participants with the highest intake (median, 1283 mg/d) had a relative risk of 0.70 (95% confidence interval, 0.50-0.97) (P = .02 for trend). The intake of skim or low-fat milk was also associated with a lower risk (P<.001). Conclusions A high intake of calcium and vitamin D may reduce the risk of PMS. Large-scale clinical trials addressing this issue are warranted. Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women. Archives of Internal Medicine 2005;165:1246-1252.

ABSTRACT: Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19–64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixty-one million) were under- or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage. You can view the article (full text) by clicking on the link below:

According to a research published in the June 11, 2005 issue of The British Medical Journal, painkillers with ibuprofen may increase the risk of heart attacks by up to 24 percent. Abstract Aims To determine the comparative risk of myocardial infarction in patients taking cyclo-oxygenase-2 and other non-steroidal anti-inflammatory drugs (NSAIDs) in primary care between 2000 and 2004; to determine these risks in patients with and without pre-existing coronary heart disease and in those taking and not taking aspirin. Design Nested case-control study. Setting 367 general practices contributing to the UK QRESEARCH database and spread throughout every strategic health authority and health board in England, Wales, and Scotland. Subjects 9218 cases with a first ever diagnosis of myocardial infarction during the four year study period; 86 349 controls matched for age, calendar year, sex, and practice. Outcome measures Unadjusted and adjusted odds ratios with 95% confidence intervals for myocardial infarction associated with rofecoxib, celecoxib, naproxen, ibuprofen, diclofenac, and other selective and non-selective NSAIDS. Odds ratios were adjusted for smoking status, comorbidity, deprivation, and use of statins, aspirin, and antidepressants. Results A significantly increased risk of myocardial infarction was associated with current use of rofecoxib (adjusted odds ratio 1.32, 95% confidence interval 1.09 to 1.61) compared with no use within the previous three years; with current use of diclofenac (1.55, 1.39 to 1.72); and with current use of ibuprofen (1.24, 1.11 to 1.39). Increased risks were associated with the other selective NSAIDs, with naproxen, and with non-selective NSAIDs; these risks were significant at < 0.05 rather than < 0.01 for current use but significant at < 0.01 in the tests for trend. No significant interactions occurred between any of the NSAIDs and either aspirin or coronary heart disease. Conclusion These results suggest an increased risk of myocardial infarction associated with current use of rofecoxib, diclofenac, and ibuprofen despite adjustment for many potential confounders. No evidence was found to support a reduction in risk of myocardial infarction associated with current use of naproxen. This is an observational study and may be subject to residual confounding that cannot be fully corrected for. However, enough concerns may exist to warrant a reconsideration of the cardiovascular safety of all NSAIDs. BMJ 2005;330:1366 (11 June)

A Kansas City nonprofit organization has formed to try to begin offering chiropractic degrees and to improve people’s health by opening wellness centers according to an article in The Kansas City Star. According to this article written by Lynn Franey a higher education reporter for The Kansas City Star, Gerald Jensen a former vice chancellor at the University of Missouri-Kansas City has created the Chrysalis Institute. Most recently, Jensen was an administrator at the Cleveland Chiropractic College in Kansas City, Missouri. To learn more read the complete story in The Kansas City Star by clicking on the link below. The Kansas City Star - Institute is planning chiropractic degrees or Chrysalis Institute

The New York State Chiropractic Association is proud to announce the May 2005 election results. The individuals below are elected to the following office: PRESIDENT Dr. Mariangela Penna VICE PRESIDENT Dr. Bruce A. Silber SECRETARY Dr. Robert Brown TREASURER Dr. Richard J. Tesoriero DIRECTOR Dr. Robert J. DeSantis, Jr.* Dr. Malcolm Levitin Dr. Louis Lupinacci* Dr. David B. Kartzman Dr. Lloyd Kupferman (* serving for a 2nd term) The new officers and Directors will assume their elected office on June 1, 2005. NYSCA thanks all the candidates that participated in this year’s election and congratulates our new Officers and Directors. In this election, nearly 450 ballots were cast representing one of our highest voter “Turn-Out” ever.

ACA Asks Doctors Nationwide for More Data into Problems Affecting Patient Care and Reimbursement (Arlington, Va) The American Chiropractic Association (ACA), as part of its ongoing aggressive campaign to correct the wrongful practices of certain chiropractic managed care networks, is asking doctors of chiropractic nationwide to provide additional information that will assist in putting an end to these practices. Among the wrongful practices that the ACA is gathering information about are the following: • Automatic downcoding or limiting physician discretion in the planning of care: The doctor submits the network's forms after examining the patient and is advised of the frequency, duration and type of care that will be covered. Requested treatment is often reduced or denied. Claims are downcoded without the doctor of chiropractic being provided the opportunity to provide any documentation supporting the claim as submitted. • Bundling: The submitted CPT code is incorporated into another submitted CPT code. • Improper utilization review including refusal to recognize coding modifiers: Managed care organizations sometimes refuse to recognize "modifiers" that chiropractors append to CPT codes to report a service or procedure that has been performed and which has been altered by some specific circumstance. • Performance management issues: Managed care networks often disregard the doctor's discretion to diagnose and treat, and limit the number of visits, x-rays and modalities. Doctors say they are reprimanded and threatened with the loss of their contract when the care they prescribe is outside the managed care organization's set standards. "For too long, there has been a misguided perception within the profession that ACA somehow condones the unfair practices of certain chiropractic networks," explained ACA President Donald Krippendorf, DC. "In reality, the ACA strongly denounces these practices and needs your support and information to put an end to what we view as unconscionable activity by these groups." The latest campaign to correct these harmful practices is an outgrowth of a resolution passed by the ACA House of Delegates in March 2002 formally outlining ACA's opposition to the improper practices of chiropractic networks and authorizing ACA staff to collect data identifying the types of abuses doctors of chiropractic experience at the hands of third-party administrators. As part of this effort, ACA recently retained the services of Milberg Weiss, one of the nation's largest class action law firms, to assist in the collection and analysis of this information. Over the past three years, hundreds of doctors of chiropractic have contacted ACA and completed "managed care data collection" forms detailing their troubling experiences with chiropractic networks - and the names of several specific organizations and trends have emerged. According to the data collected by ACA, doctors of chiropractic are most troubled by the actions of American Chiropractic Network (ACN), American Specialty Health Plans (ASHP) and Landmark Healthcare. These carriers routinely deny requested treatment and improperly reduce and deny reimbursement, putting patients and quality of care at risk, according to doctors who contacted ACA. ACA's data collection efforts have uncovered an array of serious concerns with these carriers, but more information is needed regarding particular problem areas. "We have heard your complaints, and we are further analyzing our options to deal with these activities," added Dr. Krippendorf. "We need your continued support and information to protect not only your practice and profession, but also the quality of care you provide your patients." In addition to canvassing the chiropractic profession for more data into specific problem areas, the ACA is also contacting certain chiropractic networks and demanding that they cease the misleading use of ACA's name and trademark in their communications and treatment forms. In a May 13, 2005, letter to ASHP President George DeVries, ACA Executive Vice President Garrett F. Cuneo demands that ASHP remove the "unauthorized and misleading reference and use of the ACA name" in the company's "Clinical Treatment Form." "Please be advised that the ACA views this unauthorized use of its name in connection with the misleading representation contained in your form as defamatory, a violation of its trademark and a continuing unfair trade practice that has resulted and continues to result in damage to the association," Cuneo wrote. The full letter can be found on ACA's Web site at: letter to American Specialty Health (ASHP). The ACA is requesting that doctors of chiropractic who have experienced problems with ACN, ASHP, and Landmark in the areas of restriction of treatment, downcoding, bundling and improper use of modifiers fill out the data collection form found on ACA's website at: CARE DATA COLLECTION FORM. Please fax the completed form to (703) 243-2593, Attention: PDR Department. Your information will be kept in strict confidence and your name will not be released to any managed care network. You will also find additional information and resources regarding ACA's data collection campaign and what you can do to assist in this effort on ACA's Web site at: Are You Having Problems with Chiropractic Networks and Managed Care Organizations? For more information: Felicity Feather Clancy Vice President, Communications [email protected] phone: (703) 276-8800, ext. 241 or Angela Kargus Communications and Public Relations Manager [email protected] phone: (703) 276-8800. ext 240

The Chiropractic Learning Resource Center (CLRC) planned for construction on the Palmer College of Chiropractic campus will now include state-of-the-art outpatient clinic facilities, College officials have announced. Groundbreaking for the CLRC, to be located on the east side of Brady Street, will take place later this year with an anticipated completion date in 2007. The new building is the centerpiece of the College’s $35 million capital campaign, which has raised nearly $26 million in gifts and pledges and is now in its completion phase. College officials expect to complete the campaign by the end of 2006. “The new Chiropractic Learning Resource Center and its world-class clinic facility will further enhance the education students receive at Palmer,” said Palmer President Donald Kern, D.C. “We are so excited to add clinic facilities to this new building, which will be a focal point on campus, a crossroads for the entire profession, and will provide alumni, faculty, students and researchers with an educational resource found nowhere else in the chiropractic profession.” Preliminary plans call for the facility to include more than 40,000 square feet of space, which will be used to house: • Community outpatient clinic facilities • Clinical learning resources for students • Radiology services • Rehabilitation services • Visitor center The Palmer College capital campaign goals are as follows: • $12.9 million for Chiropractic Learning Resource Center • $7.1 million for revitalization of campus facilities • $5 million for annual operating funds • $10 million for cash and deferred endowment needs As part of total contributions to the campaign thus far, Palmer College has received $5.2 million in federal funding, of which $3.9 million has been designated for the CLRC. “We are so appreciative, amazed and humbled by the level of support we have received thus far in our capital campaign,” added Palmer’s Chief Development Officer Drew Boster. “Our alumni, friends, employees and the local community have been extremely generous with their gifts and their time in this endeavor. I would like to take this opportunity to thank our local alumni and community leaders who have been instrumental in our progress thus far. Reaching our goal will ensure that we continue to graduate the most talented and skilled chiropractors in the profession by giving them the best tools, education and inspiration here at The Fountainhead of chiropractic.”

Peter D. Ferguson, D.C., of Canton, Ohio was re-elected President of the National Board of Chiropractic Examiners during their Annual Meeting May 7 in Montreal, Quebec, Canada. Dr. Peter Ferguson was elected to return as NBCE President after serving for one year as Chairman of the Board, during which Dr. James Badge served as president. Following the elections, Dr. Ferguson took the opportunity to address his intentions for the coming year. Although I was reluctant to once again serve as president, I am honored to do so. Under the circumstances that this position is only for one year, and that year being such a short period of time, my aim is to continue building upon Dr. Badge’s work over this past year and to also build upon the work that I accomplished during my previous tenure as president. I am dedicated to the continual pursuit of reducing expenses of the Board and increasing communication with the delegates, alternate delegates, state board members, chiropractic colleges and students and the chiropractic profession. My overall goal is to do the right thing for the chiropractic profession and that is continuing to do what the Board has done so well for the past 42 years—providing excellent pre-licensure examination services that regulatory bodies can depend on as appropriate and legally defensible. Dr. Ferguson was first elected to serve the National Board as Director-at-Large in 1999. When Dr. Ferguson was elected as President to the Board in 2000, the National Board was at a crossroad. Under Dr. Ferguson’s guidance, the NBCE made many changes. In response to a continual decline in exam revenue the Board cut its budget and found it necessary to increase exam fees for the first time since 1992. In 2000 Dr. Ferguson initiated National Board Days at chiropractic colleges to improve relations with the chiropractic college students. Since 2000, an NBCE director has visited every chiropractic college at least once and the NBCE has also welcomed members of chiropractic college student leadership to its facilities. Another noteworthy change experienced by the NBCE during Dr. Ferguson’s term as president was the first election of a female to the NBCE Board of Directors. Additionally, since 2000, the National Board has introduced two new, optional examinations: Acupuncture in 2003 and the NBCE Ethics and Boundaries exam in 2004. With the Board’s commitment to improving communications with the profession, the National Board began printing a quarterly newsletter in 2000, and in March 2003 introduced monthly reports. Over the past five years the Board has also been committed to the development of a comprehensive Web site that provides information on the Board and NBCE examinations, as well as news updates and other relevant information. During the past year, exam brochures and applications were included on the NBCE Web site as a convenience for examinees so that they could fill out these forms online before submission to the board. A graduate of National College of Chiropractic in Illinois, Dr. Ferguson’s responsibilities outside the NBCE have included being a member to both the U.S. Department of Defense Chiropractic Health care Demonstration Oversight Advisory Committee and to the Advisory Committee on Interdisciplinary, Community-Based Linkages, U.S. Department of Health and Human Services. In 1998, Dr. Ferguson received the prestigious George Arvidson Award for Meritorious Service to Chiropractic Licensure for his involvement with the Federation of Chiropractic Licensing Boards (FCLB), which Dr. Ferguson previously chaired. He is a fellow of the International College of Chiropractors, and also a fellow of the American College of Chiropractors. Dr. Ferguson is also a member of the Board of Trustees at New York Chiropractic College, the former director for the Council on Chiropractic Education, former president of the Ohio State Board of Chiropractic Examiners, member of the President’s Advisory Board at Walsh University and Chairman of the Civil Services Commission in Canton, Ohio. Headquartered in Greeley, Colorado, 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.

"Perseverance is the hard work you do after you get tired of doing the hard work you already did". -Newt Gingrich On May 3rd a historic course of events took place when over 100 doctors of chiropractic "Marched on Albany" to make our voices heard and that of our patients'. We met one on one with individual legislators and explained why they needed to support NYSCA/NYCC Joint Legislative Task Force's Technical Corrections Bill and other relief legislation. The DC's who attended were well briefed and prepared to answer the questions asked by these legislators. Afterwards, we all met for an informal gathering to wind down and socialize with each other. The day was a huge success and time will tell if out efforts were worthwhile. We will discuss the day's event at our meeting. In addition, the delegates report will be given on what transpired at the House meeting May 14-15, 2005. No matter what the outcome, all of us need to decide what our purpose is--in practice, in life, family… More than ever before we need to come together as chiropractors and fight this battle and win…once and for all. It will take hard work, commitment-both financial and time, but the ultimate victory will benefit all of us and our patients. We are unique, we are different and we are here to stay!