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Diet or Hormones Makes Pregnant Women Sick

Rates of nausea and vomiting in pregnancy and dietary characteristics across populations Gillian V. Pepper and S. Craig Roberts Abstract: Nausea and vomiting in pregnancy (NVP) is a pervasive and debilitating phenomenon in humans. Several adaptive explanations for NVP occurrence have been recently proposed, the two most prominent of which predict associations with nutritional intake or specific dietary components. Here we extend previous cross-cultural analyses by analysing associations between NVP prevalence in 56 studies (21 countries) and quantitative estimates of per capita intake across major dietary categories, measured for the year of study by the Food and Agriculture Organisation (FAO). Rates of nausea and vomiting in pregnancy were correlated with high intake of macronutrients (kilocalories, protein, fat, carbohydrate), as well as sugars, stimulants, meat, milk and eggs, and with low intake of cereals and pulses. Restricting analyses to studies from North America and Europe caused relationships between macronutrient intake and NVP to disappear, suggesting that they might be influenced by non-dietary confounds associated with geographical region of study. However, factor analysis of dietary components revealed one factor significantly associated with NVP rate, which was characterized by low cereal consumption and high intake of sugars, oilcrops, alcohol and meat. The results provide further evidence for an association between diet and NVP prevalence across populations, and support for the idea that NVP serves an adaptive prophylactic function against potentially harmful foodstuffs. Gillian V. Pepper (AFF1) and S. Craig Roberts (AFF1) AFF1 School of Biological Sciences, University of Liverpool, Crown Street, Liverpool L69 7ZB, UK ISSN: 0962-8452 (Paper) 1471-2954 (Online) Issue: FirstCite Early Online Publishing DOI: 10.1098/rspb.2006.3633

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ACA's Legal Efforts Against ACN Continue, Despite Adverse Ruling in Similar Class Action

Arlington, VA -- The American Chiropractic Association (ACA) continues to aggressively challenge the practices of ACN Group Inc. on multiple fronts and remains optimistic that the chiropractic profession can find relief from the managed care organization's tactics, despite an adverse ruling in a similar federal class action suit against UnitedHealthcare, a sister company of ACN. On June 19, a federal judge in Miami dismissed a national class action lawsuit brought against UnitedHealthcare and Coventry Health by 700,000 medical doctors who claimed the insurers had conspired to arbitrarily deny or reduce claims. U.S. District Judge Federico Moreno dismissed the lawsuit, known as the Shane case, due to "insufficient evidence" that the carriers conspired to deny claims in a coordinated manner. While the ACA is disappointed in this decision -- because the ruling could set a precedent and portend an adverse judgment in the Solomon case -- legal experts point out that the two cases are different and the possibility of prevailing still exists. In the Shane decision, Judge Moreno wrote that he did not condone the insurers’ practices, but he simply could not find enough evidence of a conspiracy after reviewing thousands of documents. According to ACA's legal team, the evidence ACA has compiled against ACN, which is not a party in the Shane case, is substantial and the court that made the decision in the Shane case has yet to review it. In addition, legal action is just one track in ACA's multi-pronged strategy against ACN. In addition to filing this national class action, ACA -- in cooperation with several state chiropractic associations -- is actively engaged with a number of state attorneys general, offices of insurance and boards of licensure, and the Federation of Chiropractic Licensing Boards (FCLB) regarding the tactics undertaken by ACN. According to ACA officials, these state attorneys general and state offices of insurance are reviewing the practices of ACN and other chiropractic managed care organizations and some are launching their own investigations. "The federal court's action is clearly disappointing,” said ACA President Richard Brassard, DC. “But I want to stress to the profession -- and especially to the doctors currently suffering under ACN policies -- that the ACA will exhaust every legal, administrative and political means to redress these problems. The ACA was created to fight for our patients and for chiropractic. We now have a fight of monumental proportions on our hands. We are confident we can prevail with the remedies available to us with the support of all in the profession." To augment ACA’s legal efforts, individual doctors of chiropractic and chiropractic state associations are being asked to take action by filing complaints with state regulatory agencies. In addition, doctors are encouraged to use ACA's ERISA pre-service template letters, found at www.ACAtoday.org/networks, to notify patients’ employers that the benefit they purchased for the employee is not accessible when medically necessary treatment is denied.

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FCER Comments on Study Revealing Deficit In Research on Manual Therapies for Tension-Type Headache

Norwalk, Iowa—The March 2006 issue of the Clinical Journal of Pain contains a systematic review of manual therapies research for the treatment of tension-type headache (TTH). After review of clinical and randomized controlled trials, published in English since 1994 and listed in MEDLINE, EMBASE, AMED, MANTIS, CINAHL, PEDro, and Cochrane databases, the researchers concluded that there is “no rigorous evidence that manual therapies have a positive effect in the evolution of TTH.” While these results are alarming, Anthony L. Rosner, Ph.D., LLD (Hon), Director of Research for the Foundation for Chiropractic Education and Research, admits that “regarding spinal manipulation, the most important aspect to carry away from this paper is that as a specific modality it may yet lack definitive supporting evidence in the management of tension-type headache.” The same is not true for cervicogenic headache (which this current study did not examine). For cervicogenic headache, there is high-quality evidence which suggests benefits specifically attributed to spinal manipulation. Dr. Rosner adds that “of all the healthcare providers able to distinguish between the types of headaches with an accurate diagnosis and then apply an appropriate therapy, it would appear that chiropractors more than any of the other alternatives are the best equipped to do so.” Even so, the chiropractic community must be aware that key areas of research are glaringly absent for the headaches and other conditions which they see on a regular basis. Such topics as the effects of the specific technique applied or its frequency and distribution over time are only now beginning to be addressed—and there is a long way to go. Outcome studies for pediatric headaches have yet to be published. The only way in which chiropractic is going to gain validation and reimbursement in these areas is through research, and it is through the support of FCER and its awarding of grants to deserving investigators within the chiropractic field that this goal can best be met. In the last 20 years alone, FCER—with the help of substantial financial input from NCMIC Insurance Company—has funded over $10 million in chiropractic research. Though every practicing D.C. has anecdotal, practice-based evidence supporting chiropractic efficacy for numerous conditions, that evidence will never be incorporated into systematic reviews. Quality published research is the only way that chiropractic will gain the respect it deserves in scientific circles. Please help chiropractic gain that respect today—join FCER. For more information on FCER, please go to www.fcer.org. FCER is a 501(c)(3) non-profit organization.

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THE INCREDIBLE SHRINKING MANDATE

MEMORANDUM IN SUPPORT OF A.4527/S.3340: INSURANCE EQUALITY The NYSCA Legislative Committee has been working diligently with lobbyist Don Mazzullo in an effort to promote the Insurance Equality Bill to the New York State Senate and Assembly. Accordingly, Mr. Mazzullo has composed the attached position paper, designed to enlist backing for this important bill, which has been distributed to all New York State legislators. NYSCA encourages all of its members to review the attached memorandum, since passage of the Insurance Equality Technical Corrections Bill is of great importance to all Doctors of Chiropractic in New York State

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New York Assemblyman George S. Latimer offers suggestions on how to best accomplish our legislative objectives

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

American Chiropractic Association Files Lawsuit Against ACN in Federal Court

The American Chiropractic Association (ACA) today asked the U.S. District Court in Miami to allow ACA to join as a plaintiff in the pending nationwide class action lawsuit Solomon v. Anthem, et al., and further asked that ACN Group, Inc. and United Healthcare Services, Inc. be named as additional defendants in the case. The ACA alleges that ACN participated with other managed care companies in the case in a conspiracy to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment. ACA, along with other national and state health care associations, individual doctors of chiropractic and other health care providers, challenge the utilization review and payment practices of some of the nation’s largest managed care companies, including Health Net, Humana, PacifiCare Health Systems, Aetna, United Healthcare, Wellpoint Health Networks and Prudential. The case alleges that these companies, including ACN, violated the Racketeer Influenced and Corrupt Organizations (RICO) Act by systematically and illegally denying, delaying, and diminishing payments owed to chiropractors and other health care providers. Joining the ACA in its efforts against managed care companies, particularly ACN, is the Connecticut Chiropractic Association, who is also seeking to be named as a plaintiff in the litigation. The Florida Chiropractic Association is also a plaintiff. “There is simply no greater priority for ACA than to oppose what we view as the abusive tactics of ACN and other managed care organizations who systematically deny needed chiropractic care to our patients,” said ACA President Richard G. Brassard, DC. “Doctors from across the country have provided us with reports of intimidation and coercion conducted under the guise of utilization control. This can no longer be tolerated by a profession dedicated to quality patient care. The ACA intends to expend every effort and seek every possible legal remedy to put a halt to these harmful practices.” The suit calls into question the use of financially expedient cost and actuarial criteria rather than appropriate bases of medically necessary treatment for utilization review, and alleges that these criteria are purposely imposed on providers with the knowledge that they cannot be met. Through this legal action, ACA will seek damages against ACN and the other defendants in the case on a class-wide basis. It will also seek to obtain injunctive relief to bring an end to what it views as the abusive practices and procedures of ACN. “Our case involves protection of the doctor-patient relationship as to whether care will be provided on the basis of medical necessity, or based on what we believe are contrived policies and statistics skewed to maximize profits for managed care organizations such as ACN,” said ACA Chairman Lewis Bazakos, DC. Specifically, the complaint states the defendants, including ACN: -- Systematically refused to compensate health care providers for covered services; -- Processed health care providers’ claims using either automated programs which manipulate standard coding processes or use unqualified personnel to determine whether or not the service provided was medically necessary and covered; -- Downcoded and bundled legitimate claims to less costly procedures; -- Arbitrarily refused or reduced payment for certain categories of treatment; -- Systematically failed to recognize valid assignments of benefits; and, -- Delayed payments to health care providers by requesting additional documentation, even when such documents should not be required. The ACA’s overall campaign to correct the harmful practices of some managed care networks is an outgrowth of a resolution passed by the ACA House of Delegates in March 2002 formally outlining ACA’s opposition to the improper practices of chiropractic networks. “Doctors are being forced out of their practices daily by the abusive tactics of ACN and other managed care organizations. The ACA has listened to these doctors and other doctors practicing under the threat of unwarranted terminations,” Dr. Brassard said. “Like the generations of chiropractors before us, the ACA will not back away from its responsibility to protect the profession and the patients we serve. We ask the entire profession to unite with us in this effort, as the outcome will profoundly affect the way chiropractic care is provided now and in the future.” Actions at the State Level In addition to the filing of this national class action, ACA—in cooperation with several state chiropractic associations—is actively engaged with a number of state attorneys general, offices of insurance and boards of licensure, and the Federation of Chiropractic Licensing Boards (FCLB) regarding the tactics undertaken by ACN. To help augment the legal efforts underway by ACA, individual doctors of chiropractic and chiropractic state associations are being asked to take action by filing complaints with state regulatory agencies. Furthermore, doctors are encouraged to use ACA’s ERISA pre-service template letters, found at www.ACAtoday.org/networks, to notify a patient’s employer that the benefit they purchased for the employee is not accessible when medically necessary treatment is denied. To view copies of pleadings filed by ACA in the U.S. District Court in Miami, or for more information on ACA's managed care initiatives, visit ACA's Chiropractic Networks Action Center.

FDA Acts to Improve Drug Safety and Quality

The Food and Drug Administration (FDA) announced the strengthening of its efforts against unapproved drug products. The activity will begin with prescription products containing the antihistamine carbinoxamine because of safety concerns regarding their use in children under 2 years of age. The agency is issuing a final guidance document outlining its approach to addressing other medicines that are marketed without FDA approval. The first action under the new guidance, "Marketed Unapproved Drugs--Compliance Policy Guide," concerns carbinoxamine-containing products. Carbinoxamine-containing products require FDA approval to be marketed, but numerous products containing carbinoxamine, either alone or in combination with other active ingredients, are marketed without FDA approval. To date, FDA has approved two carbinoxamine products for various allergic symptoms. Many unapproved carbinoxamine products are labeled for treatment of cough and cold symptoms, an indication for which carbinoxamine has not been found safe and effective by FDA. Many companies are selling carbinoxamine drops and syrups that are specifically labeled for use in children as young as one month of age. Carbinoxamine has never been studied in very young children, and FDA cannot predict how they will respond to it. However, children under 2 years of age are more susceptible to drug-related adverse events, in part due to the immaturity of their systems. FDA estimates that there are several hundred different unapproved active ingredients in prescription drugs on the market. The agency estimates that less than 2 percent of prescribed drugs are unapproved. "Right now, many unapproved drugs represent a public health threat because consumers wrongly assume that these widely marketed and available drugs are approved and have been found to be safe and effective by the FDA," said Acting FDA Commissioner Dr. Andrew von Eschenbach. "While we want to ensure continued patient access to necessary treatments, as a physician I feel strongly that patients expect and deserve all their prescription medicines to be FDA approved. These unapproved drugs have bypassed the agency approval process through which FDA ensures, based on reliable scientific data, that marketed drugs are safe, effective, properly manufactured, and accurately labeled." Many of the unapproved drugs affected by today's final guidance, including the antihistamine carbinoxamine, are medicines that were developed and marketed before successive changes to the drug approval process that is established in the Federal Food, Drug, and Cosmetic Act. FDA approval guarantees that a product has been reviewed and will be consistently monitored for safety, effectiveness and adherence with manufacturing quality standards. "Unapproved drugs may not meet modern standards for safety, effectiveness, quality, and labeling. Clearly this is a problem we intend to fix," said Dr. Steven Galson, Director of FDA's Center for Drug Evaluation and Research. Health care providers are often unaware of the unapproved status of some drugs and have continued to unknowingly prescribe unapproved drugs because the drugs' labels do not disclose that they lack FDA approval. Often these drugs are advertised in reputable medical journals or are included in widely used pharmaceutical references such as the Physicians' Desk Reference (PDR). Under the guidance issued today, FDA is encouraging companies to comply with the drug approval process and seek approval for their products, as well as safeguarding consumer access to important medicines. The guidance identifies as the highest priority for agency enforcement action those unapproved products that are most likely to pose a risk to public health. The guidance explains that FDA intends to continue to give priority to enforcement actions involving unapproved drugs (1) with potential safety risks, (2) that lack evidence of effectiveness, and (3) that constitute health fraud. It also explains how the agency intends to address those situations in which a company obtains FDA approval to sell a drug that other companies have long been selling without FDA approval. Those manufacturers that do not comply with drug approval requirements may be subject to enforcement action. Today's actions are part of FDA's broader initiative, launched last year, to ensure that consumers and the health care community are provided with established and emerging drug safety information so that they can make the best possible medical decisions about the safe and effective use of drugs. The agency is committed to working with companies to facilitate the process of ensuring that products are safe and effective and meet appropriate standards for manufacturing and labeling. It is noted that some unapproved drugs may provide benefits. However, since these unapproved drugs are not approved by the FDA, the agency recommends that patients and health care professionals carefully consider the medical condition being treated, the patient's previous response to the drug, and the availability of approved alternatives for treatment.

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THE SENECA FALLS HEALTH CENTER CONTINUES TO EVOLVE

The Seneca Falls Health Center located on the campus of New York Chiropractic College is offering new services in an effort to better meet the needs of the community and to broaden its complementary healthcare therapies. The additions include mental health care, podiatry, and dyslexia correction. The center will continue to provide chiropractic care, internal medicine, massage therapy, acupuncture and oriental medicine. Terry Crane McDonald, Licensed Master Social Worker (LMSW) in the state or New York, recently began providing mental health care at the Seneca Falls Health Center (SFHC). Her practice provides individual, family and group therapy and covers such areas as marital and family issues; building healthy relationships; child and adolescent behavioral problems; ADD/ADHD; parenting; domestic abuse; alcohol and drug abuse and addiction, sexual identity; education and vocation; spirituality; anxiety and panic; depression; stress; grief; meditation, relaxation; self-esteem, assertiveness and empowerment; anger management; and obsessive/compulsive disorders. Terry says people often seek counseling when they feel “stuck.” Becoming more aware of who they are helps introduce a renewed power, freedom and happiness. Psychotherapy can help this effort. Ms. McDonald earned a bachelor’s in social work from Marycrest International University and her Master of Social Work from St. Ambrose University. She completed family development leadership training at Cornell University, and is a member of the National Association of Social Work. Drs. Carrie O’Neill, DPM, and Vicki Miller-Savard, DPM, of Complete Foot Care, also recently opened an office at the Health Center. They offer a wide range of podiatric care - specializing in foot surgery and the treatment of many common ailments such as fungal nails; in-grown toe nails; plantar warts; heel pain; bunions; hammer toes; and fallen arches. Foot care knows no age limits and both pediatric and senior patients are welcomed. The doctors, excited about their new centralized location, feel it will facilitate treatment of patients from Seneca Falls and the surrounding communities. Complete Foot Care has been located in the Finger Lakes region since 2004. They plan to continue hours at their Newark, NY, office and to maintain privileges with Geneva General, Newark and Clifton Springs hospitals. Dr. O’Neill is a graduate of Elmira College and Temple University and Dr. Miller-Savard is graduated from Cornell University and the Dr. William M. Scholl College of Podiatric Medicine. Both are members of the American and New York State Podiatric Medicine associations. The Seneca Falls Health Center now offers a dyslexia correction program implemented by Lisa Anderson, a certified Davis Dyslexia Correction® Facilitator, licensed with Davis Dyslexia Association International. She operates a learning center that focuses on the root causes of learning difficulties and uses the individual’s own strengths and talents to help overcome these difficulties. Her clients learn to recognize and correct disorientations; focus attention; eliminate confusion in words, symbols and numbers, and increase self confidence and ability in reading, writing, math and physical skills. The learning center provides individualized programs to help children and adults who experience difficulties in reading, writing, spelling, math, listening comprehension, ADD/ADHD, handwriting and motor coordination. Lisa says that early intervention is beneficial in improving academic performance in children, but as long as the client is motivated, it is never too late for help. She was inspired to become a Davis Facilitator after her son, a dyslexic, found success from the program. Ms. Anderson possesses a bachelor’s degree from the University of Rochester, earned her Master of Science in Education at SUNY Cortland and is a full time teacher at Mynderse Academy in Seneca Falls. To make an appointment or for more information about these or any of the health care services available at the Seneca Falls Health Center, please call the Center at 315-568-3166.

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The use of over the counter painkillers shown to increase risk to the heart

Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials Patricia M Kearney, Colin BaigentJon Godwin, Heather Halls, Jonathan R Emberson, Carlo Patrono Abstract Objective To assess the effects of selective cyclo-oxygenase-2 (COX 2) inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of vascular events. Design Meta-analysis of published and unpublished tabular data from randomised trials, with indirect estimation of the effects of traditional NSAIDs. Data sources Medline and Embase (January 1966 to April 2005); Food and Drug Administration records; and data on file from Novartis, Pfizer, and Merck. Review methods Eligible studies were randomised trials that included a comparison of a selective COX 2 inhibitor versus placebo or a selective COX 2 inhibitor versus a traditional NSAID, of at least four weeks' duration, with information on serious vascular events (defined as myocardial infarction, stroke, or vascular death). Individual investigators and manufacturers provided information on the number of patients randomised, numbers of vascular events, and the person time of follow-up for each randomised group. Results In placebo comparisons, allocation to a selective COX 2 inhibitor was associated with a 42% relative increase in the incidence of serious vascular events (1.2%/year v 0.9%/year; rate ratio 1.42, 95% confidence interval 1.13 to 1.78; P = 0.003), with no significant heterogeneity among the different selective COX 2 inhibitors. This was chiefly attributable to an increased risk of myocardial infarction (0.6%/year v 0.3%/year; 1.86, 1.33 to 2.59; P = 0.0003), with little apparent difference in other vascular outcomes. Among trials of at least one year's duration (mean 2.7 years), the rate ratio for vascular events was 1.45 (1.12 to 1.89; P = 0.005). Overall, the incidence of serious vascular events was similar between a selective COX 2 inhibitor and any traditional NSAID (1.0%/year v 0.9%/year; 1.16, 0.97 to 1.38; P = 0.1). However, statistical heterogeneity (P = 0.001) was found between trials of a selective COX 2 inhibitor versus naproxen (1.57, 1.21 to 2.03) and of a selective COX 2 inhibitor versus non-naproxen NSAIDs (0.88, 0.69 to 1.12). The summary rate ratio for vascular events, compared with placebo, was 0.92 (0.67 to 1.26) for naproxen, 1.51 (0.96 to 2.37) for ibuprofen, and 1.63 (1.12 to 2.37) for diclofenac. Conclusions Selective COX 2 inhibitors are associated with a moderate increase in the risk of vascular events, as are high dose regimens of ibuprofen and diclofenac, but high dose naproxen is not associated with such an excess. BMJ 2006;332:1302-1308 (3 June), doi:10.1136/bmj.332.7553.1302 Patricia M Kearney, clinical research fellow1, Colin Baigent, reader in clinical epidemiology1, Jon Godwin, research fellow1, Heather Halls, research assistant1, Jonathan R Emberson, senior statistician1, Carlo Patrono, professor of pharmacology2 1 Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford OX3 7LF, 2 Department of Pharmacology, University of Rome "La Sapienza," Rome, Italy

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CCGPP releases draft of best practice

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

DR. VERNON TEMPLE ELECTED PRESIDENT OF NBCE

GREELEY, Colo.—Vernon R. Temple, D.C., of Bellows Falls, Vt., was elected as director-at-large and president of the National Board of Chiropractic Examiners during the Annual Meeting on May 6, 2006 in Portland, Ore. Dr. Temple was first elected to serve the National Board as District III director in the year 2000. He has previously served on the NBCE Executive Committee as secretary and vice president. In his work on the NBCE Board of Directors, Dr. Temple has also chaired the Computerization Committee and the Special Purposes Examination Committee. Dr. Temple is a graduate of Palmer College of Chiropractic in Davenport, Iowa, and has been in practice in Vermont since 1978. He is a diplomate of the American Board of Chiropractic Orthopedists. He is a former chairman of the Federation of Chiropractic Licensing Boards and has also served as president of the Vermont Board of Chiropractic Examination and Regulation. Headquartered in Greeley, Colorado, the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. The NBCE Executive Committee. Vernon Temple,DC - President Steve Willen, DC - Cchairman of the Board Jerry Blanchard, DC - Vice President Theodore Scott, DC - Treasurer Mary Ellen Rada, DC - Secretary Source: National Board of Chiropractic Examiners

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S.1955 FAILS ON PROCEDURAL VOTE!

(Washington, D.C - May 11, 2006) In a historic victory for chiropractors and their patients, S.1955, the Health Insurance Marketplace Modernization and Affordability Act, was withdrawn from the Senate floor today and effectively defeated when Democrats threatened to filibuster the bill. The controversial small business health plan legislation spurred an unprecedented grassroots lobbying campaign by the American Chiropractic Association and hundreds of provider and consumer groups that believed the bill would gut state patient protection laws and leave millions of patients without crucial health care benefits. “The ACA extends an enormous ‘thank you’ to the entire chiropractic profession – state associations, individual doctors, patients, students, chiropractic college leaders and other organizations – everyone who joined together to successfully defeat this potentially devastating legislation,” said ACA President Richard Brassard, DC. “A special thank you also goes out to our allies in Congress – Senators Tom Harkin, Jeff Bingaman, Ted Kennedy, Harry Reid and others – for their outstanding leadership on this important issue. Not only did we safeguard the health coverage of millions of patients across the country, but we also showed the nation’s decision makers that the chiropractic profession is a force to be reckoned with. I can assure you that your thousands of emails, faxes and phone calls to Congress, letters and news releases to local media organizations, and other grassroots efforts made the difference.” Deliberations on S.1955 began Tuesday, when Senate Democrats, in a procedural move, voted to allow the bill to advance to the Senate floor -- with debate limited to 30 hours. On Thursday afternoon, after Senate Majority Leader Bill Frist announced that debate would end and limited amendments to S.1955 would be considered, Senate Democrats voted against cloture and the bill was pulled from consideration. The defeat of S.1955 comes after a nearly two- month-long grassroots lobbying campaign kicked off in March at the ACA’s 31st annual National Chiropractic Legislative Conference (NCLC) in Washington, DC. During that meeting, ACA’s House of Delegates declared a “state of emergency” in response to S.1955 and committed to using “all available resources” to defeat the bill. Chiropractors nationwide joined together in the effort and flooded U.S. Senate offices with concerns about the bill. At the same time, ACA and a diverse coalition of labor unions, health care and consumer groups – including AARP, the American Cancer Society, the American Diabetes Association and the AFL-CIO -- shared information and resources in a national lobbying and media relations campaign to defeat the legislation. “Today, we can breathe a great sigh of relief,” added Dr. Brassard, “but only for a moment. The small business or association health plan concept is a popular one, and a new bill will almost certainly surface again in the very near future. The ACA will work to ensure that the chiropractic profession has a place at the table when a new proposal is developed, and we will once again call the chiropractic profession to action when necessary to ensure the health and well being of our patients.”

Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care

ABSTRACT Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood. Objective: To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care. Design: Observational cohort study. Setting: 2 managed care organizations. Patients: Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period. Measurements: Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview. Results: Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care. Limitations: Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage. Conclusions: Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality. Annals 2 May 2006 | Volume 144 Issue 9 | Pages 665-672

NYSCA Dignitaries Represent the Profession at New York State Democratic Committee’s Dinner

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

FCER Response to Ernst's Systematic Review of Spinal Manipulation

Norwalk, Iowa — In the April 1, 2006 issue of the Journal of the Royal Society of Medicine, Ernst and Canter summarized 16 systematic reviews published between 2000 and May 2005 on the effectiveness of spinal manipulation. The Foundation for Chiropractic Education and Research (FCER) is always open to results of research if the research proves to be of good quality and lacking bias. The biases in this study are painfully apparent, rendering the sweepingly negative “findings” little more than the authors’ personal opinions. Ernst and Canter concluded that these data do not demonstrate that spinal manipulation is an effective intervention for any condition.” According to them, the data fail to demonstrate that spinal manipulation is effective for treating back pain, neck pain, dysmenorrhea, infantile colic, asthma, allergy, cervicogenic dizziness, and any medical complaint. The exception was for back pain, where spinal manipulation may be superior to sham manipulation but not to conventional interventions. Considering the possibility of adverse events associated with spinal manipulation, the authors determined that their review "does not suggest that spinal manipulation is a recommendable treatment." This study is so far from what would be considered a methodical and robust systematic review without bias as to render it highly suspect if not meaningless. Its methods of analyses have not been validated but rather reveal the authors' own carelessness — if not outright distortion — of the literature which it cites. Many of its glaring defects are ones that the authors attempt to criticize in other work. It fails to grasp how the hypotheses and methods of analysis in the reviews that it cites are bound to deliver differing conclusions, such that Ernst and Canter go out of their way to criticize the positive findings of a single chiropractic author while overlooking their own consistently negative findings for chiropractic which appear in no less than 25% of the reviews that they include in their discussion. Finally, the authors fail to recognize the major flaws in several of the primary sources of data which comprise the systematic reviews under scrutiny in this research. There are issues surrounding the Ernst and Canter review that substantially undercut any prompt and uncritical acceptance of its conclusions. These include (1) the failure of systematic reviews and meta-analyses to consider subgroups of patients receiving treatment, (2) the design flaws of a large number of the randomized controlled trials which comprised the systematic reviews addressed in this report, (3) the failure to consider that modern evidence-based medicine is based upon clinical observation as well as randomized clinical trials, (4) the failure to adequately address the relative risks of other treatments available in conventional medicine for the conditions discussed in this review, and (5) numerous revelations of bias of one of the authors (Ernst) which have been amply demonstrated and refuted elsewhere. Under these circumstances, Ernst and Canter's study can be greeted only with the most extreme skepticism. In lacking many of the elements required for a meaningful presentation of the evidence required for supporting treatment alternatives, this current report should not be considered worthy of guiding a clinical decision. As such, the glaring weaknesses of the report only serve to undermine the public's confidence in science as a means to inform health policy.

Chiropractic Conference Brings the Nation’s Top Chiropractic Physicians Together to Determine Priority Areas for the Next 25 Years

DALLAS, TEXAS – February 27, 2006 – A consensus conference was held February 17 through February 19 at the National University of Health Science outside of Chicago to focus on recommendations in a plan of action for the chiropractic profession as a whole. Leading the Chiropractic Strategic Planning Conference was John J. Triano, D.C., Ph.D., who focused on issues of credibility and appropriate utilization of chiropractic care by the public. “It is nice to have a forum for our physicians to discuss the hurdles chiropractic care has to overcome, independent of formal professional association politics,” said Triano, who served as head of the conference’s steering committee. “Chiropractic care has come a long way in past years and this gives us a way to mold the profession to reach higher goals and better serve our patients in the future.” Attending the conference were leaders in chiropractic education, research and practice who heard recommendations from experts in the study of health professions, health care futurists, medicine and federal research programs. Together, the group worked to come to a resolution on important issues related to the current and future state of chiropractic care. Among the issues discussed were the barriers to and opportunities for greater integration and interprofessional cooperation. From these discussions, two distinct priority areas emerged, integrity and trust and equitable public support for education and research. (please see below for exact wording of resolution) Regarding the issue of integrity and trust, those in attendance focused on the inappropriate treatment and billing practices adopted by some members of the chiropractic profession that often place the economic interests of these chiropractors before the best interests of the patients. The attendees resolved that this treatment undermines public trust in all members of the chiropractic profession, whether they are participants in the practice or not. The other topic heavily discussed was equitable public support for education and research. Attendees at the conference voiced their concern of the absence of fair and equitable public funding and support for chiropractic education and research in both public and private institutions. Specifically, the conference found a lack of support within the academic and interdisciplinary environments, including participation with publicly funded universities and health care facilities. “I, along with the rest of the conference, urge the chiropractic profession along with its leaders and regulators to address the issue of integrity and trust among our profession,” said Triano. “I feel that the ultimate goal of improved quality care within the North American health care system can only be reached when all members of the profession, along with stakeholders, strive for and demand equitable public support for education and research within the chiropractic care sector.” Jim Winterstein, D.C. who also serves as a member of the steering committee added, “The chiropractic profession has much to offer the public in the way of health care. It is my hope that this planning process can begin to turn the tide toward greater cultural authority for the chiropractic profession and better care for our patients.” Future conferences are in the planning stages under the conferences multidisciplinary steering committee, which consists of professional journal editors, association leaders, a college president, private chiropractic practitioners and a medical physician who serves as director of the Samueli Institute. Formal Resolution by The Chiropractic Strategic Planning Conference: At the Chiropractic Strategic Planning Conference, leaders in chiropractic education, research, and practice resolved that the ongoing fuller integration of chiropractic education and practice within the North American health care system, and improved communication and collaboration between doctors of chiropractic and other health professionals, are in the interests of patients and all parties concerned. Following a review of the barriers to, and the opportunities for, such greater integration and interprofessional cooperation, the conference identified and acknowledged two priority areas that need to be addressed, namely: a. Integrity and trust. The inappropriate treatment and billing practices adopted by some members of the profession that place the economic interests of the chiropractor before the best interests of the patient undermines public trust in all members of the profession. b. Equitable public support for education and research. There is an absence of fair and equitable public funding and other support for chiropractic education and research in either public or private institutions. Specifically, there is a lack of support within the academic and interdisciplinary environments, including participation with publicly-funded universities and health care facilities. The Conference urges the chiropractic profession, and its leaders and regulators, to address the first above matter, and the profession and all other stakeholders to address the second above matter, to the ultimate end of improved quality care within the North American health care system. CONTACT INFORMATION: Wendy B. Kula, APR 972-991-5852 [email protected] Britney B. Chambers, MJ 972-991-5852 [email protected] The Chiropractic Strategic Planning Conference is lead by an interdisciplinary ad hoc steering committee of concerned professionals convened to address issues involved with the chiropractic care industry. Attendees and speakers at events are invited from lists of leaders, authors, scientists, practitioners and educators in chiropractic, medicine and law in North America. Members of the Samueli Institute and the National Center for Complementary and Alternative Medicine also attend the conference. A progressive, formal consensus process defining methods of improving professional transparency, accountability and appropriate utilization of these services are followed. The conference was initially conceived as a one-time event, but attendees voted that an additional meeting be convened during the spring or summer of 2006 to make further advances on critical patient care issues. For more information on the future event, please contact John J. Triano, D.C., Ph.D., at [email protected].

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MultiPlan Acquired by The Carlyle Group

Nation’s Largest Independent PPO Poised for Growth New York, NY – MultiPlan, Inc. and The Carlyle Group yesterday completed the previously announced acquisition by Carlyle of MultiPlan, the largest independent PPO in America. This acquisition will facilitate the growth of MultiPlan’s market share and expansion of its medical cost management solutions, which include the national PPO network, specialty networks, negotiation services and a claim transaction and information management engine. Mark Tabak, Chief Executive Officer of MultiPlan, said, “These are exciting times for MultiPlan, and MultiPlan is an exciting company for our time. We’re a significant player in a trillion-dollar market, and with new owners committed to our success we’re even better positioned for impressive growth.” Karen Bechtel, Managing Director and Co-head of Carlyle’s Healthcare Group, said, “We’re pleased to have gotten to this important stage. MultiPlan has the proven technology and management depth necessary to bring its growth plan to fruition. We look forward to supporting the company’s strategy and making this a successful investment.” Headquartered in New York, MultiPlan is the oldest and largest independent Preferred Provider Organization (PPO) network offering nationwide access to more than 4,300 hospitals, 100,000 ancillary care facilities and 450,000 physicians and specialists. MultiPlan serves a base of 2,000 large and mid-sized insurers, third-party administrators, self-funded plans, HMOs and other entities that pay claims on behalf of health plans. The company’s top 10 clients together deliver health coverage to more than 70 million Americans. About MultiPlan For 35 years, MultiPlan has helped healthcare payers and providers partner together to combat rising healthcare costs. MultiPlan serves as a single gateway to a host of primary, complementary and out-of-network strategies for managing the financial risks associated with healthcare claims. Clients include large and mid-sized insurers, third-party administrators, self-funded plans, HMOs and other entities that pay claims on behalf of health plans. About The Carlyle Group The Carlyle Group is a global private equity firm with $39 billion under management. Carlyle invests in buyouts, venture & growth capital, real estate and leveraged finance in Asia, Europe and North America, focusing on aerospace & defense, automotive & transportation, consumer & retail, energy & power, healthcare, industrial, technology & business services and telecommunications & media. Since 1987, the firm has invested $18.1 billion of equity in 463 transactions for a total purchase price of $73.2 billion. The Carlyle Group employs more than 650 people in 14 countries. In the aggregate, Carlyle portfolio companies have more than $46 billion in revenue and employ more than 184,000 people around the world.

Westchester Chiropractor Authors a Book on Being a Yankee Fan

The Power of the Yankee Fans New Book features all the characteristics and elements that define the Yankee faithful There is no doubt in professional sports that teams will never succeed without the support of their fans. In the case of the New York Yankees, their history in baseball is filled with many great moments, many unforgettable players and the fact that millions have cheered and supported them all through the years. Such a following is now a multi-generational phenomenon and readers can find out by joining author Joan Fallon as she presents an in-depth look at what being a Yankee fan is all about with the release of her exciting new book 27: The Voice of the Yankee Fans. 27 looks at what it will take for the Yankees to win their 27th world championship in the future as well as the fans’ role in that championship. Aside from showcasing the team’s fabled history and legendary players (including Babe Ruth and Mickey Mantle), the book also explains elements of the new and old baseball thinking, provide readers a unique look at fan participation in baseball, and finally it defines the Yankee fan as a unique individual whose love for the team can never be doubted or ignored. Thanks to its amazing content and compelling photography, and illustrations by the award-winning sports artist James Florentino, 27 is highly recommended to Yankee fans and baseball fans of all ages, and it will undoubtedly make them understand their role with the team. Even non-fans or spectators will find the book attractive not only to satisfy their interest in baseball but it will also give them the clearest definition of what is it really like to be a Yankee fanatic. For your reading pleasures, feel free to look for 27: The Voice of the Yankee Fans online at Xlibris.com, www.amazon.com and at major bookstores and libraries today! About the Author Dr. Joan Fallon, a New York chiropractor and former assistant professor at Yeshiva University and presently CEO of CureMark, a biotechnology company, is a life-long Yankee fan and student of the game. Wiith two major passions in her life baseball and children; “Dr. Joan” as she is called by her patients, has passed on her love of baseball and the Yankess to two generations of children in her office. A nationally-ranked squash player in college, “one-on-one” champion in High School and the first female to enter the Westchester County Jounior golf tournament, sports has always been a big part of her life. She has been honored to have a letter written to Mickey Mantle chosen for his farewell book: Letters To Mickey, as well as having authored numerous professional texts and papers. She takes great pride in her chiropractic pediatic practice as she is able to help numerous children, many of whom have developmental disabilities. As a patent holder and CEO of CureMark she hopes to bring significant help to children with ADD, ADHD, and autism in the very near future.

New York Assemblyman George S. Latimer offers suggestions on how to best accomplish our legislative objectives

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

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MASSACHUSETTS GOVERNOR SIGNS LANDMARK HEALTH INSURANCE REFORM BILL

Through private market reforms, all Massachusetts citizens to be insured by 2009 Governor Mitt Romney signed landmark legislation today that through a private, market-based reform will make health insurance available to every resident of Massachusetts within the next three years. “An achievement like this comes around once in a generation, and it proves that government can work when people of both parties reach across the aisle for the common good,” said Romney. “Today, Massachusetts is leading the way with health insurance for everyone, without a government takeover and without raising taxes.” The legislation was approved by a bipartisan 154-2 margin in the House of Representatives and a 37-0 vote in the Senate. It was signed at a Faneuil Hall ceremony attended by hundreds of people. “This would not have been possible without the courageous work of Senate President Travaglini, Speaker DiMasi, providers, insurers, consumer groups and all the other industry stakeholders who recognized an opportunity to do something historic,” said Romney. The law requires every individual in the state to purchase health insurance by July 1, 2007. Of the approximately 500,000 uninsured, about 100,000 are eligible for Medicaid, another 200,000 making less than 300 percent of the federal poverty level, but not eligible for Medicaid will receive premium assistance on an income-based sliding scale for policies with no deductibles, and another 200,000 with incomes above 300 percent FPL will be able to purchase lower-cost policies in the private market. Premium assistance will be financed by redirecting a portion of the $1 billion currently spent by state government on the uninsured. Beginning on January 1, 2008, failure by individuals to purchase health insurance will result in the loss of their state tax refund equal to 50 percent of an affordable health insurance premium. Penalties will be assessed for each month without creditable coverage. The creation of an entity, the Commonwealth Care Health Insurance Connector, will allow individuals to now purchase affordable plans on a pre-tax basis. The Connector will administer premium assistance for low-income individuals and facilitate employer contributions for both full-time and part-time workers and those working at more than one company. Eligible to purchase through the Connector are non-working individuals, working individuals at companies that do not offer health insurance, workers not eligible for coverage at their place of business such as part-timers, contractors and new employees, small businesses with 50 or fewer employees, and those who are self-employed. The legislation also enhances the goal of greater transparency in health care cost and quality through the collection and publication of data needed by consumers to make informed decisions. The information will allow consumers to compare the quality, track record and cost of hospitals and providers. The passage of the legislation moves Massachusetts closer to the implementation of a waiver that will allow the state to continue to receive $385 million in federal funding for each of the next two years. The waiver was negotiated by Governor Romney and Senator Kennedy last year, and was dependent on the state developing a “demonstration project” to reduce the rate of uninsured. The Executive Office of Health and Human Services has already begun providing details of the Massachusetts plan for review by federal Medicaid officials. Former U.S. Health and Human Services Secretary Tommy G. Thompson commended Governor Romney for signing what Thompson termed “groundbreaking legislation to provide health coverage to all Massachusetts families.” “Massachusetts is showing us a better way, one I hope policy makers in Statehouses and Congress will follow to build a healthier and stronger America,” said Thompson, a former Republican governor of Wisconsin. The Governor vetoed the creation of a new fee on businesses. The $295 per employee fee would have been assessed to employers with 11 or more full-time workers who do not offer and contribute to their employees’ health insurance. The Governor said the fee is “not necessary to implement or finance health care reform.” The Governor also vetoed a provision to provide dental benefits to adult Medicaid recipients, which will cost $75 million annually. Romney said the benefits expansion is financially unsustainable and noted that it provides a service not offered by most Massachusetts employers. Sixty percent of employers in Massachusetts do not provide dental coverage to their workers.

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