On April 30, 2006, a group of DC’s represented NYSCA at the the New York State Democratic Committee’s Dinner held at the famous Waldorf Astoria Hotel. In attendance were Dr. H. William Wolfson, President NYSCA Suffolk Chapter and ACA NYS Metro Delegate. Dr. Louis Lupinacci, NYSCA Board member and ACA NYS Alternate Metro Delegate. Dr. Don Littlejohn, NYSCA Board member and co-chair NYSCA Legislative Task Force. Dr. Michael Bernstein, President NYSCA Nassau Chapter, NYSCA Board member and co-chair NYSCA Legislative Task Force. Dr. Peter Samsone, President NYSCA Manhattan Chapter, and Dr. Michael Minardo a NYSCA member. These doctors attended, on behalf of NYSCA, and made their presence known to the elected officials. The doctors were able to meet and speak with the many Democratic leaders in attendance. Senator Hillary Clinton, Attorney General Eliot Spitzer, Assembly Speaker Sheldon Silver, former NYS Governor Mario Cuomo, former HUD Andrew Cuomo and Comptroller Alan Hevisi, are just a few democratic leaders these doctors were able to thank for their support of our profession. These leaders were all aware of NYSCA’s presence and told our members of their appreciation for attending this exciting event.

Assemblyman Latimer, of the 91st District, a strong and outspoken proponent of Chiropractic attends NYSCA District 8 (Westchester) April 12 Meeting. The Assemblyman 91st District encompasses City of Rye, Town of Rye (Village of Port Chester, Rye Brook, and Mamaroneck), Town of Mamaroneck, Larchmont and part of New Rochelle. Assemblyman started his appearance before the NYSCA District 8 meeting with a comparison. "Political life is like being Elizabeth Taylor's seventh husband - you know what's expected of you but can you equal the performance?" District 8 President Dr. Janusz Richards stated that Assemblyman Latimer equaled the performance Wednesday night, with his most informative talk, giving all present very specific direction on how to best accomplish our legislative aims. "Get your story to the legislators - let them know what you do." Mr. Latimer distributed handouts of our insurance equality correction bill (A04527) and our workers compensation bill (A08340) both of which he is a co-sponsor. He has worked closely with us in the past. However, he admitted that Wednesday's meeting was a learning experience for him, i.e. NYS Business Council's history of opposition to chiropractic legislation and the reasons why. Although a freshman Assemblyman, who is running for re-election this November, he comes from a most accomplished background. Originally schooled and worked in the hotel industry he is married with one daughter. He is a former City of Rye Councilman, Past Chairman of the Westchester County Democratic Party, and Past Chairman of the Westchester County Board of Legislators. It was a most profitable evening for all those that attended. All came away with strong feelings of support for this true friend of the profession. Ms. Taylor would be proud of him!

On Friday, October 21, NYSCA Board member, Lynn Pownall, DC, DACBN presented a letter to the New York State Board for Chiropractic addressed to the State Board chair, Ali M. Jafari, DC on behalf of NYSCA President, Mariangela Penna, DC. The letter addressed a number of professional issues that have an impact on the State Education Department’s mission “[t]o protect the public by fostering high standards of professional . . . practice.” The Association stated that it “believes that public protection and patient safety are not being served by the current state of professional practice by any state agency, including the State Education Department, and such altruistic sentiments as contained in the SED mission statement and goals are not being met.” “Patient protection and the standards of practice for chiropractic and the other licensed professions generally, are within the purview of the State Education Department,” Dr. Penna noted, “but the professions are not only affected by the laws and regulations of the SED, but by all of laws and all of regulations of all of the state agencies combined. In view of the current state of professional practice, the NYSCA submits that SED’s attitude in view of its stated mission to ‘protect the public’ by ‘fostering high standards of professional . .. practice’ without looking at the totality of the laws and regulation that affect patient safety and professional practice is agency-centric -- more inclined to protect the status quo rather than being patient-centered/ public safety conscious or concerned about establishing ‘high standards of professional . . . practice.’ As laudable as they are, patient protection/public safety and standards of professional practice are missions and goals that cannot be met or compartmentalized solely the province of the SED without an examination of all areas of law and regulation of the state in their totality. The NYSCA submits that the SED, as well as the other state agencies, have surrendered important regulatory and standards setting responsibilities collectively to the whims of the market place.” The NYSCA letter noted that the utilization review practices of health plans, insurers, HMOs and MCOs, Individual Practice Associations (IPAs) and independent Utilization Review agents based on proprietary guidelines not open to public scrutiny amounted to a “defacto regulation of the profession” by self-interested, private enterprises – entities raking in record profits and whose only interest is their own financial bottom for the benefit of their shareholders and does not represent “quality” health care or “high standards of professional practice.” “Who is minding the fox?,” Penna asked. The NYSCA also charged that the termination practices by plans amounted to a constructive, albeit financial, delicensing of chiropractic professionals. “Health care is everyone’s responsibility – patient, provider, employer, insurer, government and governmental agency,” Penna noted. “Health care needs to be patient-centered, evidence-based, efficacious, efficient, cost-effective, patient-responsible and transparent for everyone’s benefit. Presently, this is not the case. But the State Boards can help, including the State Board for Chiropractic," Penna said. “The development of practice guidelines and standards and written review criteria are within the ambit of the regulatory functions of a disinterested State Education Department charged with establishing and maintaining “high standards of professional . . . practice” for the public’s protection, and that the promulgation of these guidelines and standards, Penna stated, should be developed and disseminated in concert with all interested parties.” Dr. Penna’s statement was joined by a statement expressing similar sentiments by the American Chiropractic Association (ACA) given by ACA downstate delegates, H. William Wolfson, DC who is also the NYSCA District 7 President (Suffolk County).

Tarrytown, NY - “The NYS Board of Chiropractic and the Education Department are committed to the protection of the public and to the highest standards of professional services.” Cynthia Laks, Executive Secretary State Board of Chiropractic April 2004. On October 21, 2005, Dr H. William Wolfson, ACA NYS Metro Delegate addressed the Board regarding the abuses managed care companies have been perpetrating on the public and chiropractors in New York State. The American Chiropractic Association, the countries largest chiropractic organization has been taking managed care companies to task. The ACA has received numerous complaints from D.C.’s here and around the country about the abuses of managed care companies. The following is the text Dr. Wolfson read to the NYS Board. PRESENTATION TO THE NYSBC Mr. Chairman, Ms. Executive Secretary and Ladies and Gentleman of the Board, my name is Dr. H. William Wolfson. I have been a practicing doctor of chiropractic for the past 23 years and currently serve as the New York Metropolitan Delegate for the American Chiropractic Association. I am also President of the New York State Chiropractic Association, Suffolk County Chapter. I thank you for your time today and the opportunity to present what I believe are serious issues facing patients of chiropractors in New York State. Doctors of chiropractic in this state and doctors of chiropractic everywhere have an ethical obligation to practice in the best interest of their patients. I also realize this Board takes its responsibility to protect patients in this state very seriously. Permit me then to draw your attention to the activities of the ACN Group and other managed care companies. I request that this Board act and question the practices of this and other companies, as they directly affect patient care in this state. Over the course of the past several months, I have received repeated complaints and concerns from ACA and NYSCA members to the effect that ACN policies and procedures severely impact the doctors ability to provide quality patient care. I present to you the following: a letter of September 6, 2005 from the American Chiropractic Association to the New York State Department of Health outlining in specific terms the concerns and problems reported to the ACA in connection with ACN’s policies and practices. I would direct your specific attention to a copy of an August 3, 2005 letter sent to ACA’s General Counsel from the New York Chiropractic College. The College reviewed the criteria utilized by ACN in its administration of chiropractic services in New York. The startling conclusion of the College stated in part that “If NYCC were to use the ACN material above as a cornerstone for our educational process, we would need to significantly alter our curriculum, protocols, and practices and would expect to see a significant decline in positive patient outcomes”. Also included in ACA’s correspondence is a very detailed statistical analysis prepared by Dr. Jeffrey Simonoff-a professor of statistics at New York University. Dr. Simonoff, in commenting on his analysis, stated: “the [ACN] summary statistics certainly suggest that such [cost and visit-limiting controls] could be affecting practice by [in effect] truncating the number of visits from above.” In our opinion, Dr. Simonoff’s analysis supports the view that chiropractic services are artificially being reduced by ACN’s statistical maneuvering. Consequently, chiropractic benefits that have otherwise been promoted and paid for by employers-are being denied to the detriment of patient health and well being. I have personally spoken with case managers from ACN regarding patient treatment parameters and was told the average was less than seven visits per patient per year. It appears ACN has shifted the bell curve over time, consistently terminating those providers who don’t fall within their arbitrary statistics. As noted, my members have complained to the ACA, NYSCA and to my office stating that ACN has prevented patients from receiving needed chiropractic care by placing arbitrary numbers on allowed visits. My members have told me that they have written the same exact information on the required ACN forms for different patients and have received totally different authorizations for allowable visits. In my opinion and in the opinion of the ACA, utilization and treatment parameters as well as other criteria utilized by ACN are arbitrary, not based on the chiropractic principles taught by New York Chiropractic College and are not consistent with commonly accepted standards of care practiced in this State. Therefore, in our view, such parameters and criteria pose an improper interference with the doctor patient relationship and restrict necessary patient care. I would also like to submit for your consideration a letter of September 29, 2005 from the Federation of Chiropractic Licensing Boards to all Federation member boards. I would imagine that this Board may have already received this communication. But with your indulgence, I would like to make reference to several statements contained in the letter. In its letter, Dr. N. Edwin Weathersby writes on behalf of a unanimous Board of Directors, that managed care organization utilization criteria or payment policies “which interfere (or attempt to interfere) in a doctor’s ethical obligation to use sound chiropractic case management in the treatment of his or her patient, or otherwise seek to limit or to restrict the provision of needed chiropractic services, may constitute an inappropriate interference in the doctor patient relationship and pose a threat to safe, quality patient care.” The FCLB letter goes on to cite the previously mentioned conclusion of New York Chiropractic College and states: “If MCO guidelines require and/or restrict doctors to incorporate standards of care which are below those which are accepted in the profession and taught in our chiropractic colleges, then corrective actions should be undertaken”. Ladies and Gentleman of the Board and fellow colleagues, I would respectfully implore you to take that recommendation under consideration and continue to insure that the publics right to chiropractic care remains unimpeded. I urge the Board to assist the appropriate state regulatory authorities in protecting the publics right to access chiropractic care. I thank you for your time and thank you for continuing to protect the rights and best interests of chiropractic patients in the great State of New York.

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.

"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!

On April 28, 2005 the New York Chiropractic Legislative Task Force met with Attorney General Eliot Spitzer and the chief of the AG's Health Bureau, Mr. Joseph Baker regarding our issues with insurance inequality. Officers of both, the New York State Chiropractic Association and the New York Chiropractic Council as well as NYSCA attorney Ross Lanzafame, Esq. and NYSCA legislative counsel Don Mazzullo, Esq. and the NYCC legislative counsel, Andy Roffé, Esq. represented the Task Force. The meeting gave the Task Force the opportunity to discuss the non-compliance with the insurance equality law and the abuses put forth by the carriers and their IPA/Utilization Review agents. Mr. Spitzer and Mr. Baker understood our issues and recognize the areas where they might be of assistance in intervening with the Insurance Department. The Task Force will be in continuing communication with the Attorney General’s office with regard to these issues and there will be future meetings with the Health Care Bureau and the Attorney General’s aides to resolve these issues.

The New York State Chiropractic Association proudly presents the 2nd program for Achieving Excellence in Chiropractic Practice In the 21st Century Certificate Program Saturday, April 9, 1 PM to 7:00 PM at the New York Chiropractic College Postgraduate Center Levittown, NY. Call the NYCC Postgraduate Center at 800-434-3955 Today and Reserve Your Please. This is the second in a series of symposiums designed to enhance your professional skills so you can master both the challenges of today’s managed care arena and tomorrows changing healthcare delivery system. The total series is 36 C.E. credit hours. There are 6 symposiums with a certificate included upon completion. Each symposium is 6 C.E. credits. The second Program will be broken down into a Six Hour session and will feature: • Comparison Shopping: Cost of Chiropractic Care vs. Medical Treatment, Dr. Anthony Rosner, Director of Research at the FCER, PhD. Harvard • Distinguishing Fact from Fiction in Clinical Studies, Dr. Anthony Rosner • Medicare P.A.R.T. Documentation: the National Standard, Dr. Peter Pramberger, NY Chiropractic Advisory Committee (CAC) representative (1 CA will be able to attend for an additional $25 for this discussion) The Fee for this sensational program is $120.00 per session for NYSCA members. For non-NYSCA members- $150.00 per session SEATING IS LIMITED, SO RESERVE YOUR SEAT TODAY! For Reservations, Please call the NYCC Postgraduate Center at 800-434-3955 Committee Members: Chairman: Louis Lupinacci, D.C., Mariangela Penna, D.C., Thomas Ventimiglia, D.C., James Kaufman, D.C., John Pellegrino, D.C., Angelo Ippolito, D.C., Janusz Richards, D.C., Michael Siciliano, D.C., Malcomb Levitin, D.C., Michael Bernstein, D.C., Lloyd Angel, D.C., Richard Scherer, D.C., Richard Meoli, D.C.., Peter Pramberger, D.C., Lloyd Kupferman, D.C., Bruce Silber, D.C. What is the Center for Excellence? The Center of Excellence for Chiropractic Practice in the Downstate region is a program sponsored by the New York State Chiropractic Association. The purpose of the program is to advance the clinical knowledge and skills of the doctor of chiropractic on a quest toward best practice procedures. The program emphasizes patient centered care that is effective and efficient. The program is designed for progressive doctors who wish to develop their skills and promote themselves in an integrated healthcare model. The Center for Excellence is the result of the New York State Chiropractic Association long range planning toward integrating the practice of chiropractic into the mainstream of healthcare The New York State Chiropractic Association has presented a series of conferences on the integration of chiropractic practice into mainstream health care over the last several years. We have discussed the challenges that face our profession today and in the future, and some possible solutions to these challenges. In light of the changes coming up on the horizon of health care, it is apparent that the need for change and new initiatives are more important than ever. Here is a brief list of some of the challenges we face: 1. The healthcare industry is demanding that the healthcare that is delivered be evidenced based 2. The trend toward consumer driven health care will shift more responsibility to the patient 3. There is a need for chiropractors to be part an integral part of the patient’s healthcare team 4. There is a need to define and establish a model for “best practice” chiropractic care Goals of the Center for Excellence 1. Integrate chiropractic into the mainstream of health care 2. Develop the skills of the field practitioner to work in interdisciplinary teams as the practitioner of choice in providing patient centered health care that is effective for neuromusculoskeletal care of spinal conditions (injuries, disorders, diseases, illnesses, ailments or complaints) 3. Train doctors to utilize evidence based practice parameters and best practices procedures by employing quality improvement outcome measures and informatics 4. Help develop models for the role of chiropractic care in mainstream healthcare such as the “Bridges for Excellence” program or the “Leap Frog Program” 5. Increase public awareness and the healthcare industry awareness of the role of chiropractic in today’s health care system and for the future 6. Help develop Wellness care protocols for the Doctor of Chiropractic Proposed Center for Excellence Action: The committee has come up with 5 specific projects that we feel the downstate area can develop. Project Planning Strategies: I. Initiate educational Center for Excellence Conferences throughout New York State Set up a series of conferences to keep doctors informed of current healthcare trends II. Develop a chiropractic model for integration with mainstream healthcare including: Develop protocols for working as a part of an integrated healthcare team Develop protocols for standards of patient centered care III. Develop a Low Back Pain Model for programs such as the Bridges to Excellence Help to establish professional interdisciplinary teams with the doctor of chiropractic as the doctor of choice for conservative care of the low back Help to promote NCQA accrediting protocols and AHRQ protocols for chiropractic IV. Initiate a Research in Practice Clearing Center for the practitioner Collect actuarial studies on the effectiveness of chiropractic care Collect existing research information for the public information committee Collect data and consensus documents for reasonable and customary chiropractic care Collect data and consensus documents on standards of chiropractic care and treatment V. Public Information Program: Promote the web based public service program to disseminate to the media Develop protocols to establish chiropractors as spinal experts Develop protocols to establish chiropractors as health/wellness experts Develop a Speakers Bureau to work with media public services Develop NYSCA public policy resolutions The Center for Excellence Program will help you determine what an integrated practice may look like, and how to improve your practice procedures to become patient centered, more efficient and evidence influence. Chiropractic has a significant role in the health care arena, and our potential for growth is tremendous. The Center of Excellence will challenge our profession to establish cultural authority within the healthcare system. Chiropractic care should be a part of a mainstream healthcare interdisciplinary health team, with the doctor of chiropractic being the doctor of choice in providing conservative patient centered care that is most effective for neuromusculoskeletal spinal conditions.

Dr. Frank R. Cartica 05/10/1954 - 02/26/2005 It is with great sadness that we acknowledge the passing of NYSCA’s former member Dr. Frank R Cartica, D.C. of Yonkers, New York on Saturday February 26, 2005. He is survived by his wife Lois, and children Matthew, Jonathan, Genevieve, Jeremy Cartica and his mother Mary Cartica and brother of Kevin, Keith, James, John and Marybeth Muir. I am sure we will all agree that Dr. Cartica has done much for the Chiropractic profession and will be deeply missed. We ask that you keep his wife, children and family in your thoughts and prayers. Memorial Mass will be celebrated Thursday 11:00 AM at the Annunciation Church, 470 Westchester Avenue, Tuckahoe (Crestwood), NY 10707 - Tel. 914-779-4145. In lieu of flowers, memorial donations may be made to New York Fire Fighters Burn Center Foundation, 21 Asch Loop, Bronx, NY 10475.

NYSCA invites you, your family and friends to the GRAND OPENING of our BRAND NEW NYSCA Mall on the web were you can enjoy savings at nearly 800 quality on-line merchants while supporting the New York State Chiropractic Association! Nothing to join, no personal information to provide and if you have an existing account with any of the merchants, you can use that account — there is no need to re-register. It really is that simple. For each purchase you make at a participating merchant, a percentage goes to NYSCA. THIS HOLIDAY SEASON your online shopping can translate into dollars for NYSCA. Now you can shop online at Target, Omaha Steaks, Macy's, Expedia, Dell and nearly 800 other quality merchants. Your purchases in the NYSCA mall will generate income to the New York State Chiropractic Association which will be used to keep the membership dues low. To start your on-line shopping to ensure your purchases are properly credited to the NYSCA, Go to NYSCA Mall locate your desired merchant in the directory shop and save! That's it! Just the satisfaction of saving time and money while supporting us! It really is that simple. START YOUR HOLIDAYS SHOPPING TODAY Thank You and Happy Shopping!

ASHINGTON, D.C.—The brief respite from faster-growing health care costs sputtered in the first half of 2004 as health costs per privately insured American grew 7.5 percent—virtually the same rate as in 2003, according to a study released jointly today by the Center for Studying Health System Change (HSC) and the Employee Benefit Research Institute (EBRI). Health care spending growth slowed in both 2002 and 2003—after peaking at 10 percent in 2001—but outpaced growth in the U.S. economy by a considerable margin. That trend continued in the first half of 2004 with health care costs still growing at a faster rate (7.5%) than the unusually high 5.9 percent increase in per capita gross domestic product (GDP) during the same period. "Health care costs are likely to continue growing faster than workers' income for the foreseeable future, leading to more uninsured Americans and raising the stakes for policy makers to initiate cost-containment policies or accept the current trend of rapidly growing health costs and shrinking health coverage," said Paul B. Ginsburg, Ph.D., coauthor of the study and president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation. Research has shown that if health care costs rise at a significantly faster rate than incomes, more people become uninsured. In fact, the gap between trends in health care costs and incomes is the most important factor behind the long-term trend toward a smaller proportion of Americans with private insurance. "Even though health care cost increases have moderated compared to recent years, as long as they are increasing faster than wages and overall inflation, both public- and private-sector employers will continue to try to control those costs," said Dallas Salisbury, CEO of the Employee Benefit Research Institute, which underwrote the study. "That includes examining ways to shift costs to workers, and probably a movement toward account-based health plans." The study analyzes per capita spending on health care services—inpatient and outpatient hospital care, physician services and prescription drugs—commonly covered by private insurance. Per capita health care spending trends—also often referred to as cost trends—are important because they largely determine future health insurance premium trends. The study's findings are published jointly as an HSC Issue Brief and EBRI Notes titled Tracking Health Care Costs: Spending Growth Slowdown Stalls in First Half of 2004. The study is available online on both HSC’s and EBRI’s Web site. Growth in spending on hospital inpatient care slowed to 5.1 percent in the first half of 2004, down from 6.4 percent in the second half of 2003. While spending on outpatient hospital care held steady at 11.4 percent, outpatient care, nonetheless, remained the fastest growing category of health spending. Hospital utilization—inpatient and outpatient combined—continued to grow at a slow rate (0.8%) for the second year in a row, but hospital prices rose sharply—7.7 percent in the first half of 2004—and accounted for much of the hospital spending increase. The large jump in hospital prices is due in part to strong growth in wage rates for hospital workers, which have been driven up by a persistent worker shortage, particularly for nurses. Nonetheless, the most recent increase in hospital wage rates—4.5 percent in the first half of 2004—was considerably smaller than recent hospital price increases and has declined significantly from the peak wage rate increase of 6.3 percent in the second half of 2001. "Additional factors appear to be driving up hospital prices," said Bradley C. Strunk, an HSC health researcher and study coauthor. "One possibility is a sharp decline since 2001 in hospital Medicare margins—a situation that creates a strong incentive for hospitals to shift costs to private payers." The slowdown in hospital utilization growth may reflect an increase in health plans' utilization management activities as they selectively reinstate such tools as prior authorization requirements for some hospital services. The slow utilization growth in 2004 also may reflect continuing increases in patient cost sharing for hospital care. While prescription drugs receive much of the blame for rising health care costs, the reality is that the spending trend for prescription drugs has slowed markedly from the high growth rates in the late 1990s. During the first half of 2004, spending on prescription drugs per privately insured person grew 8.8 percent, slightly lower than the 9.6 percent increase in the second half of 2003. By comparison, spending on prescription drugs peaked at 19.5 percent in the second half of 1999—a time when drug spending accounted for a much larger share of the overall spending increase. During the first half of 2004, drug prices increased by 3.1 percent, largely unchanged from the 2.7 percent increase in the second half of 2003. The trend for prescription drug utilization also held steady, with drug utilization per person increasing 5.5 percent in the first half of 2004. By comparison, drug utilization grew by as much as 12.9 percent in the late 1990s. During the first half of 2004, spending on physician care grew by 5.7 percent—only slightly higher than the 5.4 percent increase in the second half of 2003. Roughly equal growth in price and utilization accounted for the increase. The price trend for physician care has not increased much in recent years—in stark contrast to the hospital price trend. ### ### The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation's changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc. *** *** Established in 1978, the Employee Benefit Research Institute (EBRI) is the only nonprofit, nonpartisan organization committed exclusively to data dissemination, policy research, and education on economic security and employee benefits. The Institute's mission is to advance the public's, the media's and policy makers' knowledge and understanding of employee benefits and their importance to our nation's economy. FURTHER INFORMATION, CONTACT: Alwyn Cassil, HSC: (202) 264-3484 Steve Blakely, EBRI: (202) 775-6341

Abstract With health care costs, and insurance premiums in particular, escalating rapidly, we may see the reintroduction of utilization management strategies associated with managed care, which seemed destined for oblivion only a short time ago. Results from a survey to assess Americans’ views of managed care cost containment strategies indicate mixed support: Despite an overall lack of confidence in managed care, Americans appear to be receptive to specific managed care practices. Those designing cost containment strategies must find a balance between imposing restrictions that moderate use and hold down costs and allowing consumers to retain some control over their own health care. Health Affairs, 10.1377/hlthaff.w4.516 Copyright © 2004 by Project HOPE Claudia Schur is a principal research scientist at NORC at the University of Chicago in Bethesda, Maryland. Marc Berk is vice president and senior fellow at NORC at the University of Chicago in Bethesda, Maryland. Jill Yegian is director of the Health Insurance Program at the California HealthCare Foundation in Oakland.

Eight NYSCA members have been selected by the New York State Department of Health to serve on the Department’s Medical Record Access Review Committee. Five members were selected to serve on a Downstate Committee and three (3) members were assigned to an Upstate Committee. The Committee members chosen by the Department are the following: ▪ Downstate Committee Members • Gary L. Haber, DC of Manhattan • Lloyd Kupferman, DC of Greenvale • Malcolm L. Levitin, DC, FACC of Rockville Centre • Donald Littlejohn, DC, of Chester and • Richard W. Scher, DC of Wantagh. ▪ Upstate Committee Members • Brian D. Justice, DC, DABCO of Rochester • Lynn B. Pownall, DC, DACNB of Jamestown, and • Richard J. Tesoriero, DC, DABCO of Oswego. The members of these committee will be convened by the Department when required to resolve disputed between chiropractic professionals and persons qualified to receive medical records. "Qualified person" pursuant to New York Public Health Law, Article I, Title II, § 18 Access to patient information, (1) Definitions means “any properly identified subject, or a guardian appointed pursuant to article eighty-one of the mental hygiene law, or a parent of an infant, or a guardian of an infant appointed pursuant to article seventeen of the surrogate’s court procedure act or other legally appointed guardian of an infant who may be entitled to request access to a clinical record pursuant to paragraph (c) of subdivision two of this section, or an attorney representing or acting on behalf of the subject or the subject’s estate.” Under Subsection (4) Medical record access review committees, the law provides, "The commissioner shall appoint medical record access review committees to hear appeals of the denial of access to patient information as provided in paragraph (e) of subdivision three of this section. Members of such committees shall be appointed by the commissioner from a list of nominees submitted by statewide associations of providers in the particular licensed profession involved; . . . . Such medical record access review committees shall consist of no less than three nor more than five licensed professionals. The commissioner shall promulgate rules and regulations necessary to effectuate the provisions of this subdivision." Under subsection (3) of the Public Health Law, providers may limit a qualified persons access to patient information for certain itemized reasons. The Committee members above will assist the Department resolve disputes between DCs and qualified persons requesting access to patients records.

The New York State Chiropractic Association's Fall Conference at the Fort William Henry Resort in Lake George, New York was a resounding success! The conference convened Friday afternoon, October 1 through mid-day Sunday, October 3 and offered doctors a Practice Enhancement Program (PEP) and roughly 33 credits of continuing education from a list of outstanding speakers, including a class on the HIPAA Security Rule, the next evolution in the HIPAA compliance series (enforcement of the Security Rule begins April 20, 2005). Saturday evening ended with an awards dinner cruise and social sponsored by McCarthy, Chechanover & Rosado, LLP Law Firm, aboard the Adirondac, a new cruise ship on scenic Lake George. The NYSCA extends is sincere appreciation to McCarthy, Chechanover & Rosado, LLP and the many other vendors who helped make the conference such a success including: OUM Chiropractor Program, American Specialty Health Networks, Harvey Professional Supply, Tri-State Diagnostics, Meditek, Inc., PMR Products, New York Chiropractic College, Islandia MRI/East Manhattan Diagnostic, Dale Professional Supply, Jack S. Beige & Associates, LLP, Scheine, Furey & Associates, LLP, NCMIC Chiropractic Solutions, McCarthy, Chechanover & Rosado, PRI Physicians’ Reciprocal Insurers, Bee Sure Distributors, Open MRI of DeWitt, D’Youville College, HUM Division of MLMIC, Harlan Health Products, and Empire Medicare Services. The next NYSCA convocation is scheduled for January 28, 29 and 30, 2005 at the fabulous Mohegan Sun Casino and Resort in Uncasville, Connecticut. We look forward to seeing you there! As the April 20, 2005 enforcement deadline approaches, doctors should start taking the necessary steps now to come into compliance with the HIPAA Security Rule. Plan on attending the January Mohegan Sun Conference now!

Dr. Dan Quatro, New York State Chiropractic Association (NYSCA) president wins a decisive victory in Tuesdays Republican Primary for the Monroe County 15th Legislative District. Quatro’s opponent was Webster Town Councilman James Carlevatti garnished 258 to Quatro’s 578 votes. “I never expected to win the primary by such a large margin, but we had the right message,” said Quatro. Dr. Quatro was appointed to the 15th District seat in July after the death of County Legislator Ray Santirocco. There is no time to sit back for County Legislator Dan Quatro and enjoy his victory as the November Election is less then two months away. His Democratic opponent in the November Election is Dolly Kujawa. Quatro will also run on the Independent and Conservative lines on the November ballot.

It is with great sadness that we acknowledge the passing of former NYSCA’s District 8 member Dr. Kenneth A. Falber who died on Wednesday, May 19, 2004. He was honored by the United States Military and his family at a private funeral. He served his country in the infantry during World War II and was decorated with three purple hearts and a silver cross. Dr. Falber practiced as a chiropractor and a hypnotherapist for 40 years at his Yonkers residence. He is survived by his loving and devoted wife, Roslyn, his children, grandchildren and great grandchild. He will be missed by the countless people whose lives he touched.

Dr. Peter J. Cueter 06/02/1952 – 04/16/2004 It is with great sadness that we acknowledge the passing of NYSCA’s District 2 (Kings County / Brooklyn) Secretary, Dr. Peter J. Cueter 51, of Westbury New York on Friday April 16, 2004. Dr Cueter died peacefully at North Shore Glen Cove Hospital. He is survived by his wife Vicky, and three sons Adam, Matthew and Andrew. He will be waked at: Dalton Funeral Home 47 Jerusalem Avenue, Hicksville, New York 11801 516-931-0262 on Sunday April 18, 2004 and Monday April 19, 2004 / Hours 2 – 5 & 7 - 9 For those who would like to forward a card or note, kindly send it to: Mrs. Vicky Cueter 7 Mellow Lane Westbury, NY 11590 Please make all donations for a scholarship in the name of, Peter J. Cueter, DC (Class of 1984) and mail to: NYCC Attention: Peter VanTyle PO Box 800 Seneca Falls, NY 13148

• Exceptional speakers headline May 2004 NYSCA Leadership Meeting at New York Chiropractic College. Field doctors invited. Twelve hours of CE offered at no charge to members; $59 to non-members. • Healthcare system about to change . . . again! How will chiropractic cope? Given the professional press lately and the scientific discussion taking place in referred journals, members probably have heard something of the latest buzzwords in health care – evidence-based medicine (EBM) and best practices. These terms have the potential to be a double-edged sword in health care practice. Used appropriately, EBM and best practices hold the potential for advancing the quality of care patient’s receive in that EBM and best practices champion patient-centered care that is scientifically-based and individualized, and refined through quality improvement measures and clinical experience. For chiropractic, EBM and best practices provide an opportunity to advance the integration of chiropractic with mainstream healthcare. Used inappropriately, however, EBM and Best Practice could also turn out to be the newest cudgel used to batter chiropractic. Indeed, as Allan Korn, MD, Chief Medical Director of the National Association of Blue Cross and Blue Shield Plans warned attendees at the ACA National Chiropractic Legislative Conference in Washington, DC, March 4, squeezed by the surging health care inflation employers have put insurers on notice that employers are no longer willing to pay insurance premiums for care that is not evidence-based. This sentiment was echoed by ACC-RAC keynote speaker, Murray Goldstein, DO, MPH a week later at the Association of Chiropractic Colleges-Consortia sponsored Research Agenda Conference convened in Las Vegas, March 11, more then 2,000 miles away. The question is, how will evidence-based, best practice information be used and what does all this mean to the average field doctor? Come to the May 22, meeting of the NYSCA House of Delegates to find out. At the same time, members should be aware that the health care system, if it can be called a “system” at all, is on the threshold of a major overhaul, provided that some action is taken on the 2003 recommendations of the Institute of Medicine (IOM), National Academies of Science (NAS or the “National Academies”). Following a thorough, multi-year study by separate interdisciplinary committees examining all of the ills that prevail in the health care system, the IOM has called for a complete overhaul of the disorganized health care system. The import of these recommendations lies in the fact that the IOM is one of the National Academies of Science (NAS) and the NAS was chartered by Congress during the Civil War in 1863 and charged with the responsibility of advising Congress on scientific matters. Unfortunately, it appears, chiropractic has been participated in these deliberations. In the most recent studies of three IOM Studies Quality Chasm Series – “Health Professions Education: A Bridge to Quality,” the IOM convened a 150 member Task Force in July 2003 under the command and direction of the IOM Health Professions Education Summit Committee, to grapple with reshaping the disorganized health care system to make it more sensible and system-like. The Committee and Task Force developed a new vision for clinical education, one that is centered on a commitment to meeting patients’ needs, not the needs of the providers, and offered the following overarching vision: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.”(1) The committee proposed a set of five core competencies that all clinicians should possess, regardless of their discipline. These include: • Provide patient-centered care -- identify, respect, and care about patients' differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness and promotion of healthy lifestyles, including a focus on population health. • Work in interdisciplinary teams -- cooperate, collaborate, communicate, and integrate in teams to ensure that care is continuous and reliable. • Employ evidence-based practice -- integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. • Apply quality improvement -- identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality. • Utilize informatics -- communicate, manage knowledge, mitigate error, and support decision making using information technology. To advance the IOM vision, the Committee called on “leaders across the professions to work together on the cross-cutting changes that must occur to effect reform in clinical education and related training environments.” (2) Furthermore, the Committee recommended integrating a core set of competencies – competencies shared across the professions – into the health professions oversight spectrum (state and federal licensure and regulatory bodies and private accreditation and certification entities) that would provide the most leverage in terms of reform for health professions education.(3) The IOM report listed ten (10) different recommendations to achieve the foregoing vision and goals including: 1• An interdisciplinary effort to develop and adopt a common language, with the ultimate aim of achieving consensus across the health professions on a core set of competencies that includes patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement and informatics. 2• A recommendation that DHHS should provide a forum and support for a series of meetings involving a spectrum of oversight organizations across and within disciplines charging attendees with developing the necessary strategies for incorporating a core set of competencies into oversight activities, based on definitions shared across the professions following consultations with health profession associations and the education community. 3• A recommendation that accreditation bodies should move forward expeditiously to revise their standards so that programs are required to demonstrate – through process and outcome measures – that they educate students in both academic and continuing education programs in how to deliver patient care using a core set of competencies.. In doing so, these bodies should coordinate their efforts. 4• All health professions boards should move toward requiring licensed health professionals to demonstrate periodically their ability to deliver patient care – as defined by the five competencies identified by the committee – through direct measures of technical competence, patient assessment, evaluation of patient outcomes, and other evidence-based assessment methods. These boards should simultaneously evaluate the difference assessment methods. 5• Certification bodies should require their certificate holders to maintain their competence throughout the course of their careers by periodically demonstrating their ability to deliver patient care that reflects the five competencies, among other requirements. 6• Foundations, with support from education and practice organizations, should take the lead in developing and funding regional demonstration learning centers, representing partnerships between practice and education. These centers should leverage existing innovative organizations and be state-of-the-art training settings focused on teaching and assessing the five core competencies. 7• Through Medicare demonstration projects, the Centers for Medicare and Medicaid Services (CMS) should take the lead in funding experiments that will 3enable and create incentives for health professionals to integrate interdisciplinary approaches into educational or practice settings, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies. 8• The Agency for Healthcare Research and Quality (AHRQ) and private foundations should support ongoing research projects addressing the vie core competencies and their association with individual and population health, as well as research related to the link between the competencies and evidence-based education. Such projects should involve researchers across two or more disciplines. 9• AHRQ should work with a representative group of health care leaders to develop measures reflecting the core set of competencies, set national goals for improvement, and issue a report to the public evaluating progress toward these goals. AHRQ should issue the first report, focused on clinical educational institutions, in 2005 and produce annual reports thereafter. 10• Beginning in 2004 , a biennial interdisciplinary summit should be held involving health care leaders in education, oversight processes, practice, and other areas. This summit should focus on both reviewing progress against explicit targets and setting goals for the next phase with regard to the five competencies and other areas necessary to prepare professionals for the 21st - century health system. The NYSCA has accepted the proposition that there cannot exist two scientific standards – one for medicine and a separate standard for chiropractic. (4, 5) It is the Association’s goal to be a proactive catalyst for change in the profession by championing professional accountability, promoting clinical and educational excellence, and fostering the development of a multidisciplinary/interdisciplinary team approach to the treatment of common neuromusculoskeletal conditions using evidence-based outcomes measures, best practices, and scientifically-based, multidisciplinary treatment guidelines derived by consensus processes. Fortuitously, the profession is working on the next generation of evidence-based chiropractic practice parameters and best practices through the efforts of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Committee underwritten by the Congress of Chiropractic State Associations (COCSA). But the profession must also be a participant in the ongoing IOM/National Academies efforts to transform healthcare and healthcare education along the principles noted above. To address these issues and more, the NYSCA has enlisted the following speakers who will examine chiropractic’s role in an integrated healthcare system; the steps the profession would need to take in order to bring about chiropractic’s participation in multidisciplinary/interdisciplinary endeavors, including the integration of the profession with the mainstream healthcare. These persons represent some of the most knowledgeable individuals and strategic elites in chiropractic and the health care system. Strategic Elite # Lewis J. Bazakos, MS, DC earned his chiropractic qualifications from the New York Chiropractic College in 1978, a Master of Science Degree from the University at Bridgeport in 1980 and his baccalaureate degree from St. John’s University in 1975. He is a former Board Member, Treasurer, Vice President, and Past President of the New York State Chiropractic Association and served as a District Officer in NYSCA District 6 and represented District 6 in the NYSCA House of Delegates and served on several NYSCA committees, particularly the NYSCA Legislative Committee. After completing his service with the NYSCA, Dr. Bazakos served as District 1 Governor of the Congress of Chiropractic State Associations (COCSA) for two years. He started serving as a delegate to the American Chiropractic Association (ACA) House of Delegates in 1991 and was elected as a Governor on the ACA Board of Governors three years ago. For the last year and a half, Dr. Bazakos has been a member of the ACA Executive Committee and is slated to be the next Chair of the ACA Board of Governors. Throughout his tenure at ACA, Dr. Bazakos has served the ACA in a variety of capacities but most notably as chair of the ACA Legislative Committee. In 1997, Dr. Bazakos filled the Alumni seat on the Board of Trustees of the New York Chiropractic College. Subsequent to his initial appointment, Dr. Bazakos has co-chaired the NYCC Board of Trustees. He is the current chair of the College Advancement Committee. Strategic Elite # Mark R. Chassin, MD, MPH, MPP, is the Edmond A Guggenheim Professor of Health Policy and Chair of the Department of Health Policy at the Mount Sinai School of Medicine. He is also Senior Vice-President for Clinical Quality at the Mount Sinai Medical Center in New York City. Dr. Chassin received his undergraduate and medical degrees from Harvard University and a master's degree in public policy from the Kennedy School of Government at Harvard. He received a master's degree in public health from the University of California at Los Angeles. Dr. Chassin is a former Commissioner of Health in New York under Governor Mario Cuomo. Dr. Chassin has also served as a senior project director at the RAND Corporation, where he led several major health services research studies and participated as co-investigator in several others including the 1991 series of RAND studies on the “Appropriateness of Spinal Manipulation for Low Back Pain. He was a co-investigator for the 1992 meta-analysis on “Spinal manipulation for low back pain” study that appeared in the Annals of Internal Medicine (October 1992). He was Senior Vice President and Co-Founder of Value Health Sciences, a private sector firm that developed software and systems for quality assessment and utilization review; and Deputy Director and Medical Director of the Office of Professional Standards Review Organizations of the Health Care Financing Administration. Dr Chassin is a renowned expert in the area of performance measurement, clinical indicators and continuous quality improvement. In 2001, he was recognized for his contributions to the fields of quality measurement and improvement with several honors. He was in the first group honored with a lifetime membership of the National Associates of the National Academies, a new program of the National Academy of Sciences. He also received the Founders' Award of the American College of Medical Quality and the Ellwood Individual Award from the Foundation for Accountability. Recently, Dr. Chassin co-chaired the IOM Quality Health Care in America Committee, which issued two reports, in the IOM Quality Chasm Series, “To Err Is Human: Building a Safer Health System released in 1999, and “Crossing the Quality Chasm: A New Health System for the 21st Century,” released in 2001. This committee was responsible for laying the groundwork that lead to the Institute’s call for a dramatic change in the way the health care providers are trained and the way the health care system functions and operates. Dr. Chassin is a member of the Board of Directors of the National Committee for Quality Assurance (NCQA) and the Association for Health Services Research (AHSR). Strategic Elite # Cynthia Laks is the Executive Secretary of the New York State Board for Chiropractic, Office of the Professions, State University of New York, New York State Education Department (SED) in Albany. She was appointed by the Board of Regents to be the Executive Secretary for the NYS Board for Chiropractic on March 1, 2003. In addition to administering the State Board, she also is responsible for reviewing all curricula of foreign professional schools and all endorsement requests for licensure; developing regulations for the chiropractic profession; participating in program registration; coordinating and monitoring disciplinary proceedings; and providing information to the Board, the Department and the public. Secretary Laks received her Master of Arts from Columbia University Teachers College, her Bachelor of Science from New York University and has taken advanced post-graduate credits in public administration at the Nelson A. Rockefeller College of Public Affairs and Policy and Russell Sage Graduate School. Not surprisingly, Secretary Laks has been intimately involved with the State Board, the State Associations and New York Chiropractic College in coordinating the development of the regulations governing mandatory continuing education for chiropractors in New York State. She was also responsible for the oversight and management of the revisions to the Guide to Chiropractic, the Application Packet for Licensure and the Office of the Professions (OP) website dedicated to chiropractic. In addition to her Executive Secretary responsibilities, Ms. Laks is also the legislative coordinator for the Office of the Professions, coordinating legislative comments provided in response to a multitude of bills that affect the 44 licensed professions under the authority of the Board of Regents. She also organizes and contributes to meetings with legislators, lobbyists and professional organization leaders. Most of the members of the State Boards know her best as the primary coordinator of the Board Member Discipline Seminars as well as the Discipline Process Resource Guide. She also has been a lead person in implementing improvements to the professional discipline hearing process and coordinates the scheduling of all first-time hearing dates for the professions. Before coming to the Office of the Professions in 1997, Secretary Laks was the Chief of the Bureau of Continuing Education Program Development within the Office of Elementary, Middle, Secondary and Continuing Education. Strategic Elite # Dana Lawrence, DC is an Associate Professor at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic. Dr. Lawrence earned his chiropractic degree from the National College of Chiropractic, a Bachelor of Science Degree from Michigan State University and a Bachelor of Science Degree in Human Biology also from National. He is licensed to practice chiropractic in Illinois, Michigan and Iowa. Dr. Lawrence is the former Professor in the Department of Chiropractic Practice a post he held from 1987 through 2003 at the National College of Chiropractic and he served in a variety of posts at National for more than twenty-five (25) years. For the last 17 years, Dr. Lawrence has been the editor of the Journal of Manipulative and Physiological Therapeutics (JMPT), and Associate editor of JMPT two years prior to that. JMPT is the only chiropractic journal to be indexed in Index Medicus maintained by the National Library of Medicine, Current Contents/Clinical Medicine, and other international databases as well. Dr. Lawrence also edits the Journal of Chiropractic Medicine and the Journal of Chiropractic Humanities. He also held the post of Director/Associate Director of the National College Department of Editorial Review and Publication from 1986 through 2003. Dr. Lawrence is a past member of the Alternative Medicine Program Advisory Council of the Office of Alternative Medicine (OAM) and the National Center for Complementary and Alternative Medicine (NCCAM). He was responsible for drafting the chiropractic entry in “Alternative Medicine: Expanding Medical Horizons.” In 1998, Dr. Lawrence was honored as “Researcher of the Year” by the Foundation for Chiropractic Education and Research (FCER) in 1998. He received numerous faculty awards while at National College, including several Professor of the Year Awards from National students. Dr. Lawrence also received a Distinguished Service Award from the American Chiropractic Association. Over the years, Dr. Lawrence has served as a consultant to more than 75 entities including stints as peer reviewer and editorial advisory board member to the Journal of Allied Health, Clinical Chiropractic, Journal of the American Chiropractic Association, Topics in Clinical Chiropractic, the Back Pain Society, The Back Letter, the Journal of the Neuromusculoskeletal System, the Journal of Chiropractic Technique, The Chiropractic Report and the Journal of Back and Musculoskeletal Rehabilitation. As editor of JMPT, Dr. Lawrence is affiliated with the World Association of Medical Editors, the Association for Continuing Higher Education, the Hastings Center for Biomedical Ethics, the Council of Science Editors, the American Medical Writer’s Association, and the Society for Scholarly Publishing. Dr. Lawrence has written or co-authored more than 80 papers and 14 book chapters and several books. Strategic Elite # Frank Nicchi, MS, DC earned his chiropractic degree from the New York Chiropractic College (NYCC) in 1978, a Master of Science Degree from the Roberts Wesleyan College, and a Bachelor of Arts Degree from the St. John’s University in 1973. Dr. Nicchi served as the Dean of Postgraduate and Continuing Education at NYCC for five of his nearly twenty-five years of services to NYCC just prior to ascending to the post of President of the College in September 2000. Since 1980, Dr. Nicchi has been an instructor at NYCC in clinical sciences and technique, and as a clinician at the college's Levittown outpatient facility. He was a member of the New York State Chiropractic Association (NYSCA), and served on the NYSCA Board of Directors from 1984-1988. Presently, Dr. Nicchi serves on the Board of Directors of the Association of Chiropractic College’s. Dr. Nicchi was an influential advocate for promoting New York State legislation in areas such as diagnostic and laboratory testing by chiropractors. More recently, as a representative of New York Chiropractic College, he has encouraged legislation for mandatory continuing education for chiropractors, and equality of education requirements for chiropractors to obtain certification status in acupuncture. Dr. Nicchi has presented at numerous chiropractic meetings, state conventions, and interdisciplinary venues on topics ranging from chiropractic management of clinical conditions to chiropractic's role in the health care system. Strategic Elite # Stephen Perle, MS, DC earned his chiropractic degree from the Texas College of Chiropractic, a Masters of Science Degree in Exercise Science from the Southern Connecticut State University and Bachelor Degrees in Biology from Excelsior College in Albany, Cellular & Molecular Biology from the University at Buffalo, and Biomedical Electrical Engineering from the Rensselaer Polytechnic Institute. He is licensed to practice chiropractic in the states of Connecticut, California and New York. He is a Certified Chiropractic Sports Physician, certified by The American Chiropractic Board of Sports Physicians. Dr. Perle is a Associate Professor of Clinical Sciences in the College of Chiropractic, a post he has held since 1991. He is also Adjunct Professor of Mechanical Engineering in the School of Engineering at the University of Bridgeport, Bridgeport, Connecticut. Dr. Perle is the first chiropractor in the United States to receive a tenure-tracked appointment from a university to teach chiropractic. Dr. Perle serves on the steering committee of the University of Bridgeport Institute for the Study of Values and Ethics and is chair of the University’s Institutional Review Board. He also serves on the post-graduate faculty or adjunct faculty at the Southern California Health Sciences University, the Royal Melbourne Institute of Technology, the Texas Chiropractic College, the New York Chiropractic College and the Northwestern College of Chiropractic. He serves as on the editorial boards of the American Running and Fitness Association’s Running & FitNews Training & Conditioning; the Journal of Sports Chiropractic and Rehabilitation and Chiropractic Sports Medicine. He was the principal investigator or co-investigator on several federally funded research grants and has authored/co-authored more than thirty articles in trade publications more than six book chapters. In the course of his career, Dr. Lawrence has presented more than 32 times in different convocations and venues. He is a regular consultant to the State of Connecticut, Department of Public Health, Division of Health Systems Regulation. He also served, as did Dr. Triano, as an Expert Panel Member to the NYSCA Long Range Planning Committee for the Profession, in September 2002. He also served the NYSCA as a former District officer and delegate in the NYSCA House of Delegates. Strategic Elite # Gregory Stewart, DC earned his doctor of chiropractic degree in 1986 from the Canadian Memorial Chiropractic College in Toronto, Ontario, Canada and a Bachelor’s Degree in Physical Education in 1982 from the University of Manitoba, Winnipeg, Manitoba. Dr. Stewart is licensed to practice chiropractic in Manitoba and Ontario. Presently, Dr. Stewart is Chairman of the Canadian Chiropractic Association. He served as President of the Canadian Chiropractic Association from 2002-2003, as a member of the CCA Board of Governors from 1997-1999; as President of the Manitoba Chiropractors’s Association from 1994-1992 and a member of the Manitoba Chiropractor’s Association Board of Directors from 1992 - 1997. Dr. Stewart is a member of the Manitoba Chiropractor’s Association; the Canadian Chiropractic Association, the Canadian Memorial Chiropractic College and the American Back Society. Dr. Stewart also is a professional service provider in Canada providing chiropractic treatment to Canadian Sports Centers, Manitoba 1999 - present; Athletics Canada 1999 Canadian Senior Championships; and Pan-American Games 1999. He is a co-participant with NYSCA President, E. Daniel Quatro on the World Chiropractic Federation Task Fore on chiropractic’s Professional Identity. It is the NYSCA’s understanding that the Canadian Chiropractic Association (CCA) which recently completed an extensive identity/branding process relative to the role of chiropractic in the Canadian healthcare system and the integration of chiropractic into the mainstream of healthcare in Canada. He was selected to be a participant of a 40-member Task Force representing the North American Region, Canadian chapter, assembled by the Toronto-based, World Chiropractic Federation. He was presented with a Distinguished Service Award from the Manitoba Chiropractor’s Association in 2003 as well as a Presidential Citation for Outstanding Service from the Ontario Chiropractic Association 2003. He has made several presentations – World Federation of Chiropractic, Orlando 2003 and a Presentation to Romanow Commission on the Future of Health Care in Canada Winnipeg, 2002. He represented the Canadian Chiropractic Association in the Public Policy Forum Ottawa, 2002 and at World Federation of Chiropractic Conference On the Identity of the Profession, San Francisco, 2004. And he was a speaker at the Occupational Health and Safety Conference, Winnipeg, 2004. Dr. Stewart practices in Winnipeg, Manitoba. Strategic Elite # John J. Triano, DC, PhD is the Co-Director of Conservative Medicine and Director of the Chiropractic Division at the Texas Back Institute, a multidisciplinary spine facility with several locations throughout Texas. Dr. Triano received his chiropractic degree from the Logan College of Chiropractic; his Master’s degree from Webster College and his PhD doctoral degree in biomechanics from the University of Michigan. Dr. Triano is a Fellow of the College of Chiropractic Scientists (Canada) and serves as an editorial advisor to the Journal of Manipulative and Physiological Therapeutics, Spine, The Spine Journal, The BackLetter, and the Journal of the Canadian Chiropractic Association. Dr. Triano is Research Professor in the Department of Engineering, Biomedical Engineering Program at the University of Texas in Arlington, and is an Associate Professor of Biomechanics at the Southwestern School of Medicine. To date he has authored or co-authored more than 63 scientific and clinical articles and 16 book chapters. He was one of two chiropractors who participated in the development of the Agency for Health Care Policy and Research (AHCPR) Guidelines released in 1994 on the treatment of Acute Low Back in Adults. He is the recipient of numerous awards and honors, including ICA Researcher of the Year (1987), FCER Researcher of the Year (1989), AHCPR Service Award (1993), ACA Council on Rehabilitation Doctor of the Year Award (1998), the DC Person of the Year (2002) and the ACA Chairman Award (2003). A leading participant in the Guidelines for Chiropractic Quality Assurance and Practice Parameters (GCQAPP also known as the Mercy Guidelines, Triano is currently the Commission Chair of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). References 1-Ibid. p. 4. 2-Ibid. 3-Angell M, Kassirer JP. [Editorial] Alternative medicine: the risks of untested and unregulated remedies. N Engl J Med 1998 (Sep 17); 339(12): 839-841. 4-Fontanarosa PB, Lundberg GD. [Editorial] Alternative medicine meets science. JAMA 1998 (Nov 11); 280: 1619-1619. To register click on the .PDF file: