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New Government Survey Reflects Widespread Use of Complementary and Alternative Therapies

According to a new nationwide government survey, [1] 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM). CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. When prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62 percent. "These new findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, M.D., Director, National Center for Complementary and Alternative Medicine (NCCAM). "The data not only assists us in understanding who is using CAM, what is being used, and why, but also in studying relationships between CAM use and other health characteristics, such chronic health conditions, insurance coverage, and health behaviors." The survey, administered to over 31,000 representative U.S. adults, was conducted as part of the Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey (NHIS). Developed by NCCAM and the CDC's National Center for Health Statistics (NCHS), the survey included questions on 27 types of CAM therapies commonly used in the United States. These included 10 types of provider-based therapies, such as acupuncture and chiropractic, and 17 other therapies that do not require a provider, such as natural products (herbs or botanical products), special diets, and megavitamin therapy. Although there have been many surveys of CAM use to date, the various surveys included fewer choices of CAM therapies. In addition, they often surveyed smaller population samples primarily relying on telephone or mail surveys versus in-person interviews used for this survey. Thus, the results from the CAM portion of the NHIS provide the most comprehensive and reliable data to date describing CAM use by the U.S. adult population. Overall, the survey revealed that CAM use was greater among a variety of population groups, including women; people with higher education; those who had been hospitalized within the past year; and former smokers, compared to current smokers or those who had never smoked. In addition, this was the first survey to yield substantial information on CAM use by minorities. For example, it found that African American adults were more likely than white or Asian adults to use CAM when megavitamin therapy and prayer were included in the definition of CAM. "We're continuously expanding the health information we collect in this country, including information on the actions people take in dealing with their own health situations," said NCHS Director Edward J. Sondik, Ph.D. "Over the years we've concentrated on traditional medical treatment, but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands." CAM approaches were most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were: • Prayer for own health, 43 percent • Prayer by others for the respondent's health, 24 percent • Natural products (such as herbs, other botanicals, and enzymes), 19 percent • Deep breathing exercises, 12 percent • Participation in prayer group for own health, 10 percent • Meditation, 8 percent • Chiropractic care, 8 percent • Yoga, 5 percent • Massage, 5 percent • Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4 percent. In addition to gathering data on the use of CAM practices, the survey also sought information about why people use CAM. Key findings indicate that: • 55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments; • 50 percent thought CAM would be interesting to try; • 26 percent used CAM because a conventional medical professional suggested they try it; and • 13 percent used CAM because they felt that conventional medicine was too expensive. Interestingly, the survey also found that about 28 percent of adults used CAM because they believed conventional medical treatments would not help them with their health problem; this is in contrast to previous findings that CAM users are not, in general, dissatisfied with conventional medicine. The results of the survey reveal new patterns of CAM use among various population groups and provide a rich source of data for future research. Furthermore, the survey results provide a baseline for future surveys, as it establishes a consistent definition of CAM that can be used to track trends and prevalence of CAM use. [1] Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

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Former NYSCA’s District 8 member, Dr. Kenneth A. Falber Passes

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.

The Palmer College of Chiropractic Women's Rugby Tradition Begins

Who says rugby is a sport just for men? The Palmer College of Chiropractic Women's Rugby Football Club played its very first game in the Quad Cities on Saturday, March 27, on Credit Island–and won handily. The women defeated the Dubuque Women's Rugby Football Club 35 to 17. The fledgling club is the first women's rugby team in the Quad Cities and is lead by president Tracy Francis, a 4th tri student from upstate New York, and co-coached by 5th tri student Don Pfau. Francis helped recruit players and organize the team, which began practicing last fall. The 20 teammates meet three times a week to practice, condition and learn the rules and strategies of rugby. Men's rugby club president Jon Glead also has assisted the team by teaching the women fundamentals. "The referee and coach of the Dubuque team commented on the extraordinary level of our players' skills, especially for a start-up team," Francis said, "which is a tribute to Don's coaching skills. Rugby is big on the East Coast, where I learned to play as an undergraduate student, but it's growing in popularity in Iowa.” "We'll be increasing awareness of rugby in the Quad Cities,” added Francis, “but we hope to spread knowledge of chiropractic, too, and how it can help athletes perform at their best."

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An Approach to Identifying Osteopenic Women at Increased Short-term Risk of Fracture

ABSTRACT Background - Identification and management of women to reduce fractures is often limited to T scores less than –2.5, although many fractures occur with higher T scores. We developed a classification algorithm that identifies women with osteopenia (T scores of –2.5 to –1.0) who are at increased risk of fracture within 12 months of peripheral bone density testing. Methods - A total of 57 421 postmenopausal white women with baseline peripheral T scores of –2.5 to –1.0 and 1-year information on new fractures were included. Thirty-two risk factors for fracture were entered into a classification and regression tree analysis to build an algorithm that best predicted future fracture events. Results - A total of 1130 women had new fractures in 1 year. Previous fracture, T score at a peripheral site of –1.8 or less, self-rated poor health status, and poor mobility were identified as the most important determinants of short-term fracture. Fifty-five percent of the women were identified as being at increased fracture risk. Women with previous fracture, regardless of T score, had a risk of 4.1%, followed by 2.2% in women with T scores of –1.8 or less or with poor health status, and 1.9% for women with poor mobility. The algorithm correctly classified 74% of the women who experienced a fracture. Conclusions - This classification tool accurately identified postmenopausal women with peripheral T scores of –2.5 to –1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.

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Medicare Service Specific Review of 98941

The NYSCA received the following letter and guidance from the Upstate Medicare Division Contracted Carrier, HealthNow. The letter is self-explanatory. This information is being supplied to you at the request of HealthNow. Please review the attached information and if you have any comments or questions please feel free to contact Barbara Adams, LPET Specialist at the number contained in the letter. Alternatively, you may elect to contact NYSCA’s Medicare Chairperson and CAC representative, Dr. Peter Pramberger at the following telephone exchange: 516-741-2940.

Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study

ABSTRACT Objective - To assess the association of ocular disorders and high doses of antioxidants or zinc with mortality in the Age-Related Eye Disease Study (AREDS). Methods - Baseline fundus and lens photographs were used to grade the macular and lens status of AREDS participants. Participants were randomly assigned to receive oral supplements of high-dose antioxidants, zinc, antioxidants plus zinc, or placebo. Risk of all-cause and cause-specific mortality was assessed using adjusted Cox proportional hazards models. Results - During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died. In fully adjusted models, participants with advanced age-related macular degeneration (AMD) compared with participants with few, if any, drusen had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86). Advanced AMD was associated with cardiovascular deaths. Compared with participants having good acuity in both eyes, those with visual acuity worse than 20/40 in 1 eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65). Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.18-2.05) were associated with increased all-cause mortality and with cancer deaths. Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89). Conclusions - The decreased survival of AREDS participants with AMD and cataract suggests that these conditions may reflect systemic rather than only local processes. The improved survival in individuals randomly assigned to receive zinc requires further study. Arch Ophthalmol. 2004;122:716-726. To view the full article click on the link below:

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Doctors of Chiropractic Offer Mothers Day Advice for Active Moms

ARLINGTON, Va., The American Chiropractic Association (ACA) has Mothers Day advice for active moms who want more time to bond with their babies: take your child along with you when you take a walk or a hike -- but be careful that you do it properly. With new products unheard of a generation ago -- like baby carriers and slings -- even the tiniest among us are able to enjoy the great outdoors. But while these items can make life easier and more enjoyable for both parent and child, they can be the cause of pain and injury if not used properly. As many mothers know, backpack-style or front-side baby carriers can be effective tools for toting your little one. However, Dr. Scott Bautch of ACA's Occupational Health Council cautions that there are risks involved with the popular backpack-style carrier. "Because the cervical spine of a child less than a year old is not fully developed, it's important at that age that the head does not bob around. The backpack-type carrier is not ideal because the parent cannot watch to make sure the child's head is stable. So a front-side carrier is better for a very young child." Dr. Bautch also urges you to consider the following: * A backpack-style or front-side carrier decreases a parent's stability when walking or hiking. It is critical that a parent gets into shape before attempting to use one of these products. * Since these carriers will change the feel of walking or hiking, they should not be used by beginning hikers. * If using a backpack-style or front-side baby carrier, make sure to select one with wide straps for your shoulders and waist. This will help distribute the carrier's weight evenly. The shoulder straps should fit comfortably over the center of your collarbone. * Once you place the child in the carrier, check to make sure there is no bunching of material against the child's body, particularly on the back, buttocks and spine. Isolated, uneven pressure like this can produce pain. The "baby sling" is becoming more and more popular thanks to its versatility of positions and comfort. But if you wish to use a baby sling, keep in mind that it is intended only for very young infants, and be sure to follow these tips: * A baby can become very hot inside the sling, so be mindful of the temperature around you. Also, make certain the baby's breathing is clear and unobstructed by the sling's material. * Never run or jog while carrying a baby in any backpack-style carrier, front-side carrier or baby sling. A baby's body is not adjusted to the cyclic pattern that is a part of running and jogging. This motion can do damage to the baby's neck, spine and/or brain. Finally, don't forget about your own health and comfort. When lifting a child, bend from the waist, but begin in a 3-point squat and implement a two-stage lift that consists of a) pulling the child up to your chest and then b) lifting straight up with your leg muscles. Chiropractic Care Can Help If you or your child experiences any pain or discomfort resulting from these or other outdoor activities, call your doctor of chiropractic. Doctors of chiropractic are licensed and trained to diagnose and treat patients of all ages, and can provide health tips for you and your children that will make enjoying outdoor activities safer and more enjoyable.

Simple and Efficient Recognition of Migraine With 3-Question Headache Screen

ABSTRACT Objective. To correlate the results of a new 3-question headache screen to 3 established methods of diagnosing migraine: the International Headache Society diagnostic criteria, physician's clinical impression, and presence of recurring disabling headaches. Background. A simple tool to recognize patients who experience migraine may facilitate diagnosis of this debilitating and frequently undiagnosed condition. Methods. Primary care physicians and neurologists in the United States enrolled 3014 adults with a diagnosis of migraine based on one of the following: International Headache Society criteria, an investigator's clinical impression, or presence of recurring disabling headaches. Each patient completed a 3-question headache screen: (1) Do you have recurrent headaches that interfere with work, family, or social functions? (2) Do your headaches last at least 4 hours? (3) Have you had new or different headaches in the past 6 months? A diagnosis of migraine was suggested by a yes answer to questions 1 and 2 and a no answer to question 3. Results. The 3-question headache screen identified migraine in 77% of the study population; including 78% of the patients enrolled based on International Headache Society criteria, 74% based on clinical impression, and 68% because of recurring disabling headaches. Conclusions. Positive 3-question headache screen results agreed well with migraine diagnoses based on International Headache Society criteria, clinical impressions, and presence of recurring disabling headaches. These findings support use of the 3-question headache screen to recognize migraine.

SPSU s land deal with Life dies

MARIETTA - The Georgia Board of Regents has rejected a proposal to allow the fund-raising foundation of Marietta's Southern Polytechnic State University to purchase the neighboring Life University campus. Following a recommendation from University System Chancellor Thomas Meredith, the Board of Regents on Wednesday decided not to approve the deal, citing "the current economic climate facing the state, the University System of Georgia and all (university system) institutions." The Life-SPSU land deal called for the private SPSU Foundation to purchase Life's 89-acre campus to expand its growing operations and, in exchange, pay off Life's $30.7 million in debt. Life, which has been struggling since losing its accreditation and seeing enrollment plummet, would then lease back about 50 percent of the campus to continue operations. SPSU foundation President Mark Graham said he was let down by Wednesday's decision by the regents. "We're just highly disappointed because it looked like a good opportunity for both sides, and it looks like a lost opportunity, too," he said. An appraisal of the Life campus, commissioned by the SPSU Foundation, placed its value at about $55 million, about $24 million less than what the foundation planned to spend. "We are very disappointed in the outcome," said foundation treasurer Gordon Mortin, who engineered plans for the land deal. "It seemed like an extraordinary opportunity. - It's not likely in our lifetime, or the lifetime of our grandchildren, that the opportunity will come again to acquire an adjacent campus for about 55 percent of the appraised value." Wednesday's decision came three days before a May 1 deadline for the regents to take action on the proposal and followed comments made last week by newly hired Life University President Dr. Guy Riekeman indicating he wanted Life to keep its campus. On April 20, the Georgia Board of Regent's Committee on Real Estate and Facilities delayed a scheduled vote on the land deal, saying they needed more time to review the financial details of the proposal. In a statement released after the decision, university system officials acknowledged the "considerable financial support" SPSU managed to gather for the project, but stated, "The Board of Regents was not assured of the long-term fiscal soundness of the project." As part of plans to purchase the Life campus, the SPSU Foundation agreed spend $2.7 million a year to pay off Life's debt. The foundation had agreed to pay about $1.3 million of that amount each year, through a combination of the lease with Life and fees collected from student housing. That left a shortfall of about $1.4 million, with The University System of Georgia expected to provide a large portion of the extra money. Because of the state budget crunch, the Board of Regents last month instructed SPSU President Dr. Lisa Rossbacher to find other sources of funding. She got $500,000 from Cobb County government during the next two years and $100,000 from the city of Marietta for the same period - a total of $600,000, plus other undisclosed sources of money. "We are gratified by the broad support of SPSU from the community, including the city of Marietta, Cobb County, the Cobb Chamber of Commerce and the Marietta Kiwanis," Dr. Rossbacher said in a statement released following Wednesday's decision. "We also have received tremendous support and assistance from our faculty, staff and students over the past months as we have worked on this proposal." While SPSU officials expressed disappointment in the decision, Riekeman celebrated the Board of Regents' decision. "The Board of Trustees and the Life college community are extremely pleased as the circumstances that led to this proposal are dramatically different today with a new administration, increased enrollment and alumni giving exceeding all expectations," he said. "I have met with SPSU's president, Dr. Lisa Rossbacher, and have expressed my desire to work together. I believe that we can all accomplish our goals. Life can maintain its pristine campus while rebuilding enrollment and aid SPSU's need for expansion. This partnership will contribute to Marietta's image and financial future." Last week, Riekeman -hired in March from Palmer Chiropractic College in Iowa in part because of his fund-raising ability - said Life has raised about $3 million from chiropractors who want to help the school. He also said he expects enrollment to grow from about 1,200 students today to between 1,400 and 1,500 students a year from now and about 3,000 within two or three years. At one point, Life University was considered the largest chiropractic college in the world, with an enrollment of about 3,600. But it was stripped of accreditation in July 2002 by the Arizona-based Council on Chiropractic Education, which questioned the operation of the school by its founder and former president Dr. Sid Williams. If SPSU were to take ownership of the land, Riekeman said last week, Life would have had to eventually find a new home to accommodate the expected increase in enrollment. [email protected] This information is reprinted with permission of the Marietta Daily Journal. Copyright 2004. For additional news stories, visit Marietta Daily Journal by clicking on the link below:

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FCER Responds to Newsweek's

April 29, 2004 Editorial Department Newsweek Magazine P.O. Box 2120 Radio City Station New York, New York 10101 To the Editor: For such a widespread condition that costs the U.S. $100B annually, I was deeply disappointed by a glaring misrepresentation which appeared in your April 26 issue on "The Great Back Pain Debate." That distortion had to do with the suggestion that "there's not a lot of data on how effective it is in the long term" when it comes to the chiropractic care of back pain patients. As the Director of Research of the largest and oldest foundation which has contributed substantially to the evidence which supports the effectiveness of spinal manipulation for back pain patients, I take strong exception to Dan Cherkin's statement. In truth, a summary of no less than 73 clinical trials involving spinal manipulation recently published in the Annals of Internal Medicine attests to the effectiveness of this treatment in managing back pain with none of the trials having produced negative results. Furthermore, official guidelines from the governments of at least 8 countries in North America, western Europe and Australia propose that spinal manipulation is one of the two most-documented and effective management strategies for back pain [the other being the use of analgesics and nonsteroidal anti-inflammatory agents]. With this type of documented effectiveness, fewest side effects, and avoidance of expensive alternatives when possible, the treatments which chiropractors apply demand far more thoughtful review in a healthcare environment that is increasingly dependent upon the documentation of rigorous scientific evidence, regrettably overlooked in your article. [Signed] ANTHONY ROSNER, PH.D., LL.D [HON.] BROOKLINE, MASSACHUSETTS Foundation for Chiropractic Education and Research 1330 Beacon Street, Suite 315 Brookline, MA 02446-3202 UNITED STATES 617-734-3397 617-734-0989 FAX [email protected] Newsweek's editorial policy limits letters to the editor to one paragraph.

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Effect of Vitamin D on Falls (A Meta-analysis)

Taking vitamin D supplements by older people can cut falls by over 20%, according to new research. A meta-analysis published in the Journal of the American Medical Association looked at data from ten randomised controlled trials. Abstract Context - Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established. Objective To assess the effectiveness of vitamin D in preventing an older person from falling. Data Sources - MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical experts, bibliographies, and abstracts. Search terms included trial terms: randomized-controlled trial or controlled-clinical trial or random-allocation or double-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vitamin D/aa[analogs & derivates] or ergocalciferol or vitamin D/bl[blood]; and with accidental falls or falls, and humans. Study Selection - We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were excluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis. Data Extraction - Independent extraction by 3 authors using predefined data fields including study quality indicators. Data Synthesis - Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval [CI], 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 person from falling. The inclusion of 5 additional studies, involving 10 001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was independent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men. Conclusions - Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered. Additional information on Vitamin D • Food sources of Vitamin D Fortified foods are the major dietary sources of vitamin D (4). Prior to the fortification of milk products in the 1930s, rickets (a bone disease seen in children) was a major public health problem in the United States. Milk in the United States is fortified with 10 micrograms (400 IU) of vitamin D per quart, and rickets is now uncommon in the US (7). One cup of vitamin D fortified milk supplies about one-fourth of the estimated daily need for this vitamin for adults. Although milk is fortified with vitamin D, dairy products made from milk such as cheese, yogurt, and ice cream are generally not fortified with vitamin D. Only a few foods naturally contain significant amounts of vitamin D, including fatty fish and fish oils (4). The table of selected food sources of vitamin D suggests dietary sources of vitamin D. • Exposure to sunlight Exposure to sunlight is an important source of vitamin D. Ultraviolet (UV) rays from sunlight trigger vitamin D synthesis in the skin (7, 8). Season, latitude, time of day, cloud cover, smog, and sunscreens affect UV ray exposure (8). For example, in Boston the average amount of sunlight is insufficient to produce significant vitamin D synthesis in the skin from November through February. Sunscreens with a sun protection factor of 8 or greater will block UV rays that produce vitamin D, but it is still important to routinely use sunscreen whenever sun exposure is longer than 10 to 15 minutes. It is especially important for individuals with limited sun exposure to include good sources of vitamin D in their diet.

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EEOC APPROVES PROPOSAL TO EXEMPT RETIREE HEALTH PLANS FROM AGE DISCRIMINATION IN EMPLOYMENT ACT

WASHINGTON - During a public meeting today, the U.S. Equal Employment Opportunity Commission (EEOC) voted to approve a proposed final rule that would permit employers, under the Age Discrimination in Employment Act (ADEA), to lawfully coordinate retiree health benefit plans with eligibility for Medicare or a comparable state-sponsored health benefit. This common and long-standing employer practice was called into question in 2000, when the U.S. Court of Appeals for the Third Circuit (Erie County Retirees Association v. County of Erie) held that the federal statute requires employers to assure that pre- and post- Medicare eligible retirees receive health benefits of equal type and value. "This rule is intended to ensure that the ADEA does not have the unintended consequence of discouraging employers from providing valuable health benefits to retirees," said Chair Cari M. Dominguez, emphasizing that the General Accounting Office has estimated 10 million retired individuals aged 55 and over count on employer-sponsored health plans as either their primary source of health coverage or as a supplement to Medicare. "Such benefits are provided on a voluntary basis at the discretion of each employer and the Commission is acting to preserve these valuable benefits for retirees." "We know that health benefits are very important to retirees. Our proposal permits the common-sense practice of coordinating employer-provided retiree health benefits with eligibility for other benefits to continue," added Vice Chair Naomi C. Earp. "This rule should be welcome news for America's retirees." The Commission's prior policy, which was rescinded by a unanimous vote in August 2001, had concluded that coordinating retiree health benefits with Medicare eligibility constituted an illegal age-based distinction under the ADEA. A Notice of Proposed Rulemaking published in the July 14, 2003, Federal Register solicited public comments on the document discussed and voted upon today. The approved proposal now will be submitted, under Executive Order 12067, to federal agencies for final review and any comments they may wish to submit. Pursuant to Executive Order 12866, a review at the Office of Management and Budget will follow. After interagency review, a final rule will be published in the Federal Register. Only after all of these steps occur will the rule become final. In addition to enforcing the ADEA, which prohibits age discrimination against workers age 40 and older, the five-member Commission enforces Title VII of the Civil Rights Act of 1964; the Equal Pay Act of 1963; Title I of the Americans with Disabilities Act of 1990; portions of the Rehabilitation Act of 1973; and sections of the Civil Rights Act of 1991. Further information about the EEOC is available on the agency's web site at:

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Treating Back Pain

NEW YORK -- Back-pain sufferers in America cost this country more than $100 billion annually in medical bills, disability and lost productivity at work. And 80 percent of Americans will battle back pain at some point in their lives, making it the number two reason for doctor visits, after coughs and other respiratory infections, Newsweek reports in the current issue. To relieve the pain, Americans wanted a quick fix and thus, between 1996 and 2001, there was a 77 percent increase in spinal-fusion surgery, the most costly (about $34,000 a pop) and invasive form of therapy. But, as General Editor Claudia Kalb reports in the April 26 cover story, "Treating Back Pain," (on newsstands Monday, April 19), many of these procedures simply don't work and doctors are now looking for simpler, more effective ways to treat one of the most vexing problems in medicine. "We've come to the point where we have to think out of the box," says Harvard researcher Dr. David Eisenberg, who is studying nonsurgical alternatives like massage and acupuncture. "The time is now." Kalb examines the controversy around spinal fusion and alternatives to treating pain. Chiropractic treatment, the most popular nonsurgical back therapy, is booming, with 60,000 chiropractors practicing today, a 50 percent increase since 1990. While experts generally agree that the treatment, which involves spinal manipulation and stretching, is safe for the lower back, there's not a lot of data on how effective it is in the long term. Dr. Dan Cherkin, of the Center for Health Studies in Seattle, is now conducting the first large trial of the practice. Massage has seen an increasing number of addicted patients, too, and research shows it does help knead out persistent pain; one study even found that patients took fewer medications during treatment, Kalb reports. Acupuncture is also popular, though there's a dearth of evidence about its effectiveness. But even conventional doctors say if it makes you feel better, go for it. Dr. Jeffrey Ngeow, an anethesiologist by training, pushes the tiny needles into patients at New York's Integrative Care Center. He says acupuncture, which seems to stimulate the release of feel-good endorphins, won't provide instant relief, but it will have a cumulative effect. And then there's back pain's relationship to stress. Dr. John Sarno, of NYU Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost all back pain is rooted in bottled-up emotions. He says patients need to recognize the connection between mind and body before they'll feel better. In addition, there is currently an NIH-funded pilot program at Harvard where a diverse group of 25 specialists -- surgeons as well as complementary medicine experts -- are educating one another on how they diagnose and treat back pain. The goal: to see if there is a more efficient, multidisciplinary way to attack the problem -- and to make it cost-effective, too. Please click on the link below for more information on this story:

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Green and black tea polyphenols consumption results in slower prostate cancer cell growth

In the first known study of the absorption and anti-tumor effects of green and black tea polyphenols in human tissue, researchers at the University of California at Los Angeles were able to detect tea polyphenols in prostate tissue after a very limited consumption of tea. More importantly, the scientists found that prostate cancer cells grew more slowly when placed in a medium containing blood serum of men who had consumed either green or black tea for five days compared to serum collected before the men began their tea-drinking regimen. Serum from men who drank comparable amounts of diet or regular soda showed no such slowing in cancer cell proliferation. The study was reported at Experimental Biology 2004, in Washington, D.C., as part of the scientific program of the American Society of Nutritional Sciences, one of the six sponsoring scientific societies of this large multi-disciplinary meeting. Recent animal and epidemiological studies have suggested tea may have anti-tumor effects against carcinoma of the prostate, and many of the polyphenolic components of tea have been found in the prostate and many other tissues in rats and mice after chronic consumption of green tea polyphenols in drinking water. Dr. Susanne Henning, UCLA Center for Human Nutrition, says the UCLA research team - a combination of nutrition scientists and urologists - focused on the possible effect of tea polyphenols on factors named polyamines and the enzymes responsible for the production of polyamines. Elevated levels of polyamines have been associated with malignancy in humans, including prostate cancer, and - since polyamines are present in prostate tissue in high concentration - are considered a logical target for chemoprevention of prostate cancer. Five days before they were to undergo radical prostatectomy, 20 men with prostate cancer were randomly assigned to consume daily either five cups of green tea, five cups of black tea, or diet or regular soda containing no tea polyphenols. Their blood serum was then collected and added to prostate tissue samples from a commercially available prostate cancer cell line called LNCaP. Analysis of the prostate tissue showed a large variation in tea polyphenol content between study participants. Tea polyphenols were found in six out of eight participants drinking green tea, seven out of seven drinking black tea, and two out of five drinking soda. The fact that two of the control participants showed polyphenols in the prostate sample might be because they were eating chocolate regularly or drinking tea before entering the study. Chocolate does contain the polyphenols epicatechin and epicatechingallate, and the turnover rate of these polyphenols - how long they might remain in tissue - is not known. They are water-soluble and are all excreted after eight hours. The maximum concentration in plasma is after two to three hours. But two important factors were different in the men who drank tea and those who did not during the five-day study. When the scientists compared the level of total polyamine to the total polyphenol content, the tea drinkers showed a significant negative correlation - the more tea components in the tissue, the less of the polyamines associated with malignancy. And when the scientists measured the proliferation of prostate cancer cells, there was a significant decrease in how fast new cancer cells appeared for the men who had consumed either green or black tea. That was true even when no tea components could be detected in the serum, indicating, says Dr. Henning, that the inhibition of cell proliferation was caused by other compounds altered through tea consumption. Prostate cancer is one of the common cancers among males in the United States, and more than a fourth of all those patients with prostate cancer are known to use alternative therapies, including green tea. This study suggests that both black and green tea are promising natural dietary supplements useful for chemoprevention of prostate cancer, according to Dr. Henning. She plans to investigate if this effect can be enhanced by consuming larger amounts of tea polyphenols in the form of green tea extract supplement capsules.

NYSCA’s District 2 (Kings County / Brooklyn) Secretary, Dr. Peter J. Cueter Passes

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

American Chiropractic Association Urges Americans to Take an Extra 2,000 Steps Per Day

America on the Move' Program Fits Chiropractic Model of Wellness ARLINGTON, Va. -- Revitalizing your health could be just steps away, according to the American Chiropractic Association (ACA). While seeking out the latest, trendiest exercise craze can be an intimidating endeavor, a good, old-fashioned walk may be all you need to help you feel great and get into shape. In support of a program called "America on the Move" -- a national initiative dedicated to helping individuals and communities make positive changes to improve their health and quality of life -- the ACA is urging Americans everywhere to simply take 2,000 more steps and consume 100 fewer calories each day than they normally would. And it's even easier to do than you might think. Dr. George McClelland, ACA Chairman and member of ACA's Wellness Committee, explains that, "Adding a short walk to your lunchtime schedule, coupled with taking the stairs at work rather than the elevator, could add up to 2,000 additional steps for many of us. And cutting just one can of soda from your day and replacing it with water can eliminate more than 100 calories." The easiest way to keep track of your extra 2,000 steps is to get your hands on a pedometer -- a small device that can count the number of steps you take. It just might be the best 10 dollars you ever spend. A lack of physical activity and poor eating habits have earned the United States the dubious distinction of being the most overweight nation in the world. The ACA aims to reverse that trend by encouraging people to take control of their own health and prevent disease before it sets in. In fact, ACA's official vision statement indicates that the ACA "seeks a transformation in health care from a focus on disease to a focus on wellness." According to Dr. McClelland, "Many health care providers are now beginning to talk with their patients about healthy lifestyles -- an approach doctors of chiropractic have taken for many years. It's simply not good enough to wait until someone gets sick to start thinking about making them well. As we've seen, that model of health care is just not working." The ACA and America on the Move hope to inspire Americans to engage in fun, simple ways to become more active and eat more healthfully. Putting their words into action, the staff at ACA not only participated in and promoted Prevention magazine's recent "National Walk to Work Day," but also formed a walking club through which staff members will take a lunchtime walk together on at least one selected day each month. As part of its mission to promote a more wellness-centered society, ACA regularly promotes and participates in national observances and programs that help people live healthier lives. To this end, promotes National Public Health Week (www.nphw.org) and participates on the steering committee of the U.S. Bone & Joint Decade (www.usbjd.org), among other initiatives. In addition, the ACA recently partnered with the Healthy People 2010 Consortium. Healthy People 2010 is a set of national health objectives designed to identify the most significant preventable threats to health and to establish national goals and objectives to reduce these threats. Through this partnership, ACA joins over 600 national membership organizations and state agencies in promoting public health. For more information, please visit www.healthypeople.gov. To learn more about how chiropractic care can help you achieve a healthier lifestyle, visit the American Chiropractic Association's Web site at:

Source

Acetaminophen Use and Newly Diagnosed Asthma among Women

Abstract Acetaminophen decreases glutathione levels in the lung, which may predispose to oxidative injury and bronchospasm. Acetaminophen use has been associated with asthma in cross-sectional studies and a birth cohort. We hypothesized that acetaminophen use would be associated with newly diagnosed adult-onset asthma in the Nurses' Health Study, a prospective cohort study of 121,700 women. Participants were first asked about frequency of acetaminophen use in 1990. Cases with asthma were defined as those with a new physician diagnosis of asthma between 1990 and 1996 plus reiteration of the diagnosis and controller medication use. Proportional hazard models included age, race, socioeconomic status, body mass index, smoking, other analgesic use, and postmenopausal hormone use. During 352,719 person-years of follow-up, 346 participants reported a new physician diagnosis of asthma meeting diagnostic criteria. Increasing frequency of acetaminophen use was positively associated with newly diagnosed asthma (p for trend = 0.006). The multivariate rate ratio for asthma for participants who received acetaminophen for more than 14 days per month was 1.63 (95% confidence interval, 1.11–2.39) compared with nonusers. It would be premature to recommend acetaminophen avoidance for patients with asthma, but further research on pulmonary responses to acetaminophen is necessary to confirm or refute these findings and to identify subgroups whose asthma may be modified by acetaminophen.

Exceptional speakers headline May 2004 NYSCA Leadership Meeting at New York Chiropractic College.

• 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:

NEW BILL WOULD GIVE VETERANS DIRECT ACCESS TO DOCTORS OF CHIROPRACTIC

ARLINGTON, VA -- The American Chiropractic Association (ACA) today applauded Congressman Bob Filner (D-CA) for introducing legislation to provide veterans with direct access to a doctor of chiropractic through the Department of Veterans Affairs (DVA) health care system. The ACA, the nation's largest chiropractic organization, worked closely with Congressman Filner on the direct access bill now before Congress and on other ongoing efforts to ensure unimpeded access to chiropractic care. In the past, segments of the federal bureaucracy have been reluctant to implement directives from Congress regarding chiropractic care. This new bill (HR 4051) seeks to send a message to opponents of chiropractic - inside and outside of the government - that America's veterans will not be denied the chiropractic care they need and deserve. "Congressman Filner is a powerful and effective leader on health care issues and a well-known fighter for America's veterans," said ACA President and U.S. Navy veteran Donald J. Krippendorf, DC. "He has shown time and again that he is committed to protecting the rights of doctors of chiropractic and chiropractic patients. Introduction in the U.S. House of Representatives of the "Better Access to Chiropractors to Keep our Veterans Healthy Act" by Congressman Filner is a strong statement of support for chiropractic care and its positive benefits for veterans and other patients." The Filner bill (HR 4051) seeks to amend Title 38 of the United States Code to permit eligible veterans to receive direct access to chiropractic care at Department of Veterans Affairs hospitals and clinics. Section 3 of HR 4051 states that "The Secretary [of Veterans Affairs] shall permit eligible veterans to receive needed [health care] services, rehabilitative services, and preventative health services from a licensed doctor of chiropractic on a direct access basis at the election of the eligible veteran, if such services are within the state scope of practice of such doctor of chiropractic." The measure goes on to directly prohibit discrimination among licensed health care providers by the DVA when determining which services a patient needs. Congressman Filner is a senior member of the Committee on Veterans Affairs. He represents California's 51st Congressional District, including Imperial County and a portion of San Diego County and the communities of Bonita, Brawley, Calexico, Calipatria, Chula Vista, El Centro, Heber, Holtville, Imperial, La Presa, National City, San Diego, Seeley and Westmoreland. In 2004, the ACA presented Congressman Filner with its Veterans Health Care Leadership Award.

DVA SECRETARY PRINCIPI GREEN-LIGHTS CHIROPRACTIC CARE FOR AMERICA’S VETERANS

Washington, DC - The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) commended Department of Veterans Affairs (DVA) Secretary Anthony Principi for issuing an historic and far-reaching blueprint for formalizing the full inclusion of chiropractic care into the massive veterans health care system in the United States. Secretary Principi’s decision today to implement more than three dozen recommendations made by a multi-disciplinary health care advisory panel will dramatically improve the quality of care available to millions of veterans in the U.S. and increase access to chiropractic care for every veteran who wants or needs to see a doctor of chiropractic. The Secretary’s bold action originated with legislative directives from Congress in 2002 and 2003 - passed at the urging of the ACA, the ACC and America’s veterans - to establish a permanent chiropractic benefit through the DVA system and authorize the DVA to hire and employ doctors of chiropractic as care providers. “This is a great victory for veterans and an historic new opportunity for doctors of chiropractic across America,” said ACA President and U.S. Navy veteran Donald Krippendorf, DC. “Secretary Principi always makes certain that veterans come first. He’s done so today by acting decisively to bring chiropractic care into veterans hospitals from coast-to-coast and to make doctors of chiropractic full partners in providing care to all those who answered our country’s call to serve.” Since the creation of the DVA health system, the nation’s doctors of chiropractic (DCs) have been kept outside the system and all but prevented from providing proven, cost-effective and much-needed care to veterans, including those among the most vulnerable and in need of the range of the health care services DCs are licensed to provide. In 2002, 4.5 million patients received care in DVA health facilities, including 75% of all disabled and low-income veterans. Although the DVA health care budget is roughly $26 billion, in 2002, less than $370,000 went toward chiropractic services for veterans. In issuing today’s order to his department to begin inclusion of chiropractic care, Secretary Principi specifically acknowledged that the goal is “to ensure that chiropractic care is ultimately available and accessible to veterans who need it throughout the DVA system.” Several key elements of Secretary Principi’s blueprint were strongly supported by the ACA and the ACC, including: · DVA’s endorsement of the integration of full-scope chiropractic care (under applicable state law) into all missions of the DVA health care system, including patient care, education, research and response to disasters and national emergencies, and DVA facilities across the country. · DVA’s endorsement of a successful and patient-friendly model - essentially based on the operations of Bethesda National Naval Medical Center - of full integration of doctors of chiropractic as partners in health care teams. · Inclusion of chiropractic care into the VA's funding of research into treatment of service-connected conditions. · Inclusion of chiropractic colleges and students in training programs at VA facilities. · Establishment of a goal to ensure continuity of chiropractic care for newly discharged veterans who have been receiving chiropractic care through the Defense Department health care system. Jean Moss, DC, President of the ACC, commended Principi’s decision to integrate chiropractic care into the DVA health system, saying, “The administration, faculty and students of chiropractic colleges across America are delighted that Secretary Principi has taken steps to ensure that DCs can now directly contribute to the health and well-being of veterans. I am pleased, too, that chiropractic college students will become eligible to participate in internship programs at DVA hospitals and that a fair share of federal research funding will be directed to further documenting the efficacy and cost-effectiveness of chiropractic care.” Dr. Krippendorf added, “The ACA is a membership organization that is comprised of thousands of hard-working health professionals who are pillars of their communities in all 50 states. Our advocacy for full inclusion of chiropractic care in the DVA system is part of our broader campaign to ensure that DCs and their patients are treated fairly in all of the Federal government’s health care programs and initiatives. We’ve made great progress across the board, but the fight for fairness continues and the ACA is ever vigilant.” In addition to legislation authorizing the DVA to employ chiropractors (Public Law 108-170), ACA-backed bills to test expanded access to chiropractic services under Medicare (Public Law 108-173) and to accelerate the implementation of chiropractic care in the military (Public Law 108-136) were also signed into law by President Bush in 2003. In 2004, the ACA will make it a priority to ensure that Secretary Principi’s recommendations are speedily implemented, and work with Congress on new legislation to ensure that chiropractic patients are never wrongly denied access to care. There are about 60,000 DCs in the U.S. and an estimated 25 million chiropractic patients. “Today’s historic action involved the hard work and determined efforts of several members of the DVA’s Chiropractic Advisory Committee, including Drs. Reed Phillips, Cynthia Vaughn and Rick McMichael,” said ACA Chairman and Army veteran George McClelland, DC. “These outstanding leaders have helped improve America’s veterans health care system, eliminated discriminatory practices against their fellow DCs and won meaningful protections for a most deserving group of chiropractic patients.”