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Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study

Summary Background Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth. Methods In a longitudinal study, we studied 198 children born in 1991–92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass. Findings 49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r=0•21, p=0•0088) and lumbar-spine (r=0•17, p=0•03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p<0•0001 and p=0•0110, respectively) and childhood bone mass (p=0•0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p=0•0286). Interpretation Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring. The Lancet 2006; 367:36-43

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The Role of Vitamin D in Cancer Prevention

Abstract Vitamin D status differs by latitude and race, with residents of the northeastern United States and individuals with more skin pigmentation being at increased risk of deficiency. A PubMed database search yielded 63 observational studies of vitamin D status in relation to cancer risk, including 30 of colon, 13 of breast, 26 of prostate, and 7 of ovarian cancer, and several that assessed the association of vitamin D receptor genotype with cancer risk. The majority of studies found a protective relationship between sufficient vitamin D status and lower risk of cancer. The evidence suggests that efforts to improve vitamin D status, for example by vitamin D supplementation, could reduce cancer incidence and mortality at low cost, with few or no adverse effects. American Journal of Public Health, 10.2105/AJPH.2004.045260

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Appeals Court Overturns Adverse District Court Ruling; The Fight Continues

ACA’s HHS Lawsuit Continues to Reap Benefits for Chiropractic Profession (Arlington, Va. - Dec. 14, 2005) The U.S. Court of Appeals has reversed a lower court decision allowing medical doctors and osteopaths to perform “manual manipulation of the spine to correct a subluxation” on Medicare beneficiaries, paving the way for chiropractors to pursue further hearings on the issue under a new administrative review process enacted in 2003. The Dec. 13 decision represents a major step in the American Chiropractic Association’s (ACA) landmark lawsuit against the U.S. Department of Health and Human Services (HHS) and comes at a critical time as millions of Medicare patients are choosing Medicare managed care plans as part of their new prescription drug benefit. “The ACA is extremely pleased that the District Court’s ruling allowing M.D.s and D.O.s to provide a uniquely chiropractic service was nullified,” announced ACA President Richard Brassard, DC. “We are happy that the issue is now whether or not a practitioner is ‘qualified,’ not whether or not a practitioner is simply licensed. The ACA’s position has been and remains that only chiropractors are qualified by education and training to correct subluxations. Because of the appeals court’s decision, chiropractors can continue to fight to safeguard their right to be the sole providers of this service and to ensure Medicare patients’ rights to access doctors of chiropractic.” In its Dec. 13 opinion, a three-judge appeals panel overturned an Oct. 14, 2004 District Court ruling that stated: “The court will simply reiterate its conclusion that 42 U.S.C. 1395x(r) does not prevent doctors of medicine and osteopaths from performing a ‘manual manipulation of the spine to correct a subluxation.’” The appeals panel ruled that the District Court lacked the jurisdiction to make this decision and that the final decision must be made through a newly revised appeals process. Through this process, individual chiropractors file complaints on behalf of their Medicare patients through the managed care organization. From there, complaints move to an administrative law judge. The appeals panel further questioned the District Court’s opinion on the issue of which health care providers are qualified to provide the chiropractic service – not simply which providers have a license to do so. “The regulation states that ‘[I]f more than one type of practitioner is qualified to furnish a particular service, the HMO ... may select the type of practitioner to be used.’ ... (emphasis added). The HMO’s invocation of this provision would squarely present the question of whether medical doctors and osteopaths, as well as chiropractors, are ‘qualified to furnish’ the service of manual manipulation of the spine to correct a subluxation.” According to ACA’s legal team, this language suggests that simply possessing a medical or osteopathic license will not be sufficient to provide the chiropractic service; the MD or osteopath must prove that they are qualified to do so by education and training. “The appeals court decision is especially significant as seniors are being encouraged to join Medicare managed care programs in which they will find no meaningful chiropractic services,” added Dr. Brassard. “Doctors of chiropractic nationwide must familiarize themselves with the new appeals process and report on any Medicare HMO that does not offer chiropractic services through doctors of chiropractic.” The ACA is exploring ways it can assist individual doctors of chiropractic through the administrative review process and provide them with the resources and materials they need to establish their unique qualifications to an administrative law judge, if necessary. Earlier court rulings in ACA’s lawsuit against HHS, filed in 1998, have also resulted in “monumental victories for Medicare patients,” according to Dr. Brassard – the most important being the decision prohibiting physical therapists from providing manual manipulation of the spine to correct a subluxation to Medicare patients. “Before ACA filed its lawsuit,” Dr. Brassard explained, “Medicare HMOs were given the green light to misappropriate taxpayer dollars to pay non-physician physical therapists to deliver the chiropractic physician service of 'manual manipulation of the spine to correct a subluxation’ under Medicare – or to deny the service to beneficiaries altogether. That unfair and illegal practice has ended as a direct result of our lawsuit.” Other victories that occurred as a direct result of the HHS lawsuit were: The preparation and release of a government study showing the virtual elimination of chiropractic services to Medicare beneficiaries entering the Medicare Managed Care system where there is a medical doctor gatekeeper requirement; And, a government mandate that all Medicare Managed Care plans must make available and pay for manual manipulation of the spine to correct a subluxation. “The ACA and the National Chiropractic Legal Action Fund (NCLAF) thank the thousands of supporters and contributors who have stood with us through this monumental legal battle,” said Dr. Brassard. “Because of your commitment, we will continue to work together to ensure that Medicare beneficiaries receive the safe and effective chiropractic care they need and deserve.” For a copy of the Dec. 13 decision, additional information on Medicare managed care plans, and resources on the Medicare administrative review process, visit ACA’s Web site at:

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Obstructive Sleep Apnea as a Risk Factor for Stroke and Death

ABSTRACT Background: Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension. Methods: In this observational cohort study, consecutive patients underwent polysomnography, and subsequent events (strokes and deaths) were verified. The diagnosis of the obstructive sleep apnea syndrome was based on an apnea-hypopnea index of 5 or higher (five or more events per hour); patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional-hazards analysis was used to determine the independent effect of the obstructive sleep apnea syndrome on the composite outcome of stroke or death from any cause. Results: Among 1022 enrolled patients, 697 (68 percent) had the obstructive sleep apnea syndrome. At baseline, the mean apnea-hypopnea index in the patients with the syndrome was 35, as compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, the obstructive sleep apnea syndrome was associated with stroke or death from any cause (hazard ratio, 2.24; 95 percent confidence interval, 1.30 to 3.86; P=0.004). After adjustment for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the obstructive sleep apnea syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95 percent confidence interval, 1.12 to 3.48; P=0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P=0.005). Conclusions: The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension. The New England Journal of Medicine. November 10, 2005; Vol. 353; No. 19, pp. 2034-2041.

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Study links low selenium levels with higher risk of osteoarthritis

(Embargoed) CHAPEL HILL -- People without enough selenium in their bodies face a higher risk of knee osteoarthritis, a first-of-its-kind new study suggests. University of North Carolina at Chapel Hill Thurston Arthritis Center medical scientists and colleagues conducted the research. It focused on the knees of 940 participants enrolled in the Johnston County (N.C.) Osteoarthritis Project, a continuing, federally supported investigation of osteoarthritis that began 15 years ago and is headquartered at UNC. Scientists found that for every additional tenth of a part per million of selenium in volunteers' bodies, there was a 15 percent to 20 percent decrease in their risk of knee osteoarthritis. Those who had less of the trace mineral than normal in their systems faced a higher risk of the degenerative condition in one and both knees. The severity of their arthritis was related to how low their selenium levels were. "We are very excited about these findings because no one had ever measured body selenium in this way in relationship to osteoarthritis," said study leader Dr. Joanne Jordan of UNC. "Our results suggest that we might be able to prevent or delay osteoarthritis of the knees and possibly other joints in some people if they are not getting enough selenium. That's important because the condition, which makes walking painful, is the leading cause of activity limitation among adults in developed countries." Jordan is associate professor of medicine and orthopaedics at the UNC School of Medicine. Also associate director of the school's Thurston Arthritis Research Center, she is principal investigator of the long-term Johnston County Osteoarthritis Project. That investigation is the largest and longest of its kind ever done and has involved some 4,400 volunteers, both blacks and whites, whose experiences with arthritis doctors follow and analyze. Jordan and colleagues will present results of their study in San Diego Tuesday (Nov. 15) at the annual meeting of the American College of Rheumatology. Co-authors are UNC statistician Fang Fang; Dr. Lenore Arab of the University of California at Los Angeles; Dr. Steven J. Morris of the University of Missouri in Columbia; Dr. Jordan Renner, professor of radiology and allied health sciences at UNC; Dr. Charles G. Helmick of the Centers for Disease Control and Prevention (CDC) in Atlanta; and Dr. Marc C. Hochberg, professor of medicine at the University of Maryland. The team got interested in the possibility that selenium might play a role in preventing osteoarthritis in part because in severely selenium-deficient areas of China, people frequently develop Kashin-Beck disease, which cause joint problems relatively early in life. The U.S. study involved comparing the extent of knee osteoarthritis in each subject as shown on carefully examined X-rays with how much selenium was in their systems. At the University of Missouri, Morris determined the latter from toenail clippings taken during physical examinations in North Carolina. He employed a complicated nuclear technique known as Instrumental Neutron Activation Analysis. "We found that when we divided the participants into three groups, those with the highest selenium levels faced a 40 percent lower risk of knee osteoarthritis than those in the lowest-selenium group," Jordan said. "Those in the highest selenium group had only about half the chance of severe osteoarthritis or disease in both knees. Some of the findings were even stronger in African-Americans and women." The bottom line was that there appears to be a clear relationship between selenium and osteoarthritis, she said. "The next step will be in the laboratory to see how selenium affects cartilage," Jordan said. "It might act as a protective antioxidant. Later, we'll want to expand the study with larger samples and see whether selenium supplementation reduces pain or other symptoms." Most people get enough selenium in their diets in the United States if those diets are varied and include foods that come from different regions, she said. "If you were just growing most of your own food in soil that did not have much selenium and not eating vegetables and meat from elsewhere, you could potentially get in trouble with selenium deficiency," Jordan said. Osteoarthritis, the most common form of arthritis, afflicts almost a million North Carolinians and more than 21 million people nationally, including many adults over age 65, the physician said. Some estimates suggest that as many as 70 million Americans will suffer from some form of arthritis within the next 20 years as baby boomers age. ### Support for the research came from the CDC and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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New study shows chiropractic is cost-effective in treating chronic back pain

Arlington, VA -- A new study finds that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes. A group of chronic low-back patients who underwent chiropractic treatment showed higher pain relief and satisfaction with the care and lower disability scores than a group that underwent medical care, according to an October 2005 study in the Journal of Manipulative and Physiological Therapeutics (JMPT). Although several cost-effectiveness studies outside the United States have favorably compared chiropractic to medical care, this new study is one of the first to compare low-back treatment costs and outcomes within the structure of the American health care system. In the United States alone, back pain associated costs are estimated to reach $48 billion this year, and, at any given time, 80 percent of the U.S. population suffers from back pain – statistics that make this study especially pertinent, according to the authors. Specifics of the study: The study involved 2780 patients with mechanical low-back pain who referred themselves to 60 doctors of chiropractic and 111 medical doctors in 64 general practice community clinics in Oregon and one in Vancouver, Wa. Chiropractic care included spinal manipulation, physical therapies, an exercise plan, and self-care patient education. Medical care consisted of prescription drugs, an exercise plan, self-care advice, and a referral to a physical therapist (in approximately 25 percent of cases). The costs of treatment and patients' pain, disability, and satisfaction with their health care were assessed at 3 and 12 months after the initial visit to the doctor. The office costs alone for chiropractic treatment of low-back pain were higher than for medical care. However, when costs of advanced imaging and referral to physical therapists and other providers were added, chiropractic care costs for chronic patients were 16 percent lower than medical care costs. The differences between medical and chiropractic total costs were not statistically significant for acute or chronic patients. The study did not include over-the-counter drug, hospitalization, or surgical costs. Both acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic treatment. The advantage of chiropractic care was clinically significant in the chronic patient group at 3 months' follow-up, but smaller in the acute group. Improvements in patients' physical and mental health were comparable in both the chiropractic and the medical group, with the exception of physical health scores in the acute patients in the chiropractic group, which showed an advantage over the medical group. "With their mission to increase value and respond to patient preferences, health care organizations and policy makers need to reevaluate the appropriateness of chiropractic as a treatment option for low-back pain," concluded the study authors. The Journal of Manipulative and Physiological Therapeutics, the premier biomedical publication in the chiropractic profession and the official scientific journal of the American Chiropractic Association, provides the latest information on current research developments, as well as clinically oriented research and practical information for use in clinical settings. The journal's editorial board includes some of the world's leading clinical researchers from chiropractic, medicine, and post-secondary education.

NBCE TO REDUCE FEES IN 2006

GREELEY, Colo. — National Board of Chiropractic Examiners (NBCE) President Peter D. Ferguson, D.C., announced today that, in accordance with a vote of the full Board of Directors, the NBCE will reduce its examination fees effective in 2006. The board made this decision at its fall board meeting in Charlotte , N.C. The NBCE will reduce fees for its Parts I, II and III examinations by $25 each and for the Part IV Examination by $100. These reductions correspond to an overall seven percent decrease in the current price of each exam. In 2006, the NBCE will reduce exam fees by: NBCE EXAM / FEE REDUCTION Part I / $25.00 Part II / $25.00 Part III / $25.00 Part IV / $100.00 The new fee structure will be included in the spring 2006 applications, available at www.nbce.org by Nov. 15 and mailed to chiropractic colleges by mid-December. “One factor that made this decision possible is the commitment by the Board of Directors to reduce costs following its annual meeting in May. The board has taken a hard look at our budget during this fiscal year,” Dr. Ferguson explained. “By reducing costs where possible, we have enacted substantial savings that we can pass on to our examinees.” In addition, the NBCE has worked to reduce the cost of administering its exams. For example, by making exam applications and brochures available online, the NBCE has saved substantially on printing costs. The board’s decision is also due to an increase in the number of new students enrolling at chiropractic colleges. The NBCE relies on revenues from its exams to cover its costs. With increased enrollments, revenue streams will increase during the next few years as more students take NBCE exams. “We are very excited about passing these fee cuts on to the students,” said Dr. Ferguson. “I can assure our examinees that we will continue to keep a watchful eye over our budget. By employing a conservative fiscal approach, we hope to pass along savings not just in 2006 but into the future as well.” Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers, and scores standardized written examinations for candidates seeking chiropractic licensure throughout the United States and in several foreign countries. The NBCE also produces and administers a practical skills examination for use in chiropractic licensure.

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NO-FAULT MEDICAL MILL ENTERPRISE SMASHED

Over Thirty Charged in Scheme to Bilk Insurance Companies of $12M Westchester County District Attorney Jeanine Pirro was joined by New York State Police Major Frank Koehler, Yonkers Police Commissioner Robert Taggart, Westchester County Police Commissioner Thomas Belfiore, New York City Police Department Deputy Inspector Alan Cooper, New York State Insurance Frauds Bureau Director Charles Bardong, the National Insurance Crime Bureau, the New Jersey Attorney General’s Office and numerous insurance carriers to announce the results of a three-year investigation into the systematic fraudulent billing of no-fault accident claims by a major medical mill operating in Westchester County. It is alleged that Elm Street Medical, PC operating out of One Elm Street, Tuckahoe, New York, bilked insurance companies by exploiting the no-fault provisions of the New York State Comprehensive Motor Vehicle Insurance Reparations Act. (This act entitles persons injured in automobile accidents to a minimum of $50,000 of medical coverage regardless of who is at fault.) Over a period of approximately three years, Elm Street Medical bilked dozens of insurance companies by upcoding (i.e. the submission of claims containing codes for expensive medical services never provided) or by submitting bogus claims for medical services on behalf of patients who had not been in a car accident. Elm Street’s physicians would routinely recommend numerous tests or treatments including physical therapy treatment; chiropractic services; dental evaluations, testing and treatment; orthopedic evaluations; psychiatric evaluations and treatment; psychological evaluations and treatment; neurological evaluations and testing; durable medical goods; and excessive diagnostic testing all provided for at the Elm Street facility. Some of the procedures that were billed for were never performed and others were shams. Additionally, a simple five minute procedure would be routinely upcoded and billed for a more complicated and longer higher reimbursement procedure. All of the patients were required to assign all insurance payments to Elm Street. Patients also received a promise of proceeds from any potential lawsuit as a result of their injuries. In order to further the operation, LEONARDO VELEZ, an emergency room employee at Saint Joseph’s Hospital in Yonkers and BARRY SUAREZ, a paramedic employed at Empress Ambulance Service, forwarded confidential patient information about individuals involved in accidents from numerous Westchester County hospitals to co-defendant BRUCE NIXON. Nixon, posing as a doctor or hospital patient care coordinator, would refer these patients, most of whom were in minor fender bender accidents, for unnecessary follow-up medical treatment at Elm Street. Nixon would make approximately $1,500 for each referral. Another defendant, JEAN RICHARDSON, actively participated in this criminal enterprise by setting up fictitious accidents. It is alleged that Richardson, while a shelter director at Westhab, Inc., a non-profit organization that administers the daily operation of Westchester County’s homeless shelter system, used Westhab employees and residents to pose as injured car accident victims for the purpose of creating false insurance claims. Not only did uninjured Westhab residents and employees pose as injured patients, but they were also shuttled to the Elm Street offices in official Westhab vans. Richardson is no longer employed by Westhab, Inc. The Elm Street Enterprise, through its office managers, ALEXANDER KARSHENBOYM and SERGEY CHIZHOV, paid runners (recruiters), including, BRUCE NATHANIEL NIXON, JEAN RICHARDSON and others, to steer claimants to medical clinics owned and operated by the Elm Street Enterprise. The runners paid BARRY SUAREZ and LEONARDO VELEZ, and others to steal confidential patient information to permit the runners to contact the patients and turn them into claimants at the medical clinics owned by the Elm Street Enterprise. Many of these claimants had been in real, but minor automobile accidents. Others, such as ROBERT WECHSELBLATT and runner JEAN RICHARDSON, were not in automobile accidents, but knowingly permitted their names and pedigree information to be placed on fictitious accident reports and thereafter told insurance carriers and others that they had been involved in actual automobile accidents. In order to legitimatize the false insurance claims submitted by the Elm Street enterprise, it is alleged that SHARON DAVIS, a former New York City Police Department Administrative Aide, and LORETTA STOKES, a former New York City Police Department Administrative Aide, assisted in the creation of forged police accident reports by knowingly entering false data about fictitious accidents into the New York City Police Department database, so that an accident report number could be assigned. These defendants received up to $300 per report for their criminal activity. They are charged with Criminal Facilitation in the Fourth Degree. The enterprise also included corrupt medical professionals and staff employed by the Elm Street Enterprise, including VLAD MEISHER, MD; JOHN GELFAND, MD; YEFIM SOSONKIN, MD; TOBIAS SHKLOVER, MD; HERBERT FENTON, DDS and others, purportedly rendering and providing medical treatment to these claimants and creating reports documenting the services they purportedly provided. The fraudulent reports and claims submitted to insurance carriers detailed fictitious, unnecessary and/or underperformed medical visits and procedures as well as treatment contrary to generally accepted medical practice. On June 23, 2004, the Westchester County District Attorney’s Office, the New York State Police, and the New York State Insurance Frauds Bureau executed three search warrants resulting in the seizure of hundreds of patient files from the Elm Street Medical offices. It is believed that the Elm Street operatives received over $12 million dollars during a five year period from 1999 to 2004 as a result of running this criminal enterprise. Of the 34 charged, fourteen (14) individuals and six (6) corporations were indicted. All twenty (20) indicted defendants were part of the Elm Street enterprise operating to defraud insurance carriers through the submission of fraudulent no-fault automobile claims. Those indicted were ALEXANDER KARSHENBOYM; SERGEY CHIZHOV; ELLA CHIZHOV; VLAD MEISHER, MD; JOHN GELFAND, MD; TOBIAS SHKLOVER, MD; YEFIM SOSONKIN, MD; HERBERT FENTON, DDS; BRUCE NATHANIEL NIXON; BARRY SUAREZ; LEONARDO VELEZ; JEAN RICHARDSON and ROBERT WECHSELBLATT. One indicted individual remains at large. Corporate summons were also issued for six corporations owned and operated by the enterprise; ELM STREET MEDICAL, PC; ELM NEUROLOGICAL CARE, PC; COMPAS MEDICAL, PC; BOGART AVENUE MEDICAL, PC; ANDA MANAGEMENT CORPORATION; and ALL-SHURE CORPORATION. Moreover, the following 14 individuals were arrested and charged by felony complaint: ANDREW CHEVANNES, ALLAN BAILEY, SHEENA GRAVES, KEVIN GOEFF, GISELLE RIVAS, ROSE ORTIZ, VINCENT JENKINS, LEON AKERY, SHARON CLARK, ANDRE CABAN, KEN COLEMAN, DENISE AHMAD, IBRAHIM AHMAD and PATRICIA TERRY. The investigation is continuing. Among the crimes charged against defendants are Enterprise Corruption, Insurance Fraud in the First Degree and Money Laundering in the First Degree, all class “B” felonies, as well as Insurance Fraud in the Second Degree and Grand Larceny in the Second Degree, class “C” felonies. If convicted, those defendants charged with class “B” felonies face a maximum of twenty-five years in state prison. District Attorney Jeanine Pirro thanked the following insurance companies for their investigative assistance: Allstate, GEICO, Liberty Mutual, Nationwide, Countrywide, State Farm, Progressive, One Beacon and AutoOne. DA Pirro also thanked Lawrence Hospital, the Westchester Medical Center, Saint Joseph’s Hospital, Saint John’s Riverside Hospital, Mount Vernon Hospital, Sound Shore Hospital, Empress Ambulance Service and the NYPD Fraudulent Accident Investigation Unit. DA Pirro also thanked the New York State Motor Vehicle and Insurance Fraud Prevention Board for their assistance. -END – In compliance with Disciplinary Rule 7-107A of the Code of Professional Responsibility, you are advised that a charge is merely an accusation and that a defendant is presumed innocent until and unless proven guilty.

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NYSCA Addresses State Board on Chiropractic Issues

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).

GOVERNOR PROPOSES COMPREHENSIVE WORKERS’ COMPENSATION REFORMS

Challenges in Manufacturing Sector Emphasizes Need for Dramatic Reforms Plan Strikes Balance by Reducing Costs for Businesses and Increasing Benefits for Injured Workers Governor George E. Pataki today proposed a comprehensive plan to reform New York’s Workers’ Compensation system by reducing costs for businesses while increasing benefits for injured workers. The new measures proposed by the Governor would further improve New York’s business climate, expand the State’s job-creation efforts and keep New York business -- especially manufacturing-based business -- competitive in the global marketplace. The Governor’s plan would reduce Workers’ Compensation costs for businesses by more than 15 percent, while increasing benefit levels for injured workers by 25 percent. The new reforms come on top of the historic workers’ compensation reforms the Governor fought to achieve in 1996 that have already reduced costs by 25 percent on average. The Governor proposed a series of additional reforms to the workers’ compensation system in 2004, but the Legislature failed to act on them. “Whether it’s cutting taxes, eliminating unnecessary regulations or reducing workers’ compensation costs, we know that lowering the cost of doing business is a proven way to create new jobs and that’s exactly what we’ve done in New York during the past 11 years,” Governor Pataki said. “In 1996, we worked together to achieve historic and long overdue reforms to the Workers’ Compensation system, which have already reduced costs for businesses by 25 percent. But Workers’ Compensation is one of the biggest costs for businesses and if left unchecked can be an impediment to creating new jobs.” “We’re working hard to help manufacturing-based businesses, such as Delphi in Western New York, stay competitive in the global economy and protect thousands of New York jobs, and these new reforms mark another step in those efforts,” the Governor said. “These new reforms strike a balance between controlling costs for those who create jobs – businesses -- with the needs of workers who risk their health and safety to provide for their families and keep New York’s economy growing. “The time to act is now. I urge the Legislature to work with me to enact these important reforms so that we can help New York businesses better compete, protect tens of thousands of jobs across the State and ensure benefits for injured workers,” the Governor added. The Governor’s plan would reduce workers’ compensation costs for businesses by 15 percent by creating a system of tiered benefit levels for injuries that are not currently scheduled under the law, reducing litigation, better coordinating anti-fraud efforts and authorizing comprehensive fee schedules for medical goods and pharmaceuticals. It would also increase benefit levels for workers injured on and off the job, increasing the maximum weekly indemnity benefits paid to injured workers by 25 percent from $400 to $500 per week. Daniel Walsh, President of the Business Council of New York State said, “We welcome this new initiative by Governor Pataki to craft a comprehensive workers' compensation package which recognizes the many inequities in the current comp system. Taken as a whole, this initiative will help employers of all sizes and types, particularly those in New York's manufacturing community. We look forward to working with the Governor and the Legislature in a good faith effort to bring the comp system more in line with that of our competitor states.” Randy Wolken, President of the Manufacturing Association of Central New York said, “It is imperative that New York realizes the impact workers comp costs truly have on employers, and our competitiveness with other states. The recent premium increase particularly impacts manufacturers; with MACNY members reporting increases of 15-29% since October 1st. Last year closed without a resolution to New York’s workers comp crisis. Now, more than ever, it is crucial to resolve this issue, and move forward on meaningful reform. We look to work with the Governor, the Legislature, labor, and others on this crucial issue to preserve high-paying manufacturing jobs in New York.” Andrew J. Rudnick, President & CEO, Buffalo Niagara Partnership, said, “For upstate employers, especially in manufacturing, workers comp costs are a particularly heavy burden. The Governor's proposed reforms go a long way to relieve that burden, and increased investment and jobs should be a direct result.” Mark Alesse, New York State Director of the National Federation of Independent Business said, "Governor Pataki’s exciting new Workers’ Compensation reform bill is welcomed news for the state’s 1.5 million small businesses and their workers. If the Legislature passes this initiative, worker benefits will rise, and overall Workers Comp costs will drop, fostering new employment growth.” Workers’ Compensation Board Chairman David P. Wehner said, “These reforms strike a balance between controlling costs and the needs of workers --addressing the major concerns of both the business and labor community. The Governor clearly understands that while New York must support injured workers, we must also keep our economy strong. We can fulfill and balance these obligations without piling unnecessarily high workers’ compensation rates on our businesses.” The Governor’s plan generates savings of more than 15 percent by reducing frivolous claims against the Second Injury Fund, expanding the Alternate Dispute Resolution program to include the unionized manufacturing sector and by joining 37 other states that have created a system of tiered benefit levels for permanent partial disabilities. Specifically, the Governor’s proposed legislation also addresses the following issues: PROTECTING INJURED WORKERS ● - Authorizes the phasing in of the first workers’ compensation benefit increases for workers injured on-the-job and their beneficiaries in New York State since 1992. ● - Authorizes a 100 percent increase in the maximum disability benefit for workers injured off-the-job (Disability Benefits) from the current $170 maximum to a maximum of $340. ● - Enables workers to protect themselves better by allowing for supplemental benefits in amounts up to two-thirds of their average weekly wages. ● - Allows claimants to receive non-emergency medical procedures costing less than $1,000 without prior insurer authorization. Currently injured workers must seek authorization before any non-emergency procedure over $500. ● - Requires employers to file an injury report (C2) to their carrier within 3 business days of notification of injury and to the Board within 5 days. ● - Requires that carriers or self insured employers provide the injured workers the option of a Section 32 settlement agreement on all claims. ● - All claims that are unresolved within one year or controvert will be transferred to the expedited hearing calendar giving this claim a higher priority status. ● - Requests for discretionary Full Board Review (Appeals) must be filed within 30 days and imposes a fine of $500 on employers, carriers or claimant representative for filing frivolous appeals. ● - Requires the Board to schedule a pre-hearing conference within 45 days upon learning that a claim is disputed. ● - Expands the successful “payment without prejudice” provision to include prescription medicines. Under this program, insurers may provide benefits for up to one year while a case is litigated, without admitting liability. ● - Accelerates the delivery of benefits to injured workers by enhancing the conciliation process to lessen potentially lengthy litigation. REDUCING COSTS FOR EMPLOYERS ● - Reduces employer assessment for the Second Injury Fund by more than $190 million by adjusting the calculation used to determine the assessments from 150 percent of the previous year’s disbursements to 115 percent. ● - Expands the Alternate Dispute Resolution (ADR) program to include the unionized manufacturing sector. Currently only unionized construction can utilize this cost savings program that enables employers to reduce litigation and trim costs by resolving claims outside of the workers’ compensation system under rules that are collectively bargained. ● - Establishes a Pilot Program to encourage the voluntary delivery of compensation and medical benefits to injured workers without intervention by the Board, but subject to the Board’s supervision. ● - Enacts savings by creating a tiered system with regard to the duration of benefits for permanent partial disabilities (PPD). This system would provide for benefits to be coordinated with the severity of an individual’s disability. (An independent study of New York’s workers’ compensation system conducted in 2001 by the Workers’ Compensation Research Institute concluded that New York’s average indemnity cost per PPD claim is 110 percent above the median state.) ● - Establishes a medical committee to develop objective medical criteria for determining the level of impairment sustained by injured workers. • Reduces the assessment for the Second Injury Fund by initiating a $250 filing fee for carriers or businesses seeking reimbursement from the Fund, of which $200 is returnable if the carrier/employer is successful in its claim for reimbursement. ● - Directs the Chair of the Workers’ Compensation Board to adopt a schedule of maximum fees allowable for prescription medicines and durable goods such as prosthetic devices, and requires that generic medicinal equivalents be used whenever possible. ● - Deems ineligible for benefits, all persons incarcerated and convicted of a crime. ● - Enables carriers or self-insured employers to contract with a network or networks to perform diagnostic tests, x-ray examinations, MRI’s or radiological exams and require claimants to use facilities within that network (except in emergency cases), giving employers greater control over medical costs. ● - Amends the Executive Law, the Insurance Law, requiring the Workers’ Compensation Board Fraud Inspector General, the State Insurance Department’s Insurance Fraud Unit and the State Insurance Fund’s fraud investigations unit to work with increased collaboration, including quarterly meetings to coordinate enforcement efforts. Workers' compensation is a no-fault wage replacement and health care benefit system that serves workers who are injured on the job. Payments of benefits are the responsibility of the injured worker's employer who is required by law to obtain insurance or self-insure to cover the costs of workers' compensation benefits. The Workers’ Compensation Board maintains permanent jurisdiction over injured worker claims whether they are opened or closed.

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Dr. Wolfson, ACA NYS Metro Delegate addresses the NYS Chiropractic Board

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.

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Specific Exercise VS. General Exercise for Low Back Pain

ABSTRACT Effects of Recreational Physical Activity and Back Exercises on Low Back Pain and Psychological Distress: Findings From the UCLA Low Back Pain Study Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD and Chi Chiao, MS, PhD Objectives. We sought to estimate the effects of recreational physical activity and back exercises on low back pain, related disability, and psychological distress among patients randomized to chiropractic or medical care in a managed care setting. Methods. Low back pain patients (n=681) were randomized and followed for 18 months. Participation in recreational physical activities, use of back exercises, and low back pain, related disability, and psychological distress were measured at baseline, at 6 weeks, and at 6, 12, and 18 months. Multivariate logistic regression modeling was used to estimate adjusted associations of physical activity and back exercises with concurrent and subsequent pain, disability, and psychological distress. Results. Participation in recreational physical activities was inversely associated—both cross-sectionally and longitudinally—with low back pain, related disability, and psychological distress. By contrast, back exercise was positively associated—both cross-sectionally and longitudinally—with low back pain and related disability. Conclusions. These results suggest that individuals with low back pain should refrain from specific back exercises and instead focus on nonspecific physical activities to reduce pain and improve psychological health. October 2005, Vol 95, No. 10 | American Journal of Public Health 1817-1824 Eric L. Hurwitz is with the Department of Epidemiology, School of Public Health, University of California, Los Angeles, and the Southern California University of Health Sciences, Whittier. Hal Morgenstern is with the Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor. Chi Chiao is with the Department of Community Health Sciences, School of Public Health, University of California, Los Angeles.

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Chiropractic Coverage Expanded Under Federal Employee Plan Benefit for 2006

The Federal Employee Plan Benefit for 2006 has been updated. These updates include expanded chiropractic coverage under the Standard Option Plan. Previously under the Standard Option there was no benefit for spinal manipulation. Attached please find the details of the new 2006 benefit. Under the Standard Option, benefits may be provided for covered services in a Medically Underserved Area as long as they are within the scope of licensure. American Chiropractic Association Kara Murray Project Manager Office of Professional Development and Research 800.986.4636 ext. 242 703.243.2593 (fax)

Doctors of Chiropractic Offer Tips to Reduce Risk of Back Pain

October is Spinal Health Month, which offers an outstanding opportunity to speak with your local chiropractor about the natural ways you can improve your spinal health and enhance your overall well being. The American Chiropractic Association (ACA) is offering a free patient information page on its Web site, "Tips For a Healthy Spine," that provides simple posture, lifting, and healthy lifestyle guidelines to ward off unnecessary back pain. Visit http://www.acatoday.com. "The goal of a doctor of chiropractic is to offer the highest-quality, professional health care, while teaching patients how to maintain their physical well being and a healthful lifestyle," says ACA President Dr. Richard Brassard. "Spinal Health Month is the perfect time to take control of your health by discovering this natural approach to wellness." With a thorough knowledge of the structure and functioning of the human body, doctors of chiropractic make diagnoses and take steps to correct problems using manual therapies, such as spinal adjustments; dietary and lifestyle advice; and other such natural tools to care for their patients. In fact, medical doctors, realizing the important role doctors of chiropractic can play in relieving pain and restoring health, are referring more of their own patients to doctors of chiropractic than ever before. This integrative health care approach is allowing professionals of different specialties to work together to improve patients' health. Over 30 million Americans sought chiropractic care last year alone, and recent studies show that patient satisfaction is extremely high for those who seek care from a doctor of chiropractic. Surveys have also indicated that chiropractic patients are willing to recommend chiropractic treatment to friends, family and colleagues. Dr. Brassard notes that the key to spinal health is prevention; listen to your body's warning signals and adjust your lifestyle. The ACA recommends the following tips to help prevent back injuries. * Don't lift by bending over. Instead, bend your hips and knees and then squat to pick up an object. * Don't twist your body while lifting. * Push, rather than pull, when you must move heavy objects. * If you must sit for long periods, take frequent breaks and stretch. * Wear flat shoes or shoes with low heels. * Exercise regularly. An inactive lifestyle contributes to lower-back pain. According to Dr. Brassard, "It is essential that we keep ourselves in good physical condition, and spinal health is a key aspect of overall well being. You can achieve optimum health with the help of your doctor of chiropractic."

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Pediatricians Attitudes and Vaccinations

Childhood immunizations are under greater levels of scrutiny by the public. Media stories publicizing the possible link of autism to vaccinations have resulted in parental refusal of immunizations for their young children. A recent study of pediatricians' attitudes toward patients who question the need for childhood immunizations found that many pediatricians would prefer to discharge patients who did not comply with their recommendations. Click on the URL below for the rest of this story:

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WellPoint Inc. to buy WellChoice Inc.

WellPoint, Inc. (NYSE: WLP) and WellChoice, Inc. (NYSE: WC) jointly announced today that they have signed a definitive merger agreement whereby WellChoice would operate as a wholly owned subsidiary of WellPoint. The transaction brings together WellChoice, the parent company of Empire Blue Cross Blue Shield, the largest health insurer in the State of New York, and WellPoint, the nation's leading health benefits company. The combined company will now serve more than 33 million medical members as a Blue Cross or Blue Cross Blue Shield licensee in 14 states and through its HealthLink and UniCare subsidiaries. "This merger brings together two very strong companies focused on providing consumers with the best possible value in health benefits," said Larry C. Glasscock, president and chief executive officer of WellPoint. "Additionally, both companies share the strength and tradition of the Blue Cross Blue Shield brand, one of the most trusted brands in America." "Our companies also share a vision of improving health care," Glasscock said. "Together, we can make that vision a reality by continually developing innovative products that meet customers' needs, by enabling consumers to make better informed health care decisions, and by working collaboratively with hospitals and physicians to improve quality and safety. In doing so, we will help hold down the rising cost of health care." "While premiums must keep pace with rising health care costs, we can assure our members in all of our states that this merger will not add in any way to premium increases," Glasscock added. "Both WellPoint and WellChoice have strong track records of reducing administrative costs while improving customer satisfaction. The synergies we can achieve through this merger, along with the ability to spread administrative costs over a larger membership base, will contribute to our ongoing efforts to keep premiums affordable for customers. Because both WellChoice and WellPoint believe that all health care is local, our merger provides that WellChoice customers will continue to be served by the same local health plan they know today, with decisions made by local management based in New York City." After the close of the transaction, Michael Stocker, M.D., president and chief executive officer of WellChoice, will become president and chief executive officer of a newly combined Northeast Region of WellPoint. As such, Dr. Stocker will have responsibility for business operations in New York, Connecticut, New Hampshire and Maine. He will serve on WellPoint's Executive Leadership Team and report directly to Glasscock. The headquarters for the Northeast Region will be located in lower Manhattan. "This transaction serves the best interests of all our important constituencies and we are very pleased to become part of an enterprise that shares our vision and focus on quality health care at an affordable price," said Dr. Stocker. "Our customers will experience no disruption, and there will be no changes in our networks or benefits as a result of the merger. When combined, our companies will be ideally positioned to promote preventative health care, to engage consumers in maintaining their own good health, and to make the investments necessary to lead positive change in our country's health care system. At the same time, we will be able to draw upon the resources of the nation's leading health benefits company to serve our customers even better." Glasscock added, "It is more important today than ever before for companies to be socially responsible and actively involved in helping make their communities better places to live and work. Both WellChoice and WellPoint have long histories of significant charitable contributions and community involvement, and combined, our role in the community will be even more effective." The merger will strengthen WellPoint's leadership in providing health benefits to National Accounts - large employers with multi-state operations. New York City is the headquarters of more Fortune 500 companies than any other U.S. city, and the merger gives WellPoint a strategic presence in this important market. Both companies have achieved growth among large national employers, building on the strength of the Blue brand and its broad national networks of physicians and hospitals. With Blue plans in 14 states, the combined company can offer large national employers leading local presence in more markets than any other health benefits company. The merger will also enhance the combined company's ability to offer consumer-driven health solutions, which are a growing choice of consumers and employers alike. In June, WellPoint acquired Lumenos, a pioneer and leader in consumer-driven health plans, and WellChoice has incorporated Lumenos technology into its Empire Total Blue consumer-driven product. "Our recent acquisition of Lumenos, combined with WellChoice's successful deployment of Lumenos features in Empire Total Blue, will allow us to immediately offer Lumenos' full product line to new and existing National Accounts headquartered in WellChoice's service area," Glasscock said. Both companies believe that maintaining a strong local presence is very important in the delivery of health benefits, and that philosophy will continue with the merger. In addition, opportunities for professional growth could be created for employees of both WellPoint and WellChoice as a result of the merger. This transaction is expected to be neutral to 2006 earnings per share and accretive thereafter. At least $25 million in pre-tax synergies are expected to be realized in 2006 and approximately $50 million in 2007, with annual pre- tax synergies of at least $125 million expected to be fully realized on an annual basis by 2010. The transaction is structured as a merger of WellChoice, Inc. with a wholly owned subsidiary of WellPoint and is intended to be tax free with respect to the WellPoint stock to be received in the transaction by WellChoice stockholders. The consideration of $77.23 per share to be received by the stockholders of WellChoice will be comprised of $38.25 in cash and WellPoint stock at a fixed exchange ratio of .5191 of a share of WellPoint stock for each share of WellChoice stock (valued at $38.98 per share at the market close on September 26, 2005). The transaction will be accounted for under the purchase method of accounting. The New York Public Asset Fund, which currently owns approximately 52 million shares of WellChoice common stock, will receive approximately $1.989 billion in cash and approximately 27 million shares of WellPoint common stock from the merger based on Monday's closing stock price. The New York Public Asset Fund has agreed to vote its shares, representing approximately 62% of the outstanding shares of WellChoice, Inc., in favor of the transaction. The transaction will be subject to customary closing conditions, including approval of WellChoice's stockholders and various regulatory approvals. WellPoint and WellChoice currently expect the transaction to close in the first quarter of 2006.

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Prince Charles Commissioned a Report on Alternative Medicine

The report in support of alternative therapies, such as chiropractic manipulations is to be sent to ministers (in London) in October. This study would report on money-saving benefits of complementary medicine if offered by the National Health Service (NHS) as standard. A study by research firm, Fresh Minds, which had been hired by Princes Charles, an enthusiast for complementary therapies, suggest that savings of between £500m and £3.5bn could be achieved by offering spinal manipulation therapies, such as chiropractic. If general practitioners (GP) offer homeopathy as an alternative to standard drugs up to 10% could be cut from the prescription drugs’ bill, totaling nearly £480m, the report emphasize.

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US study reports-OTC Painkillers Raise Blood Pressure in Women

Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in US Women John P. Forman*; Meir J. Stampfer; and Gary C. Curhan Abstract Acetaminophen, ibuprofen, and aspirin are the most commonly used drugs in the United States. Although the frequency of their use has been associated with hypertension, prospective data examining the dose of these drugs and risk of hypertension are lacking. Furthermore, whether certain indications for analgesic use, particularly headache, mediate the association is unclear. We conducted 2 prospective cohort studies among older women 51 to 77 years of age (n=1903) from the Nurses’ Health Study I and younger women 34 to 53 years of age (n=3220) from the Nurses’ Health Study II who completed detailed supplemental questionnaires pertaining to their analgesic use and who did not have hypertension at baseline. We analyzed incident hypertension according to categories of average daily dose of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin. Information on indications for analgesic use as well as relevant confounders was also gathered prospectively. Compared with women who did not use acetaminophen, the multivariable adjusted relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women and 1.99 (1.39 to 2.85) among younger women. For nonsteroidal anti-inflammatory drugs, similar comparisons yielded multivariable relative risks of 1.78 (1.21 to 2.61) among older women and 1.60 (1.10 to 2.32) among younger women. These associations remained significant among women who did not report headache. Aspirin dose was not significantly associated with hypertension. Higher daily doses of acetaminophen and nonsteroidal anti-inflammatory drugs independently increase the risk of hypertension in women. Because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they may contribute to the high prevalence of hypertension in the United States. From the Renal Division (J.P.F., G.C.C.), Department of Medicine, Brigham and Women’s Hospital, Boston, Mass; Channing Laboratory (J.P.F., M.J.S., G.C.C.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass; and Department of Epidemiology (J.P.F., M.J.S., G.C.C.), Harvard School of Public Health, Boston, Mass. Hypertension published August 15, 2005, 0.1161/01.HYP.0000177437.07240.70

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Is Your Management Agreement A Swan or A Duck?

 

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A high protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations

ABSTRACT Background: Ad libitum, low-carbohydrate diets decrease caloric intake and cause weight loss. It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake. Objective: We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake. Design: Appetite, caloric intake, body weight, and fat mass were measured in 19 subjects placed sequentially on the following diets: a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk. Blood was sampled frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve (AUC) for insulin, leptin, and ghrelin. Results: Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC. Mean (±SE) spontaneous energy intake decreased by 441 ± 63 kcal/d, body weight decreased by 4.9 ± 0.5 kg, and fat mass decreased by 3.7 ± 0.4 kg with the ad libitum, high-protein diet, despite a significantly decreased leptin AUC and increased ghrelin AUC. Conclusions: An increase in dietary protein from 15% to 30% of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss. This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets. American Journal of Clinical Nutrition, Vol. 82, No. 1, 41-48, July 2005 © 2005 American Society for Clinical Nutrition

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