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U.S. Senate Committee: Doctors of Chiropractic Eligible for Federal Loan Repayment Program

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 Originally enacted in 1970, NHSC allows selected health care professionals engaged in the delivery of primary care services to be reimbursed for student loans in return for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



GREELEY, Colo.—Salvatore D. LaRusso, D.C., of Wellington, Fla., was elected on March 8 by the board of the National Board of Chiropractic Examiners (NBCE) to fill a vacancy in the roll of Director-At-Large. The vacancy was created by the untimely death of Dr. Earl L. Wiley who passed away in November 2007. Dr. LaRusso will complete the unexpired term of Dr. Wiley which will end in May 2009. At that time, Dr. LaRusso will be eligible for re-election. Dr. LaRusso is a graduate of New York Chiropractic and obtained his undergraduate degree in business administration from Seton Hall University. He has been active in many international, national, state and local organizations. In 1998, Dr. LaRusso was a gubernatorial appointee to the Florida Board of Chiropractic Medicine, serving as board chair in 2005, 2006 and 2007. From 2005 to present, he serves as chairman of the Florida Board’s Certified Chiropractic Physicians Assistant Committee. Dr. LaRusso is a long-standing member of both the Florida Chiropractic Association and the Florida Chiropractic Society (FCS) serving as president of the FCS from 1992-1993 and chairman from 1993-1997. The FCS named Dr. LaRusso Chiropractor of the Year in 1994, awarded him the Gavel Award in 1993 and honored him the Distinguished Service to the FCS in 1992. Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.


ACA Announces Development of Patient Advocacy Database During National Chiropractic Legislative Conference

The American Chiropractic Association (ACA) has announced it will launch a historic and bold advocacy effort later this year by creating a national database of chiropractic patients. Designed to strengthen the profession’s political voice, the planned database was unveiled during the association’s National Chiropractic Legislative Conference (NCLC) Feb 27-28 in Washington, D.C. More than 500 practicing doctors of chiropractic and energetic students attended NCLC, where they heard speeches from government leaders, received advocacy education and training, urged elected officials to support pro-chiropractic measures, and networked with colleagues from around the country. “In the upcoming election cycle, chiropractic must grab the attention of members of Congress and the White House,” said ACA President Glenn Manceaux, DC. “We must galvanize our patients to action and fully engage them in the lobbying effort if we are to effect change.” Throughout NCLC, ACA’s lobbyists emphasized the need for the profession to make its mark on policymakers in the next few months and years. They referred to the convergence of certain factors—including the election of a new president, urgent calls for Medicare reform, and increasing momentum for a national health care system—as a “perfect storm” with a potentially significant and lasting impact on chiropractic’s future. Keynote speaker and famed political consultant James Carville echoed the importance of leveraging the influence of chiropractic patients and grassroots lobbying efforts. “If five patients call your congressman, it’s much more effective than just you.” “We’re going to have fewer dollars chasing more sick people. All the other people who don’t wish you well and want a bigger part of that health care resource are going to be at the table. You just have to be political,” he said. In commenting on the current political scene—which he called a “fascinating time in American politics”—Carville told conference attendees to expect a Democratic Congress in 2009. “I can’t tell you what the health care system is going to look like four years from now, but I can tell you it’s going to be different.” In addition to Carville, several members of Congress addressed the conference delegation, sharing their views on national health care reform and other issues important to the profession. Rep. Jim Clyburn, D-S.C., U.S. House majority whip, made his first appearance at NCLC. Rep. Clyburn emphasized that chiropractors must be involved in health care debates to ensure that all sides of issues are represented. “One person making decisions is efficient, but we can’t have that,” he said. “We need your input to make health care delivery in this country both efficient and effective.” Rep. Bob Filner, D-Calif., a longtime champion of chiropractic direct access within the VA health care system, said there are still obstacles to overcome, particularly the use of MD gatekeepers who do not believe in chiropractic and therefore are unlikely to refer patients. “There has to be direct access,” he said. “If we change the behavior, hearts and minds will follow.” Pennsylvania Rep. Phil English (R) said he supports greater competition in the health care system and urged doctors of chiropractic to continue their advocacy work. “Your association has been a critical advocate in giving people choices and leading the nation toward a consumer-driven health care system—and I salute you,” he said. Sen. Tom Harkin, D-Iowa, told NCLC attendees that his support of chiropractic over the years has made him unpopular with some medical constituencies, but it has nevertheless been a consistent theme of his advocacy work in Congress. “We’ve won some big challenges in the past and we’ve got many ahead of us,” Harkin said. “It’s time to fully integrate chiropractic into all active military health care systems” and “it’s time to commission doctors of chiropractic in the Public Health Service Corps,” he proclaimed. Several members of Congress visited with the delegation during the NCLC congressional reception, including: Russ Carnahan, D-Mo.; Vernon Ehlers, R-Mich.; Nick Lampson, D-Texas; and Jim Moran, D-Va. House of Delegates Meeting Each year, NCLC is held in conjunction with an official business meeting of the ACA House of Delegates. The HOD portion of the event included the passage of several important resolutions: ---The association clarified that the strapping codes CPT® 29200-29280 and 29520-29590 should be reported when performing Kinesio Taping; whereas, reporting neuromuscular reeducation CPT® 97112 or other codes would not be appropriate. ---The ACA House of Delegates reaffirmed its support for the American Public Health Association (APHA) and encouraged all doctors of chiropractic to maintain membership in and become active with the APHA. ---The ACA revisited its policy on chiropractic pediatrics. The current policy statement now reads: “The ACA recognizes that the Doctor of Chiropractic is an important member of the integrative pediatric health care team and encourages Doctors of Chiropractic to work with pediatric practitioners from other fields of healthcare when appropriate to maximize each child’s health and well-being.” Education Seminars Well Attended More than 80 doctors of chiropractic attended two premier education seminars offered during NCLC. On March 1, Susan McClelland presented the ACA turn-key program, “Coding and Clinical Documentation for the Chiropractic Practice: Strategies for Success.” Additionally, on March 2, Dr. Thomas O'Bryan kicked off a year-long tour of his signature presentation, “Unlocking the Mysteries of Gluten Sensitivity: Musculoskeletal and Neurological Complications.” The seminars were offered in partnership with the Virginia Chiropractic Association and the District of Columbia Chiropractic Association.

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AMA Issues Correction to Impairment Ratings Guide After ACA Complaint

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

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House Introduces Resolution Calling for Immediate Commissioning of Chiropractors into Armed Forces


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Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based, Case-Control and Case-Crossover Study

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

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UnitedHealthcare Rescinds Headache, Pediatric Policy

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


News from New York State Board for Chiropractic (NYSBC)

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


Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

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

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Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey

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

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CCGPP to Release Upper Extremity Chapter on October 10

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



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

CCGPP Releases Wellness Chapter Draft

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


People in Pain: How Do They Seek Relief?

Abstract Little is known about how people with pain seek relief. To estimate the proportion of the population reporting recent pain, to identify ways people seek pain relief, and to report the perceived effectiveness of pain relief methods, we conducted a secondary analysis of results from a nationwide survey of the general U.S. population. Of the 1204 respondents, 31% had experienced moderate to very severe pain within the past 2 weeks and 75% of these had sought medical attention. Only 56% of those who sought medical attention got significant pain relief. Although seeking medical attention was the primary pain relief strategy, almost all of those with pain had tried multiple alternative methods for pain control, with 92% of pain sufferers having tried 3 or more alternative strategies. People who did not seek medical attention were more likely to report pain relief from prayer and going to a chiropractor than were those who sought medical attention. Factors leading to inadequate pain relief included difficulty communicating with a health professional and lack of health insurance. People who perceive that their pain is not understood by medical providers and those without health care insurance coverage are at greater risk for poor pain control. Perspective This article presents an analysis of data from a national survey on pain and the effectiveness of ways people seek pain relief. Difficulty communicating with health professionals and lack of health insurance contributed to inadequate pain relief. Almost all people with pain used multiple methods to control their pain. Volume 8, Issue 8, Pages 624-636 (August 2007)

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Council on Chiropractic Guidelines and Practice Parameters Announces Release of Additional Components to the Chiropractic Compass

Fifteen months after the release of the first draft of the low back evidence stratification for public comment, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is poised to release additional components of the Chiropractic Clinical Compass beginning immediately with the Preface, a revised Introduction, and a newly created chapter on Methodology. Each of these three sections will be available for review on the CCGPP website next week at The next draft of evidence stratification scheduled for release for public comment is Wellness, Non-musculoskeletal and Special Populations, which will be posted at on September 1. CCGPP anticipates the release of one additional draft approximately every 30 days beginning with "Upper Extremity Conditions" on October 1 followed by Low Back Part A, Cervical Spine, Soft Tissue, Thoracic Spine, and Lower Extremities. As was done previously, drafts will be posted on the CCGPP website ( for 60 days of comment. Notification of each release and instructions for submitting comments will be distributed to stakeholders prior to posting via traditional communication outlets. Interested constituent members are urged to organize review efforts now. A previous draft of the low back evidence stratification released for public comment a year ago was the subject of a significant amount of very helpful feedback, much of which was discussed and worked through in a constructive session with stakeholders at the Congress of Chiropractic State Associations annual meeting in Baltimore last November. Based on suggestions received, the low back team has elected to perform a more comprehensive review of the literature pertaining to diagnostic issues, which will further delay re-release of portions of the low back chapter. Over 600 comments have been received, reviewed and addressed, using methodology similar to that used to address public comments to statutory or workers' compensation regulations in states like Texas. Similar comments were collapsed and addressed with one of three possible responses: 1. agreement with the criticism and appropriate revision of the document 2. no response, when no supporting evidence was provided for the critique 3. disagreement with the criticism, with rationale for the disagreement A large number of urgent requests have been voiced by the profession for high quality evidence of efficacy to support care, particularly in addressing third party payor denials and to assist with regulatory hearings. The literature review to date demonstrates excellent quality of literature support for the primary chiropractic treatment approaches to low back pain, which are unlikely to be changed by review of additional literature at this time; therefore the commission has elected to re-release the low back chapter in two parts. Part A will consist of treatment approaches and other aspects which generated little or no comment. Part B, which will consist of diagnostics and related issues, will be deferred pending additional literature review and synthesis. A new chapter concerning the vertebral subluxation has been commissioned by the Association of Chiropractic Colleges. A committee, headed by Drs. Carl Cleveland III and Meridel Gatterman and comprised of content experts from the various colleges, has been charged with developing the chapter following CCGPP methodology, which is outlined in the introduction. In keeping with the agreements reached with COCSA members in Baltimore last year, the recommendations of constituents have been revisited and addressed. Among other suggestions was the need to improve formatting, and to that end professional assistance has been retained to make the document more readable and user friendly. The Council is quick to point out, however, that editing is for the purpose of clarity and readability and not for any content or conclusion edits. The Council is pleased to announce the appointment of Cheryl Hawk, DC, PhD, of Cleveland Chiropractic College, as new Chair of the CCGPP Research Commission. Dr. Hawk is currently Vice President of Research and Scholarship at Cleveland Chiropractic College. She is a 1976 graduate of National College of Chiropractic and practiced full-time for 12 years. In 1991, she earned a PhD in Preventive Medicine from the University of Iowa and also became a Certified Health Education Specialist (CHES). She has been the primary writer of successful grant and contract proposals totaling over $5 million. She is also an author on over 60 peer-reviewed articles and book chapters. Currently Dr. Hawk serves on the ACA Wellness Campaign Committee and as the CCGPP Team Leader for "Wellness, Non-musculoskeletal Conditions and Special Populations." From 2003-2006, she served as the appointed chiropractic representative on the National Advisory Committee for Interdisciplinary, Community-Based Linkages of the U.S. Health Resources and Services Administration Bureau of Health Professions. In 2005, she was named "Researcher of the Year" by the Foundation for Chiropractic Education and Research. "We are very fortunate to have someone of Dr Hawk's caliber take over the reins. Dr Hawk brings a fresh perspective, as well as years of clinical experience and research expertise. We're very excited to have her on board," noted Dr. Whalen. Dr Hawk replaces outgoing Chair Jay Triano, DC, PhD, who stepped down on the heels of his appointment as professor and Interim Dean of Graduate Education and Research for the Canadian Memorial Chiropractic College. He has also been appointed as Associate Professor in the School of Rehabilitative Science at McMaster University. Dr. Triano, a biomechanist and formerly a clinician and researcher at the Texas Back Institute, served as CCGPP Research Commission Chair since 2003 and was instrumental in orchestrating the broad and diverse pool of researchers from across the country and internationally who collaborated to review and rate the literature on the various conditions. Simply finding doctors with the special skills necessary for the task, much less convincing them to volunteer hundreds of hours of their time was a Herculean task. Organizing the massive effort among dozens of clinicians and academic topic volunteer experts was a major undertaking, and now that framework has been established, Dr Triano felt comfortable in turning over the reins. "While this project has required the collective efforts and sacrifice of dozens of the profession's best and brightest, no one involved would dispute that without the persistence and vision of Dr Triano, the project would ever have made it this far. We all owe Dr Triano a debt of gratitude," noted CCGPP Chairman Dr Wayne Whalen. Dr. Triano now joins the ranks of prior Research Commission chairs Charles Lantz, D.C., Ph.D., Dana Lawrence, D.C. and William Meeker, D.C., M.P.H., who have all served CCGPP with distinction. Dr Alan Adams, an expert on literature evaluation, continues to serve as Commission Vice Chair in a primarily advisory role. Further information, as well as the draft chapters when released, is available at the CCGPP web site below:


Conservative Management of Mechanical Neck Disorders: A Systematic Review

ABSTRACT Objective. To determine if conservative treatments (manual therapies, physical medicine methods, medication, and patient education) relieved pain or improved function/disability, patient satisfaction, and global perceived effect in adults with acute, subacute, and chronic mechanical neck disorders (MND) by updating 11 systematic reviews of randomized controlled trials (RCT).

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SELF Magazine Examines the Alleged Link Between Chiropractic Cervical Manipulation and Vertebral Artery Dissection

Please be advise that an article in the May issue of SELF magazine that examines the purported link between vertebral artery dissection and chiropractic cervical manipulation. The story will not be available on newsstands until next week, but it is already posted online. Read the story by clicking here. While the views of ACA spokesperson Dr. William Lauretti, an expert on the topic of vertebral artery dissection, are included in the article, the piece is overwhelmingly negative and details the stories of several patients -- particularly a 43-year-old mother of four who believes her stroke was caused by a chiropractic adjustment. In its official response issued this morning, ACA explains to the editors of SELF magazine that the article needlessly alarms current and potential chiropractic patients about a safe, effective and appropriate treatment for those with common forms of neck pain and headache. Moreover, there is no definitive evidence that chiropractic manipulation is the cause of vertebral artery dissections. To read ACA’s full response, clicking here. Patient Communications Patients, staff and colleagues may ask you about this article. To help combat any negative publicity that might occur in your community as a result of this article, ACA is offering the following information: Chiropractic &; Stroke: Key Messages What are the Risks of Chiropractic Neck Adjustments? By William J. Lauretti, DC Chiropractic Manipulation & Cervical Artery Dissection. A JACA article by Michael T. Haneline, DC, MPH, and Gary Lewkovich, DC NCMIC’s CVA Monograph Executive Summary & Warning Signs Poster Patient Education Page: Chiropractic &; Headaches Research Excerpts that Show the Positive Benefits of Chiropractic Care ACA is also asking doctors of chiropractic to monitor SELF’s blog where readers can discuss the story. Doctors and chiropractic patients are encouraged to post positive messages about the benefits of manipulation. To visit the blog, click here.

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Foundation for Chiropractic Progress Announces 2007 Campaign

To increase the public’s awareness of the benefits of chiropractic care through positive press – this is the mission of the Foundation for Chiropractic Progress. Since July 2006, the Foundation has advertised in major publications such as Newsweek, Health Magazine, Business Week, New York Times Magazine, U.S. News and World Report, and Sports Illustrated. More than 18 million positive impressions regarding chiropractic have been communicated to the general public through this medium. In addition, a TV commercial produced by the Foundation was recently aired to over 150 million viewers. During the 2007 campaign, we will continue to advertise in national publications with circulations of over 1 million. Realizing that advertising alone will not significantly change public opinion, the Foundation retained a prominent public relations agency, CPR Communications. With more than twenty-five years working with the media, this firm is responsible for generating positive press to complement the advertising campaign for the profession. Their efforts have already shown positive results as they generated cover stories on Sarah Harding in New Living Magazine and Total Health Magazine. In cooperation with the Foundation the agency has developed a comprehensive public relations campaign for 2007. Monthly press release to the general media on topics related to the profession, monthly Public Service Announcements to the print and electronic media, and a quarterly adversarial on topics promoting the profession are just a few positive press highlights for 2007. Also exciting is the addition of a “Health Seekers Calendar” - developed to provide appropriate health tips to consumers who visit the Foundation’s web site ( Additionally, a Foundation blog will be established for consumers. With this feature, we will also have the ability to monitor the health blogs of prominent publications like the New York Times and The Washington Post for positive stories about chiropractic. The reality is that chiropractic is considered the best-kept secret in health care. The Foundation for Chiropractic Progress is working for you to increase the positive press about chiropractic and change that reality. Every dollar received from vendors and doctors will go directly to the advertising/public relations campaign. We invite you to join the Foundation and build on the positive press of this campaign. If you wish to make a pledge and/or contribution to the Foundation, please visit ( Contributions are also received at P.O. Box 560, Carmichael, California 95609-0560.

Over 150 Million Households to View Chiropractic Message

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 Contributions are also received at P.O. Box 560, Carmichael, California 95609-0560


CCGPP releases draft of best practice

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) has released the long-awaited initial draft of their low back best-practice document. This draft will remain posted on this site in order to solicit responses for 60 days, from May 11, 2006 until July 10, 2006. After that date, this draft will be removed from this site and your comments will be compiled by our survey contractor. The lower back team will then examine the results obtained for any potential impact on the chapter, with changes being made as necessary. The following draft includes introductory chapter background information. This is followed with rationale and other information that will assist the reader in the examination of the document and which will provide insights into the process that our organization followed when constructing this document. The full text information on the lower back is next followed by tables, appropriate references and search strategies employed. We request that the reader examines the draft in its entirety in order to be able to arrive at informed conclusions concerning the content. CCGPP has focused on typical presentations seen in a chiropractic office in this document and the subject material of other chapters may be found elsewhere on this site. Since wellness care has always been a traditional and significant focus of chiropractic practice, this topic is both woven into individual chapter information as well a separate chapter which also addresses this component of care. At the conclusion of the draft document, the reader will be directed to a third-party survey site to answer a few questions and to also provide additional comments, if it is appropriate. The site is: Again, if you are an interested consumer, patient, third-party payor representative, representative of a governmental agency or other interested stakeholder, you may instead visit www, in order to examine more abbreviated lower back draft summary information and to also offer comments. Comments and additional references provided by the reader potentially can alter the draft, so we request that contributors formulate responses carefully and accordingly.