Texas Chiropractic Association

Texas Journal of Chiropractic

Volume XXV, Issue 1 First Quarter 2011

The Texas Legislature ConvenesNew Chiropractic Advocacy WebsiteCapitol NewsTMA v TBCE Legal Brief Outlines StoryInsurance Changes Discriminatory policiesMDs in CongressTBCE Rules ChangesThe PR of Disease

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Texas Chiropractic Association

Texas Journal of ChiropracticVolume XXV, Issue 1 First Quarter 2011

Inside

Texas Legislature, Now Open! ! ! ! 3

Capitol News Week 1! ! ! ! ! 4

TMA v TBCE Appealed; Legal Brief Outlines Story! 8

MDs in Congress: 3.36% of Membership !! ! 12

TBCE Announces Two Final Rules and One New Rules Proposal! ! ! ! ! ! ! 13

Ibuprofen and Migraines: Half-way effective.! ! 16

United Healthcare's Response to "Non-essential" Chiropractic Service! ! ! ! ! ! ! 16

DON'T Avoid the Draft!! ! ! ! ! 17

Chiropractic Advocacy Website Unveiled!! ! 17

Kaiser Reverses Adverse CMT Policy! ! ! 18

STARTING with Chiropractic Saves 40% on Low Back Pain Care! ! ! ! ! ! ! ! 19

The PR of Disease! ! ! ! ! ! 19

The AMA's Gift to Chiropractic?! ! ! ! 20

College News! ! ! ! ! ! 22

In Other News ! ! ! ! ! ! 24

Publication of an advertisement does not imply approval or endorsement by the Texas Chiropractic Association. The association shall have the absolute right at any time to reject any advertising for any reason.

For advertising rates contact the TCA Office. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type. Copyright 2011 All Rights Reserved: Texas Chiropractic Association

Texas Journal of ChiropracticThe Official Publication of

The Texas Chiropractic Association

1122 Colorado, Suite 307Austin, TX 78701

Phone: 512 477 9292Fax: 512 477 9296

E-mail: info@chirotexas.orgwww.chirotexas.org

Executive OfficersPresident: Ed Fritsch D.C.

President Elect: Jorge Garcia D.C. Secretary: Jack Albracht D.C.

TCA StaffExecutive Director: Patte Kent

Communications Director: Chris Dalrymple D.C.

Legislative Director: Chip Kent

Board of DirectorsDistrict 1! Dan Petrosky D.C.District 2! Jon Blackwell D.C.District 3! Jason Clemmons D.C.District 4! Mark Bronson D.C.District 5! Dr. John Quinlan D.C.District 6! Cody Chandler D.C.District 7! David King D.C.District 8! Robert Hoffman D.C.District 9! James Welch D.C.District 10! Shane Parker D.C.District 11! Max Vige D.C.District 12! Yvonne Landavazo D.C.

PoliciesAnnual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. Contact the TCA for subscription rates for non members.

The print Texas Journal of Chiropractic is published up to four times per year by the Texas Chiropractic Association under the supervis ion of the TCA Publ icat ion Committee.

Opinions expressed are those of the contributors and do not necessarily reflect the policy of the Texas Chiropractic Association or the Texas Journal of Chiropractic.

Texas Legislature Opens January 11The Legislature of the State of Texas is a bicameral (two-chambered legislative body composed of a 31-member senate and a 150-member House of Representatives.

T h e L e g i s l a t u r e i s t h e constitutional successor of the Congress of the Republic of Texas since Texasʼ entry into the United States in 1845.

The Legislature meets in regular session beginning the second Tuesday in January of each odd-numbered year. The regular sessions are limited to 140 calendar days.

The Lieutenant Governor, elected by separate statewide election, presides over the Senate.

The House members elect their own Speaker of the House to preside over the House of Representatives.

Both the Lt. Governor and the Speaker of the House have wide latitude in choosing the committees of their legislative houses, thereby exerting a l a r g e i m p a c t o n t h e development and enacting of laws within the state.

Only the Governor may call the Legislature into special sessions, unlike other states where the legislature may call i t se l f in to sess ion. The Governor may call as many sessions as desired. The

Texas Constitution, however, limits the duration of each special session to 30 days and lawmakers may consider only those issues designated by the Governor in his "call," or proclamation convening the special session (though other issues may be added by the Governor during a session).

B i l l s p a s s e d b y t h e Legislature take effect 90 days after its passage unless two-thirds of each house votes to give the bill either immediate effect or earlier effect. The Legislature, of course, may provide for an effective date that is after the 90th day. Most bills are given

3 Texas Journal of Chiropractic

Call for Keeler Award NominationsEstablished in 1934 by Dr. Clyde Keeler, The Texas Chiropractic

Association’s award designating the Chiropractor of the year, The Keeler Plaque, is Texas Chiropractic’s most prestigious award.

Nominations for the Keeler Plaque should be sent to:

Dr. Curtis McCubbinSecretary, Keeler Plaque Committee

P. O. Box 272Hunt, Tx 78024

All nominations will be held in strict confidence to assure that the recipient will be surprised when their name is announced.

A candidate shall be:

A member in good standing in the TCA

Of good moral character

A promoter of chiropractic advancement in at least one of the three years immediately proceeding the year in which the award is to be presented. Such advancement may be in research, public relations,

school participation, promotion or support.

The candidate’s main endeavor must be in the practice of chiropractic and must have promoted chiropractic throughout their career.

Civic, church or community involvement, individually or within organizations or groups, and holding offices in local, state or national

chiropractic organizations, chiropractic boards, and chiropractic college boards may also be considered.

a n e f f e c t i v e d a t e o f September 1.

State legislators in Texas make $600 per month, or $7,200 per year, plus a per d i e m w h i c h i s p a i d t o legislatures at $128 for every day the Legislature is in session. That adds up to $17,920 a year for a regular session (140 days).

Members of the 82nd Texas Legislature may be found online.

CLICK HERE FOR MEMBERS OF TEXAS

HOUSE OF REPRESENTATIVES

----

CLICK HERE FOR MEMBERS OF THE TEXAS

SENATE

----

CLICK HERE TO FIND OUT SPECIFICALLY WHO REPRESENTS YOU

Capitol News... Week 1

Governor Addresses Lawmakers

T h e A u s t i n A m e r i c a n Statesman REPORTS HERE that"As Texas lawmakers opened their 82nd biennial session grappling with how to plug a whopping $27 billion hole in the budget, Gov. Rick

Perry amped up the agenda by fast-tracking two hot-button issues for action: private p r o p e r t y r i g h t s a n d immigration."

"A day usually reserved for pomp and circumstance was also marked by drama. On the House side, Speaker Joe Straus was elected with some resistance after months of boisterous opposition from tea pa r t y and conse rva t i ve activists. And in the Senate, Sen. Steve Ogden, the upper chamber's chief budget writer, outlined why cuts to education and health care programs will be necessary."

"Perry said in proclamations to the Senate and House that he was des igna t i ng as "emergency" issues the protection of private property rights in eminent domain cases and the abolition of so-called sanctuary cities. The des ignat ion means tha t legislation on those issues can be fast-tracked for quick approval."

"As the governor discussed priorities, lawmakers and new members took their oaths of office. In the House .... there was more theater over the speaker's race. Straus had all but locked up his re-election to the chamber's top job Monday when 70 Republicans said they would vote for him. The pledges effectively killed the efforts of Rep. Warren Chisum, R-Pampa, and Rep. Ken Paxton, R-McKinney, who had tried to unseat him for not being conservative enough."

Texas Journal of Chiropractic 4

Call for Nominations for Young Chiropractor of the Year

Established over half a century ago, this award is for the purpose of recognizing doctors who have shown

outstanding dedication and who have made long-lasting contributions to the profession and their community, and who are under 40 years of age at the time of the award’s

receipt. Send nominations to 2010 recipient:

Dr. Jon D. Blackwell, D.C.6109 Ridgewood

Amarillo, Tx 79109 or via email at jon@nts-online.net

Check www.chirotexas.org Click HERE for the “Texas Journal of Chiropractic”

"On Tuesday, only 15 of the 150-member body voted a g a i n s t S t r a u s . T w o lawmakers were present but didn't vote..."

Joe Straus Elected House Speaker

I n a n a r t i c l e REPORTED HERE the Statesman notes "The re-election of Texas House Speaker Joe Straus to begin the 2 0 1 1 l e g i s l a t i v e s e s s i o n T u e s d a y showed that the tea party, while a potent force in Texas politics, is not the dominant force. For months, activists used e-mails, social media and phone calls to try to rally opposition to Straus, who, no matter what he does, seems unable to s h a k e t h e l a b e l o f a moderate."

"In conversations throughout the duration of the speaker's race, lawmakers, staffers and lobbyists have pointed to a number of reasons for Straus' win. For one, he was helped by lawmakers' reverence for the traditions of the House and the relationships formed within. Even some of the House's most conservative lawmakers rejected the notion that keyboard-happy activists and the fear of defeat in the next Republican primary w o u l d b u l l y t h e m i n t o abandoning a speaker whom most find approachable and fair-minded."

"To be fair, that there has even been a discussion about a speaker's race during the past couple of months is a testament to the strength of

the tea party in Texas. After Republicans won a legislative majority larger than any expert anticipated on Nov. 2, Straus was quick to produce a l i s t o f m o r e t h a n 1 2 0 lawmakers who pledged to support him for speaker on the first day of the session. ... But defeating Straus seemed to become a preoccupation of many supporters of the tea party movement."

"Some Republican members r e s p o n d e d b y p u b l i c l y declaring their opposition to the speaker. But most either hedged their bets or stuck with him as it became clear that, regardless of who the speaker was, the House was m o v i n g i n a m o r e conservative direction."

"A number of other factors worked to Straus' advantage.

For one, after an emotionally charged, prolonged battle for the speakership in 2009, w h e n S t r a u s b e a t conservative favorite Tom

C r a d d i c k , m a n y lawmakers did not have the stomach for ano the r speake r ' s fight. It helped that Straus had given rank-and-file members more control over legislation than Craddick, who c e n t r a l i z e d considerable power in the speaker's office."

Senator Hutchison Announces End of

Tenure

The Austin American Statesman REPORTS HERE that "U.S. Sen. Kay Bailey Hutchison said Thursday she won't seek re-election next year, ending a nearly 20-year tenure in Washington and opening up one of the best jobs in Texas politics."

"When my current term is up, I will have served Texas for 19 years in the United States Senate," Hutchison said in a statement. "I intended to leave this office long before now, but I was persuaded to continue in order to avoid disadvantage to our state."

Lt. Gov. David Dewhurst said "While my focus remains on the challenges we face here at the state level and making t h e u p c o m i n g s e s s i o n successful, I fully intend to explore running for the United States Senate."

5 Texas Journal of Chiropractic

" H u t c h i s o n , a f o r m e r U n i v e r s i t y o f T e x a s cheerleader, TV reporter and state lawmaker who first won the Senate seat in 1993, has long been one of the most popular politicians in Texas. But her stock dropped last year when she badly lost a challenge to Gov. Rick Perry in the Republican primary. Hutchison had said that she would resign the Senate seat after that primary, win or lose, but she changed her mind shortly after the race and left open the possibility that she would run again in 2012. T h o u g h s h e h a s b e e n indecisive about her plans at several points during the past couple of years, Thursday's announcement is, by all indications, final."

"Hutchison said … that she would be forever grateful for the chance to serve in the Senate. 'I will now look forward to living full time in Texas with my family," she said, "and to keep working for our state's interests as long as I live.'"

Sunset Commission Advocates Agency Changes

T h e A u s t i n A m e r i c a n Statesman REPORTS HERE that "The Sunset Advisory Commission came out with a n u m b e r o f n o t a b l e recommendations …."

“In a surprise vote, the state Sunset Advisory Commission d e c i d e d u n a n i m o u s l y Wednesday to do away with

the Texas Youth Commission and the Juvenile Probation Commission and merge it into a single agency that would oversee all state corrections programs for youths."

“A panel of lawmakers issued fi n a l s u n s e t r e v i e w s Wednesday for nine state agencies, recommending that t h e fi v e - m e m b e r Te x a s Transportation Commission be abolished and that the Texas Youth Commission and the Texas Juvenile Probation Commission merge, among a

slew of other changes. The 12-member Sunset Advisory Commission also voted to change the name of the Texas Railroad Commission to the T e x a s O i l a n d G a s Commission, and said it should be headed by a single elected commissioner instead of the three who now govern it. The name change would better reflect the agencyʼs duties as regulator of the stateʼs oil and gas industry, Sunset staff concluded. The panel rejected Rep. Rafael

Anchiaʼs recommendation that a single elected commissioner replace the three-member appointed board overseeing the Texas Commission on Environmental Quality.”

“Gov. Rick Perry could gain even tighter control over the Te x a s D e p a r t m e n t o f Transportation under a series o f p r o p o s a l s a p p r o v e d Wednesday by the Texas Sunset Advisory Commission. The panel voted 7-5 to abolish t h e fi v e - m e m b e r Te x a s Transportation Commission and place the department under the authority of a s i n g l e s t a t e w i d e commissioner. Perry would appoint that commissioner, just as he has all five of the highway chiefs who now oversee the department, and the appointment would have to be confirmed by the Senate.”

Stage Set for Budget Release

The Statesman REPORTS H E R E t h a t " H o u s e

Appropriations Committee Cha i rman J im P i t t s , R-Waxahachi … echoed the commitment to Texans that the state will not raise taxes to balance the state budget."

" B u t s o m e m e m b e r s ʼ opposition to any new sources of state revenue might soften a bit once legislators see the concrete and local effects of balancing the 2012-13 budget by cuts alone, Pitts said at a talk sponsored by the Texas Tribune.

6Texas Journal of Chiropractic

That budget will match the $72 billion revenue estimate unvei led by Comptro l ler S u s a n C o m b s . . . a n d assumes no new revenue nor use of the $9.4 billion rainy day fund. Combsʼ estimate is $15 billion less than what was appropriated for general state operations in the 2010-11 budget and $27 billion shy of the amount agencies say they need to maintain the current level of services. ʻThere are no sacred cows this session,ʼ Pitts said.”

"The stateʼs top priorities, however, will remain so. They will get the same proportion of state dollars, just drawn from a smaller pot. Under that equation, public education, for example, would get $4 billion less than the $36 billion in the current general fund budget."

House Members Agree to Cut Their Own Budgets

R E P O RT E D H E R E , t h e Statesman notes "Members of t h e T e x a s H o u s e o f Representatives voted ... to cu t t he i r own budge ts , essentially a symbolic cost-cutting measure but one that could also end up shaving the salaries of some staffers."

"When he introduced House Resolution 3, Rep. Charlie Geren, R-Fort Worth, told his fellow House members to lead by example as they head into a chal lenging legislat ive session."

"Members will have to find ways to save money this session, and each state agency could have to cut at least 10 percent of their b u d g e t s a s l a w m a k e r s prepare to tackle a potential $27 billion budget shortfall."

"After todayʼs vote, each member of the 150-member chamber will have his or her operat ing budget cut to $11,925 a month, down 10 percent from $13,250 per month."

"The Houseʼs move ... wonʼt significantly affect the massive shortfal l . But Rep. Mark Strama, D-Austin, said that since lawmakers will ask agencies to cut their budgets, they should live by the same rules."

".... members will have to decide to cut the salaries of their staff members, lay off people or supplement staff salaries with campaign funds."

More Tort Reform

HERE the Statesman reports "Gov. Rick Perry made the case for comprehensive tort law reform ... at a breakfast sponsored by the Texas Public Policy Foundation, which advocates for smaller government . Per ry sa id lawsuit abuses are hindering Texasʼ otherwise welcoming business climate."“I hope the 82nd Legislature will consider improving our important tort protections during this session of the Legislature, with even greater

accountability, transparency and efficiency,” he said. “Victims of frivolous lawsuits shouldnʼt have to bear the financial burden of defending themselves.”

"The governor advocated a “loser pays” approach to such l i t igation, and called for expedited trials for lawsuits involving between $10,000 and $100,000 ...."

More Body Guards

The Statesman REPORTS HERE that "Executive security i n T e x a s i s n o t j u s t gubernatorial anymore and has been expanded to include the state's three other top officials after "credible threats" were documented. Lt. Gov. David Dewhurst confirmed ... that he had been provided state bodyguards on an as-needed basis starting last mon th , as have House Speaker Joe Straus and A t t o r n e y G e n e r a l G r e g Abbott."

"For years, the governor was the only top official with an executive security detail, a l though the l i eu tenan t g o v e r n o r, s p e a k e r a n d attorney general have been put under protection for short periods because of threats."

"For their part, DPS officials r e m a i n e d m u m o n t h e change. They would not discuss any additional cost. 'We do not discuss security at t h e C a p i t o l ' o r t h o s e p r o t e c t e d , c h i e f D P S

7 Texas Journal of Chiropractic

spokeswoman Tela Mange said."

"In recent months, as drug-war violence has flared along the Texas-Mexico border, Te x a s l a w m a k e r s h a v e acknowledged that they have been warned to be careful w h e n t h e y a r e i n t h e area. . . .Then came [ the] slaying of a federal judge and w o u n d i n g o f a congresswoman in Arizona."

"Yes, legislators are taking precautions when they go out in the border areas," said state Rep. Aaron Peña, R-Edinburg. "As elected officials, we have that threat ... and we can and do" ask for DPS escorts when out in public. I ask for it when I need it," Peña said. "We are living in different times now. ...The additional security is needed."

TMA v TBCE Appealed; Legal Brief Tells StoryThe matter of TMA v TBCE has been appealed to the Third Court of Appeals and its 30-plus page brief to that court may be found HERE [http://www.chirotexas.org/node/546] in three parts.  The brief includes a myriad of information and is used to create this article.

Historical Summary

Here is a history of what has thus far happened in the

Texas Medical Association's endeavor to regu la te a profession that is not its own.

" T h e Te x a s B o a r d o f Ch i rop rac t i c Exam ine rs (TBCE) is the entity charged with regulating the practice of chiropractic in Texas as a u t h o r i z e d u n d e r t h e Chiropractic Act," the brief notes.   "Prior to the 2005 legislative session, TBCE underwent Sunset review.  As a result of that review, the Legislature adopted HB 972 a m e n d i n g t h e T e x a s Chiropractic Act which ... mandated that TBCE adopt a scope of practice rule."

The brief then notes that "TBCE adopted its scope of practice rule in 2006, and Texas Medical Association (TMA) brought th is su i t challenging certain provisions of TBCE's rule."   The Texas Medical Board (TMB) joined in the su i t and the Texas Chiropractic Association "later i n t e r v e n e d t o r a i s e constitutional challenges."

"In the fall of 2009," the brief continues, "the parties filed cross motions for summary judgment.  On November 24, 2009, the trial court entered

an order that granted TMA and TMB's motions as to m a n i p u l a t i o n u n d e r anesthesia (MUA) and needle electromyography (needle EMG) and denied their motion a s t o T B C E ' s u s e o f 'diagnosis' in the scope of practice rule."

"The court further ordered that TBCE and TCA's motions for partial summary judgment were denied with regard to MUA and needle EMG and granted in part as to the use of 'diagnosis' in TBCE's rule.  The court further reserved j u d g m e n t r e g a r d i n g 'diagnosis' as it relates to the scope of practice."

"In the summer of 2010, the parties filed supplemental cross motions for summary judgment as to the use of 'diagnosis.'  The court granted TMA and TMB's motion as to t h e r e m a i n i n g i s s u e s concerning diagnosis and entered final judgment on September 7, 2010, which provided as follows: declared inva l id and vo id [ ru les ] concerning MUA; declared inva l id and vo id [ ru les ] concerning needle EMG; and declared invalid and void [rules] concerning diagnosis."

Questions

As a result of this final judgment the appeal to the Third Court of Appeals has been filed.   The TBCE brief focuses primarily upon three issues:  "Did the trial court err in applying its own definition of 'incision' in place of TBCE's

8Texas Journal of Chiropractic

adopted definition and policy and in holding that needle EMG was not part of the s c o p e o f p r a c t i c e o f chiropractic? ... Did the trial court err in applying legislative history regarding prior law to determine that needle EMG was not within the scope of practice of chiropractic? ... Did the trial court err in construing the Chi ropract ic Act as prohibiting MUA?"

The reader is referred to the full brief for more detailed information; the following arguments are excerpted for the purpose o f o f fer ing illustration for the  chiropractic p r o f e s s i o n ' s  b e t t e r understanding.  

The Legislature Directs

"In 2005, the Legislature amended the Chiropractic Act and made several changes regarding scope of practice, inc lud ing adding a new d e fi n i t i o n f o r s u r g i c a l procedure ... and mandating t h a t T B C E a d o p t r u l e s clarifying activities within the scope of practice through an i n c l u s i v e r u l e m a k i n g process .... After nearly a year of rule making, TBCE adopted the scope of practice rule in 2006."

"This case arises from TBCE's adoption of a rule defining the s c o p e o f p r a c t i c e o f chiropractic in Texas as directed by the Legislature .... TMA's suit challenged specific provisions of TBCE's rule dealing with three issues:  needle electromyography

(needle EMG), manipulation under anesthesia (MUA), and the use of the word 'diagnosis' in the rule.  TBCE was subject to sunset review during the 2005 legislative session, and one of the issues that the r e v i e w a d d r e s s e d w a s T B C E ' s p r o c e s s f o r determining scope of practice issues and, in particular, needle EMG .... this review was built upon nearly a decade of discussion that had included several Attorney General Opinions."

EMG With Needles

The brief notes that "....TBCE described needle EMG as follows:   Needle EMG is a t y p e o f e l e c t r o - n e u r o diagnostic testing.   Needle EMG does not involve the injection of any substances or the removal of any tissue."   It also notes that "Manipulation under anesthesia (MUA) is a procedure that is joint ly c a r r i e d o u t b y a n a n e s t h e s i o l o g i s t a n d a chiropractor in which a patient is placed under a general anesthetic so that a part of a patient's musculoskeletal s y s t e m m a y b e f r e e l y manipulated."

The brief argues that "The trial court erred in applying its own c o n s t r u c t i o n o f t h e Chiropractic Act's terms in place of TBCE's rule adopting a definition of 'incision' and a policy regarding the use of needles.   TBCE's definition and policy regarding the use of needles were consistent with the Chiropractic Act and

its general objectives.   In determin ing that needle electromyography (needle EMG) was part of the scope of practice of chiropractic in Texas, TBCE read the Act as a whole and harmonized its provisions.   TBCE further c lar ified i ts author i ty to regulate the practice of needle EMG by adopting a definition for 'incision' and a policy regarding when needles could be used as part of the practice of chiropractic."

Supporting this assertion is the argument that "The trial court erred in holding that needle EMG was not part of the scope of practice of chiropractic and in applying the common meaning of 'incision' in place of TBCE's a d o p t e d d e fi n i t i o n a n d policy .... the trial court rejected TBCE's interpretation of the Chiropractic Act and applied the common meaning of 'incision' in place of TBCE's a d o p t e d d e fi n i t i o n a n d policy .... While the trial court acknowledged that 'whether the ordinary meaning ... would include a needle entry is subject to debate,' the court failed to then defer to TBCE's determination that the use of a needle would not be an incision .... the trial court instead substituted its own finding that use of a needle would constitute an incision in place of TBCE's finding and rule."   The brief cites legal precedent for its conclusion.

"As the Chiropractic Act does not include a definition for 'incision,' TBCE adopted a

9 Texas Journal of Chiropractic

rule defining the term as '[a] cut or a surgical wound; also, a division of the soft parts made with a knife or hot laser' .... Further, TBCE adopted a policy describing when the use of needles was consistent with the scope of practice of chiropractic in Texas:  Needles may be used in the practice of chiropractic under standards set forth by the Board but may not be used for procedures that are incisive or surgical. (A) The u s e o f a n e e d l e f o r a procedure is incisive if the procedure results in the removal of tissue other than for the purpose of drawing blood.   (B) The use of a needle for a procedure is surgical if the procedure is listed in the surgical section of the CPT Codebook .... Read together, the definition for 'incision' excluded from the s c o p e o f p r a c t i c e a l l procedures that involve slicing open the body and the policy clarified that a needle would only be incisive if it was used to remove tissue other than blood .... TBCE sought to harmonize the Chiropractic Act's prohibition on the use of incisive or surgical procedures with its allowance for the use of needles in acupuncture and to draw blood as well as the ability of a chiropractor to analyze, examine, or evaluate the biomechanical condition of t h e m u s c u l o s k e l e t a l system  .... TBCE construed the Act as a whole and harmonized its provisions."

In this way, the brief argues, "TBCE's construction is that if

a ch i ropractor may use needles for acupuncture, if acupuncture needles are not incisive, if a chiropractor may use a needle to draw blood, and if a chiropractor may use 'objective or subjective means to analyze, examine, or evaluate the biomechanical condition of the spine and musculoskeletal system' then a ch i ropractor may use needles for other purposes, i n c l u d i n g n e e d l e E M G , provided that no tissue is removed and that the use is not listed in the surgery s e c t i o n o f t h e C P T Codebook."

"The court acted arbitrarily in a p p l y i n g t h e c o m m o n meaning of 'incisive' in place of the definition and policy adopted by the TBCE .... in direct contradiction to the statutory mandate for the promulgation of the scope of practice rule."   "TBCE's construction is in harmony w i t h t h e a l l o w a n c e f o r chiropractors to use needles for acupuncture, where the Legislature has provided that t h e u s e o f n e e d l e s i s nonsurgical and nonincisive."

"The trial court further erred in looking to legislative history when TBCE had resolved any ambiguities in the Act through its rulemaking.  The trial court failed to defer to TBCE's construction of the Act and ins tead looked to p r io r legislative history as part of the basis for its decision."

"The trial court additionally relied on legislative history

from 1995 as support for determing that needle EMG was not part of the scope of practice in Texas .... This rel iance disregarded the subsequent ten year reviw of t h i s i s s u e , s u b s t a n t i v e c h a n g e s m a d e t o t h e Chiropractic Act in 2005 as part of HB 972, and other statutory changes s ince 1995."

"As the text of the Act and TBCE's scope of practice rule was not ambiguous, there was no need for the court to have looked to legislative history or other extrinsic aids to determine whether needle EMG was within the scope of practice of chiropractic."  "The trial court elected instead to draft its own rule excluding needle EMG from the scope of chiropractic.  The trial court did this even though the Legislature had declined to draft such a rule and even t h o u g h t h e c o u r t ' s construction was in contrary to the Legislature's specific authorization for TBCE to p romu lga te a scope o f practice rule."

The brief points out that while in 1995 State Represenative Kyle Janek M.D. may have s o u g h t t o p r o h i b i t c h i r o p r a c t o r s f r o m t h e practice of needle EMG, " R e p r e s e n t a t i v e J a n e k succeeded in removing the explicit authorization for TBCE to certify chiropractors to perform needle EMG ... the legislature did not adopt l a n g u a g e t h a t c l e a r l y excluded needle EMG from

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t h e s c o p e o f practice" [emphasis added].

The brief describes three separate Attorney General opinions relating to needle EMG and points out that "These opinions served to frame the discussion of needle EMG dur ing the Sunset Commission's review of TBCE prior to the 2005 legislative session.   The Sunset staff report addressed the need for TBCE to adopt a scope of practice rule and the need to clarify whether needle EMG was within the scope of practice of chiropractic .... During the 2005 session, the Legislature did not address needle EMG, but they did amend the Chiropractic Act to add a new defini t ion of 'surgical procedure' and a d i r e c t i v e t h a t T B C E p romu lga te a scope o f practice rule."   The brief concludes that "This could be interpreted as a legislative deferral of the needle EMG issue as a matter for TBCE to address in its rulemaking on the scope of practice."

Manipulation while Anesthetized

"The trial court also erred in ruling that manipulation under a n e s t h e s i a ( M U A ) w a s p r o h i b i t e d u n d e r t h e Chiropractic Act.   The trial cour t er red in re ject ing TBCE's construction of the Act as a whole and TBCE's harmonizing of all the Act's provisions" [emphasis added]. "The court and TBCE agree that MUA is listed in the

surgery section of the CPT Codebook and thus a surgical p r o c e d u r e u n d e r t h e Chiropractic act .... This limitation, however, must be construed in context with two other provisions."   The brief t h e n p o i n t s o u t t h a t chiropractors ARE authorized to per fo rm nonsurg ica l , n o n i n c i s i v e p r o c e d u r e s including adjustment and m a n i p u l a t i o n ;  a n d t h a t m a n i p u l a t i o n o f t h e musculoskeletal system is at the core of chiropractic."  The brief argues that "all three provisions .... must be read together and harmonized in

order to give effect to all of the p r o v i s i o n s .   T B C E ' s construction does that.   The court's construction relies on a double negative ...."  

" T B C E ' s l o n g - s t a n d i n g interpretation has been that," the brief states, "[the Act] prohibits the board from certifying MUA practitioners."  Further, it notes, "TBCE's i n t e r p r e t a t i o n i s a l s o c o n s i s t e n t w i t h R e p r e s e n t a t i v e U h e r ' s statement that the original purpose of the amendment was to p rov ide fo r t he

qualification of chiropractors that perform MUAs."

The brief concludes on this p o i n t t h a t " T B C E ' s construction is consistent with the plain meaning of the statutory provision in the context of the chiropractic act a s a w h o l e . . . . W h i l e R e p r e s e n t a t i v e J a n e k succeeded in amending the proposed language so that chiropractors may not be certified to perform MUAs [the Act] does not unambiguously prohibit chiropractors from performing MUA." 

Conclusion

The conclusion argued is that   "....  the trial court erred  in  construing the Chiropractic Act  and TBCE's scope of practice rule, giving too much weight to legislative h i s t o r y and  i n su f fic i en t considerat ion to TBCE's construction of the Act and the d e fi n i t i o n s a n d p o l i c i e s  a d o p t e d b y rulemaking as directed by the Legislature." 

The brief concludes that "....the rule adopted by TBCE was a reasonable exercise of t h e C h i r o p r a c t i c A c t ' s mandate for promulgation of a scope of practice rule.   The portions of the trial court's judgment invalidating the rules concerning needle EMG and MUA should be reversed and judgment rendered for TBCE and TCA."

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MDs in Congress: 3.36% of MembershipAs the new congress begins there will be a record number of 18 physicians in Congress-- 16 MDs in the House and two in the Senate. This represents a 64% increase over current numbers. Johns Hopkins research found "a total of only 25 physicians in the House or Senate in all the years from 1960 to 2004."

The Senate will have double the number of MDs in the chamber: Incumbent Sen. Tom Coburn, MD (R-Okla.), a family physician will be joined by newcomer Rand Paul, MD (R-Ky.), an ophthalmologist. Paul is the son of Rep. Ron Paul, MD (R-Texas), an ob/gyn . In the House , s i x physicians will be joining the 10 incumbents who kept their seats.

These 18 MD members of the 112th Congress represent 3.36% of the congressional members. MedpageToday reports that "Although that's a far cry from the 10.7% of the signers of the Declaration of Independence who were physicians, it's not that far b e h i n d t h e 4 . 6 % o f Congressional seats held by physicians over the first 100 years of our history.”

The incumbents include nine R e p u b l i c a n s a n d o n e D e m o c r a t . A m o n g t h e

Republicans, there are three from Louisiana:

• cardiothoracic surgeon Charles Boustany,

• FP John Fleming, and

• gastroenterologist Bill Cassidy

and three from Georgia:

• orthopedic surgeon Tom Price,

• FP Paul Broun, and

• ob/gyn Phil Gingrey.

Texas has had two MDs in their congressional delegation:

• Ron Paul and

• Michael Burgess, both ob/gyns.

Another ob/gyn, David "Phil" Roe, of Tennessee, fills out the Republican physician contingent in the House.

T h e l o n e D e m o c r a t i c physician in Congress will be incumbent representative Jim

McDermott, a psychiatrist from the state of Washington.

T h e s i x n e w p h y s i c i a n r e p r e s e n t a t i v e s , a l l Republicans, are:

• Larry Bucshon, MD, of Indiana, a thoracic surgeon;

• Andy Harris, MD, of M a r y l a n d , a n anesthesiologist;

• Dan Benishek, MD, of Michigan, a general surgeon;

• Nan Hayworth, MD, of New York, an internist;

• Scott DesJarlais, MD, of Tennessee, a family physician; and

• Joe Heck , DO, o f Nevada, an emergency physician.

M e d p a g e To d a y i n t h e i r reporting notes “3.36% -- doesn't even come close to a number that can control legislation. Oh, wait, it does. We've all watched as one vote tipped the balance on one bill or another. That 's been especially true -- and will be even more so come January -- in the Senate where the Democrat/Republican scales are so evenly balanced. If the physician members of the next Congress can sometimes forget about thei r par ty affiliation and vote, instead, as a professional bloc, then just maybe things like the SGR can get fixed. Or new health

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legislation can reflect the realities of medical practice. Or at least maybe they can block passage of healthcare bills that make no sense. Just think: a new meaning for ʻDr. Noʼ!"

TBCE Announces Two Final Rules and One New Rules ProposalT h e T e x a s B o a r d o f Chiropractic Examiners has announced two new rules which have been made final, and one new rules proposal. The new ru l e p roposa l c o n c e r n s R u l e 7 1 . 3 , Qualifications of applicants. Bold type indicates additions, [brackets and italics] indicate deletions. Says the new rule:

(a) - (b)(No change.)

(c) For each student admitted a Chiropractic College must document and retain evidence in the student's file regarding the basis upon which the student was judged to be qualified for admission, and clearly inform the student at the time of admission that limitations of practice venue and licensure might occur. Students must demonstrate that qualifications for student acceptance and resultant enrollment are appropriate to the program objectives, goals and educational mission of the program or institution. Each student admitted to

begin the study of chiropractic on the basis of academic credentials from institutions within the United States must m e e t t h e f o l l o w i n g requirements:

( 1 ) A l l a p p l i c a n t s [matriculants] must furnish proof of having earned a minimum of 90 semester hour credits of [appropriate pre-p ro fess iona l educa t i on ] courses at an institution or institutions accredited by a nationally recognized agency not including courses included in a doctor of chiropractic degree program. [Included in these credits must be a minimum of 48 semester hour credits in the course areas noted in paragraph (2) of this subsection. In addition, all mat r i cu lan ts mus t have earned a cumulative grade point average of at least 2.50 on a scale of 4.0 for the courses listed in paragraph (2) of this subsection and for the required 90 semester hours. Quarter hour credits m a y b e c o n v e r t e d t o equivalent semester hour credits. In situations in which one or more courses have been repeated with equivalent courses, the most recent grade(s) may be used for g r a d e p o i n t a v e r a g e computation and the earlier grade(s) may be disregarded.]

( 2 ) A l l a p p l i c a n t s [Matriculants] must present proof of graduation from a bona fide chiropractic college t h a t i s a c c r e d i t e d b y ch i roprac t ic educat iona l accrediting body that is a

member of the Councils [sic] on Chiropractic Education International. [a minimum of 48 semester hours' credit (or t he qua r t e r -hou r c red i t equivalents), distributed as follows:]

[(A) English Language Skills: 6 semester hours;]

[(B) Psychology: 3 semester hours;][ (C) Socia l Sciences or Humanities: 15 semester hours;]

[(D) Biological Sciences: 6 s e m e s t e r h o u r s . T h e B i o l o g i c a l S c i e n c e s requirements must include p e r t i n e n t l a b o r a t o r y experiences that cover the range of material presented in the didactic portions of the course(s); and][(E) Chemistry: 12 semester h o u r s . T h e C h e m i s t r y requirement may be met with at least 3 semester hours of general or inorganic chemistry and at least 6 hours of organic chemistry and/or biochemistry coursed with unduplicated content. At least 6 semester hou rs o f t he chemis t r y c o u r s e s m u s t i n c l u d e p e r t i n e n t l a b o r a t o r y experiences, which cover the range of material presented in the didactic portions of the courses.]

[(F) Physics and related studies: 6 semester hours. The physics requirement may be met with either one or more physics courses with undupl icated content (of which one must include a

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pertinent related laboratory that covers the range of mater ia l in the d idact ic portions of the course), or three (3) semester hours in physics (with laboratory) and three (3) semester hours in e i t h e r b i o m e c h a n i c s , kinesiology, statistics, or exercise physiology.]

[ (3) In each o f the s ix distribution areas, if more than one course is taken to fulfill the requirement, the course content must be unduplicated. In the event an institution's transcript does not combine laboratory and lecture grades for a single course grade, the admitt ing institution may calculate a weighted average of those grades to establish the grade in that science course.]

The proposed new Rule 71.3 would then read "(1) All applicants must furnish proof of having earned a minimum of 90 semester hour credits of courses at an institution or institutions accredited by a nationally recognized agency not including courses included in a doctor of chiropractic degree program. (2) Al l applicants must present proof of graduation from a bona fide chiropractic college that is accredited by chiropractic educational accrediting body that is a member of the Councils on Chiropractic Educational International."

Rules 75.25 and 80.3 have been finally approved by the

TBCE and are presented here for your edification:

Rule 75.25 Impaired Licensees and Applicants.

a) The board shall require a licensee or applicant to submit to a mental and/or physical e x a m i n a t i o n b y t h e appropr ia te hea l th care provider designated by the board i f the board has probable cause to believe that the licensee or applicant is i m p a i r e d . A n i m p a i r e d l icensee or appl icant is considered to be one who is unable to practice chiropractic with reasonable skill and safety to patients by reason of age, illness, drunkenness, excessive use of drugs, narcotics, chemicals, or any other type of material; or as a resul t of any mental or physical condition.

(b) Probable cause may include but is not limited to, any one of the following:

(1) sworn statements from two people, willing to testify before the board, that a certain l icensee or appl icant is impaired;

(2) evidence that a licensee or applicant left a treatment p rog ram fo r a l coho l o r chemical dependency before completion of that program;

(3) evidence that a licensee or a p p l i c a n t i s g u i l t y o f intemperate use of drugs or alcohol;

(4) evidence of repeated arrests of a l icensee or applicant for intoxication or offenses in which intoxication is a factor;

(5) evidence of recurring temporary commitments to a mental institution of a licensee or applicant;

(6) chiropractic records and/or medical records showing that a licensee or applicant has an illness or condition which results in the inability to function properly in his or her practice; or

( 7 ) m e d i c a l r e c o r d s ev idenc ing a menta l o r physical condition of the licensee or applicant.

Rule 80.3 Request for Information and Records

from Licensees

(a) Request for chiropractic records. Upon request, a licensee shall furnish copies of chiropractic records or a summary or narrative of the records pursuant to a written consent for the release of the information or records. The requested information or record shall not be released if the licensee determines that access to the information would be harmful to the physical, mental, or emotional health of the patient. The licensee may delete from the requested records confidential information about another p e r s o n w h o h a s n o t consented to release. For purposes of this chapter,

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"chiropractic records" means any records pertaining to the history, diagnosis, treatment or prognosis of the patient including records of other health care practi t ioners contained in the records of the licensee to whom a request for release of records has been made. "Patient" means any person who consults or is seen by a licensee for the p u r p o s e s o f r e c e i v i n g chiropractic care.

(b) Written consent.

(1) The wr i t ten consent required by subsection (a) of this section shall be signed by:

(A) the patient;

(B) the patients' personal representative if the patient is deceased;

(C) a parent or legal guardian if the patient is a minor;

(D) a legal guardian if the patient has been adjudicated incompetent to manage his or her personal affairs; or

(E) an attorney ad litem for the patient as authorized by law, including the Health and Safety Code, Title 7, Family Code, Chapter 11 or the Probate Code, Chapter 5.

(2) The written consent shall c o n t a i n t h e s p e c i fi c information or chiropractic records to be released under the consent; the reasons or purposes for the release; and

the person to whom the information is to be released.

(3) The patient, or other person authorized to consent, has the right to withdraw the consent to the release of any information. Withdrawal of consent does not affect any information disclosed prior to the written notice of the withdrawal. Any person who received information made c o n fi d e n t i a l b y t h e Chiropractic Act may disclose the information to others only to the extent consistent with the authorized purposes for which consent to release information was obtained.

(c) Reasonable time. A copy of chiropractic records or a summary or narrative of the records requested under subsection (a) of this section shall be furnished by the licensee within a reasonable t ime, not to exceed 15 business days from the date of the request.

(d) Denial of request. If the licensee denies the request under subsection (a) of this s e c t i o n f o r a c o p y o f chiropractic records or a summary or narrative of the records, either in whole or in part, the licensee shall furnish t h e p a t i e n t a w r i t t e n statement, signed and dated, stating the reason for the denial. Chiropractic records r e q u e s t e d p u r s u a n t t o subsection (a) of this section may not be withheld based on a past due account for care or treatment previously rendered to the patient.

(e) Fee for records. The l i censee may charge a reasonable fee for furnishing the information requested under subsection (a) of this section, in accordance with the following provisions:

(1) The fee shall be paid by the patient or someone else on the patient's behalf.

(2) A licensee may require payment in advance except from another licensee or other health care provider, including a chiropractor licensed by any other state, territory, or insular possession of the United S ta tes o r any s ta te o r p rov i nce o f Canada , i f requested for purposes of emergency or acute medical care.

(3) In the event payment is not received, within ten c a l e n d a r d a y s f r o m notification of the charge, the l icensee shall notify the requesting party in writing of the need for payment.

(4) A reasonable fee for a paper copy shall be a charge not to exceed:

(A)$30 for retrieval of records and processing the request, including copies for the first 10 pages;

(B)$1.00 per page for pages 11-60;

(C)$.50 per page for pages 61-400; and

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(D)$.25 per page for pages over 400;

(5) A reasonable fee for copies of films or other static diagnostic imaging studies shall be a charge not to exceed $45 for retrieval and processing, including copies for the first 10 pages, and $1.00 for each additional page over 10.

(6) Reasonable fees may also include actual costs for mailing, shipping or delivery.

(7) A reasonable fee for completing and signing an affidavit or questionnaire certifying that the information provided is a true and current copy of the records may not exceed $15.00.

(8) In addition to the fee contemplated in paragraph (7) of this subsection, reasonable fees may also include the actual costs paid by the l icensee to a notary for n o t a r i z i n g a n a f fi d a v i t , ques t i onna i re , o r o the r document.

(f) Subpoena not required. A s u b p o e n a s h a l l n o t b e required for the release of chiropractic records requested pursuant to subsection (a) of this section.

Ibuprofen and Migraines: Half-way effective.

Medscape.com REPORTS HERE that "Ibuprofen is an effective treatment for acute m i g r a i n e h e a d a c h e s , providing pain relief in about half of patients, but complete relief in only a few .... "

M ig ra ine i s a common, disabling condition and a burden for the individual, health services and society. Many sufferers do not seek professional help, relying instead on over-the-counter analgesics.

"The goal of this review was to assess the effectiveness and tolerability of ibuprofen, given as monotherapy or together with an antiemetic, vs placebo and other active treatment for relief of acute m i g r a i n e h e a d a c h e s i n adults."

C o n c l u d e t h e a u t h o r s : "Ibuprofen is an effective t r e a t m e n t f o r a c u t e m i g r a i n e h e a d a c h e s , providing pain relief in about half of sufferers, but complete relief from pain and associated symptoms for only a minority."

United Healthcare's Response to "Non-essential" Chiropractic ServiceThe ACA reports that " On October 27th we sent [ACA House of Delegate Members]

information about United H e a l t h c a r e ʼ s E s s e n t i a l Benefits Guide in which various health care services are categorized as either Essential, Mixed, or Non-essential benefits .... I am pleased to report to you that one day after publicizing our d i s p l e a s u r e a t U n i t e d H e a l t h c a r e ʼ s E s s e n t i a l Benefits Guide the senior management of UnitedHealth Group and Optum requested a meeting with us to discuss the matter."

"On November 2nd the ACA Executive Committee and key staff members met wi th UnitedHealth Groupʼs EVP/CMO, a UnitedHealthcare National Medical Director, and Optum Physical Health ʼs S e n i o r V P f o r C l i n i c a l Programs. We explained to them that the Essent ia l Benefits Guide appeared to be an attempt to segregate and eliminate chiropractic services by listing them as " n o n - e s s e n t i a l h e a l t h benefits." We also noted that UnitedHealthcareʼs action was o f c o n c e r n b e c a u s e i t categorizes “chiropractic” as a treatment versus a profession with multiple state-authorized diagnostic and treatment services available for patient care, an approach we have n o t s e e n t a k e n b y UnitedHealthcare with any other provider type."

" F o l l o w i n g t h e A C A ʼ s descr ip t ion o f a reas o f concern UnitedHealthcare provided background on the development of the Essential

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Benefits Guide. According to Mr. OʼConnellʼs notes, Dr. Reed Tuckson, UnitedHealth Groupʼs EVP and Chief of Medical Affairs, summarized the meeting and next steps as follows:

Dr. Tuckson appreciated the courteous and candid manner in which the ACA presented their concerns.

The purpose for creating the Essential Benefits Guide was t o c o m m u n i c a t e U n i t e d H e a l t h c a r e ʼ s interpretation of the PPACA which UnitedHealthcare was required to comply with by September 23, 2010 and for which Interim Final Rules h a v e n o t y e t b e e n published.Insurers are required by the PPACA to categorize services using the terms “essential” and “non-essential” which, while not intended, can be misinterpreted to imply insurers have made a value judgment regarding individual services.

UnitedHealthcare noted that they relied only on their e x i s t i n g c e r t i fi c a t e s o f coverage to determine which services to list as “non-essential”; there was no scientific analysis completed to make this determination.In categorizing “chiropractic” as a non-essential service, UnitedHealthcare did not intend to create the potential impression that all services provided by chiropract ic

p h y s i c i a n s w e r e n o n -essential.

UnitedHealthcare will review the Essential Benefits Guide t o s e e i f t h e r e i s a n opportunity to better describe t h e s e r v i c e s t h a t a r e categorized as non-essential. The ACA w i l l have the opportunity to review any proposed changes prior to the release to the general public."

"We believe that Dr. Tuckson is now aware of the possibility of misinterpretation of its categorization and will take a h a n d s - o n a p p r o a c h t o oversee efforts to rectify the situation."

DON'T Avoid the Draft!The Texas Ch i rop rac t i c A s s o c i a t i o n r e c e n t l y announced that some 14% of TCA members, and over 5 percent of the entire Texas D o c t o r o f C h i r o p r a c t i c population, is making use of the TCA autodraft program for their dues, for political action contributions, for litigation c o n t r i b u t i o n s a n d f o r Chiropractic Defense Fund Contributions.

The autodraft program helps the profession save money by e l i m i n a t i n g t h e b i l l i n g statement, provid ing for c o n t i n u a l d u e s a n d contribution payments, and allows for more efficient and effective business budgeting since the autodraft provides for a known quantity of regular income.

Says the TCA "it's easy! The more who use the autodraft program the fewer envelopes and stamps we have to lick!"

JUST CLICK HERE

Chiropractic Advocacy Website UnveiledThe chiropractic advocacy group MyTexasDoctor.org unveiled its new chiropractic a d v o c a c y w e b s i t e a t www.mytexasdoctor.org today.

The site is geared toward the general public and includes videos, information, donation links, and the ability to register to receive updates on the chiropractic profession and to

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a d d r e s s o n e ' s s t a t e r e p r e s e n t a t i v e s a n d government officials with a simple click of a button.

Everyone is URGED to r e g i s t e r a t www.mytexasdoctor.orgH e r e a r e s o m e o f t h e o b s e r v e d f e a t u r e s o f www.mytexasdoctor.org:

A Call to Action Video presentation explaining "The Texas Medical Association (TMA) has taken legal action in an attempt to take away your ability to choose a Doctor o f Ch i ropract ic as your healthcare provider. TMA is claiming the law is unclear on whether your Doctor o f Chiropractic is qualified to give you a diagnosis. The solution is to make the law perfectly clear: Doctors of Chiropractic can diagnose, and Texans can choose the type of doctor they desire for their healthcare."

A What's At Stake Video explaining that "Through its lawsuit against Doctors of Ch i roprac t i c , the Texas M e d i c a l A s s o c i a t i o n i s attempting to set up their members as the gatekeepers who control access to health care, e ffect ive ly dr iv ing Doctors of Chiropractic (their competition) out of business. If TMA is successful, Texas consumers who prefer to see Doctors of Chiropractic will be at a disadvantage – and certainly Texans who prefer to use chiropractors as their primary doctor will be forced to seek care elsewhere."

A Take Action Now button  where voters may send a d i rect e-mai l to var ious government officials with issue specific templates.

A Fund the Cause Button w h e r e A N Y O N E m a y contribute directly to the support and defense of the chiropractic profession in Texas.

A Stay Informed Button where one may register to receive e-mail newsletter updates.

A N e w s a n d U p d a t e s S e c t i o n w i t h p d f fi l e s providing information for the p u b l i c r e g a r d i n g t h e chiropract ic profession's struggle to be allowed to provide services we have been trained to provide.

A Fighting Back Section that explains what the public can do to insure that their access to chiropractic care is not limited or removed.

Sponsored by the Texas Chiropractic Association the www.mytexasdoctor.org is a useful tool in sharing with the world the necessity for action in support of the chiropractic profession in Texas.

Kaiser Reverses Adverse CMT Policy

The American Chiropractic Associat ion reports that "Kaiser Permanente Mid Atlantic States and Mid-Atlantic Permanente Medical G r o u p ( K a i s e r ) h a s suspended its decision to exclude cervical Chiropractic Man ipu la t i ve Trea tmen t (CMT) from coverage. The change came a f te r t he A m e r i c a n C h i r o p r a c t i c Association (ACA) outlined in a letter to Kaiser the scientific evidence that documents that cervical spinal manipulation is both clinically effective and safe."

"ACA took swift action in August when it learned that K a i s e r h a d r e v i s e d i t s Chiropractic Manipulation Medical Coverage Policy. Along with the letter outlining the large body of clinical research support ing the effectiveness and safety of cervical manipulation, ACA President Rick McMichael, DC, noted at the time in a public statement that, i f a l l o w e d t o s t a n d , t h e restriction would be harmful to chiropractic patients and doctors. "

"Kaiser responded to ACAʼs a c t i o n s w i t h a l e t t e r acknowledging that further consideration was needed and stating that the policy would be suspended. The insurer also recognized (in the letter) the value of keeping its M i d - A t l a n t i c p o l i c i e s consistent with the other Kaiser regions, which do not have such a restriction on

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CMT services provided by chiropractic physicians."

"ACA will remain in touch with Kaiser to ensure that their future policies are based on the best available evidence. There is just no scientific evidence suggesting that a v i s i t t o a c h i r o p r a c t i c physician for CMT causes any higher incidence of stroke than a typical visit to a primary care medical physician. ”

STARTING with Chiropractic Saves 40% on Low Back Pain CareA new study finds that low back pain care initiated with a doctor of chiropractic (DC) saves 40% on health care costs when compared with care in i t iated through a medical doctor.

Featuring data from 85,000 Blue Cross Blue Shie ld benefic ia r ies , the s tudy concludes that insurance companies that restrict access to chiropractors for low back pain treatment may pay more for care than they would if t h e y r e m o v e d s u c h restrictions.

Low back pain is a significant public health problem. Some 85 percent of Americans have back pain at some point in their lives, and back pain treatment accounts for about $50 billion annually in health

care costs—making it one of the top 10 most cos t ly conditions treated in the United States.

"The study ... looked at Blue C r o s s B l u e S h i e l d o f Tennesseeʼs intermediate and large group fully insured population over a two-year span. The insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays."

"Results show that paid costs for episodes of care initiated by a DC were almost 40 pe rcen t l ess than ca re initiated through an MD. After risk-adjusting each patientʼs c o s t s , r e s e a r c h e r s . . . . estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for Blue Cross Blue Shield of Tennessee."

The PR of DiseaseAccord ing to an ar t i c le REPORTED HERE "The manner in which prescription drugs are marketed today can be readily understood if you r e a d t h e 1 9 2 8 b o o k "Propaganda," by Edward Bernays, the father of PR. Bernays knew that public relations business was less about selling things than about creating the conditions for things to sell themselves."

"Pharmaceutical marketers, following in his footsteps, sell drugs by selling diseases -- a system known as "disease branding .... Drug companies are master marketers and they f u l l y embrace the ideology that Edward Bernays' -- the father of PR -- is most known for. Instead of trying to sell their drugs on their own merit, they invest untold amounts o f money in to creating diseases their drugs are meant to treat. By doing this, they create instant patients, patients who will likely go to their physicians and request the said drug by name."

"Pharmaceutical companies spend more on marketing than research -- almost twice as much," the article cites and "Part of these costs often go toward hiring expensive PR firms, celebrity spokespeople, a n d p h y s i c i a n s a n d academics to pedal their wares. As CNN reported, in o r d e r t o m a r k e t i t s

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a n t i d e p r e s s a n t P a x i l , GlaxoSmithKline hired a PR firm to create a "publ ic awareness campaign" about a n " u n d e r - d i a g n o s e d " disease. The disease? Social anxiety disorder … previously known as shyness .... As a result, mentions of social anxiety in the press rose from about 50 to over 1 billion in just two years … social anxiety disorder became the "third most common mental illness" in the U.S. … and Paxil skyrocketed to the top of the charts as one of the most profitable and most prescribed drugs in the United States."

The article states "Clearly there was not a rapid rise in t h e n u m b e r o f p e o p l e s u f f e r i n g f r o m e x t r e m e shyness during this time … there was just a masterful marketing campaign that successfully whispered into enough people's ears, 'If you're shy or nervous around others, you need to take this drug.'"

The article further observes "One of the key strategies that drug companies depend on to make med ica l i za t i on o f society work is targeting your news media with stories designed to create fears about a condition or disease, and draw attention to the latest treatment. This has led to problems on several key levels: People with benign, normal symptoms end up taking dangerous drugs. Once you're convinced that natural signs of aging and common conditions are diseases or

treatable symptoms, you take drugs for such things as balding, anxiety, mild bone loss and indigestion, which puts your health at risk over issues that were not true illnesses or risks in the first place."

Another problem cited is that "many of these conditions are entirely treatable with diet and lifestyle modifications" and p e o p l e w i l l i g n o r e t h e improvement of function for t h e c o n v e n i e n c e o f a dangerous drug.

The article observes "People who are tested regularly end up undergoing unnecessary treatments with drugs and invasive surgery. Very few people after middle age can pass standard medical tests without being told that they have some sort of "risk." This risk is then turned into a pseudo-disease leading to such things as dangerous breast and colon surgery and "preventive" medications, instead of outlining natural strategies that would actually help a person's health to thrive."

Most obvious, however, is that "As a result of "disease mongering," the more the medical industry influences a nation, the sicker that nation "considers itself to be." It eats away at your self-confidence and teaches you that you're weak and incapable of staying well, and that all signs and symptoms are potentially dangerous conditions and diseases."

"The only winners in this grand scheme are the ones who profit financially."

"The only way to break out of this self-destructive system is to take a stand for yourself, and take control of your own health."

The AMA's Gift to Chiropractic?Jeffrey Cronk, DC, CICE, writes in an article entitled Alteration of Moation Segment Integrity: the AMA's Gift to C h i r o p r a c t i c ? a n d REPORTED HERE, that "Alteration of motion segment i n t e g r i t y ( A O M S I ) i s a significant gift from the AMA that allows us to methodically locate, substant iate and objectively prove the severity of the spinal subluxation. Of course, it comes as a gift only as long as we handle it with a high level of responsibility."

"Alteration of motion segment integrity is determined by exact mensuration procedure published in the AMA Guides t o t h e E v a l u a t i o n o f Permanent Impairment. It is a spinal subluxation that can be objectively identified with a high degree of accuracy, e s p e c i a l l y w h e n o n e a c k n o w l e d g e s t h e advancements that have occurred in assessment of stress imaging (X-ray, DMX)."

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"Historically, AOMSI first showed up in writing in June 1 9 9 3 , w h e n t h e A M A developed the injury model of spinal assessment and listed the findings and criteria in its new DRE (Diagnosis Related Estimate) categories. This w a s t h e fi r s t o p e n acknowledgment from the AMA that spinal subluxation's could cause significant, and p e r h a p s p e r m a n e n t , reductions in a patient's health status. This meant that the AMA had validated what we had been stating for a very long time. Ironically, this validation came some six years after the resolution of the Wilk case."

"Some in our profession u n d e r s t o o d t h i s " o p e n acknowledgement" for what it really was and made sure AOMSI was included in the first chiropractic practice guidelines to be published in the federal government's N a t i o n a l G u i d e l i n e Clearinghouse Project (NGC). They had the foresight to make sure, with strong peer review, that AOMSI was within the scope of chiropractic management and listed as a component of the vertebral (spinal) subluxation complex. These guidelines were first published in 1998 and have had two successful and very helpful revisions, still listed in the NGC today."

"The 1990s seemed to be the explosion years for "evidence-based health care." The lynchpin was guidelines. Inherent in guidelines is that

fact that they are objective. Inherent in the term objective is the ability to verify the presence of; anyone can read and veri fy what is in a guideline, which is why they are so important. Guidelines build consensus, which builds group solidarity of belief or sentiment. We often see that guidelines in one area are cited for the foundation of o t h e r g u i d e l i n e s . T h i s g u i d e l i n e - b u i l d i n g phenomenon has led to further val idat ion of the s i g n i fi c a n c e o f A O M S I fi n d i n g s a n d , i f w e acknowledge and apply it, leads to further credibility of our profession as the leaders; the body with the longest and highest level of experience in s p i n a l s u b l u x a t i o n management."

"All providers were engaging in this activity, including the sports medicine specialists .... These providers were building guidelines to handle the health and safety of athletes who received an injury or had a condition that could affect t h e i r a b i l i t y t o s a f e l y participate in their chosen athletic activity. They needed t o d e v e l o p g u i d e l i n e s (consensus) as to what to do with athletes when they sustained certain types of injuries...."

"These guidelines openly acknowledged that spinal subluxations due to spinal ligament damage can be serious and included them. AOMSI findings now became either a relative or an absolute

contraindication to return to contact sports, which makes complete sense. Why would you put an athlete with this level of spinal ligamentous injury right back into full-con tac t spo r t s , w i t hou t stabilizing the injury and allowing it to heal? These guidelines provided further c o n s e n s u s a s t o t h e significance of the findings of AOMSI. This fact seems to go u n n o t i c e d a n d unacknowledged by some in our profession."

"Common sense tells us that patients who have significant spinal subluxations from acute ligament trauma need to be managed by providers who understand the significance of t h e c o n d i t i o n t h e y a r e treating."

"The chiropractic profession established the technology to assist with accurately and reliably locating AOMSI. The AMA gave it a name and credibility, and established its significance. It is now time for our profession to fully endorse and incorporate the evaluation of AOMSI in every one of our patients who has suffered a traumatic injury to their spine."

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Check www.chirotexas.org Click HERE for the “Texas Journal of Chiropractic”

TCC, TSU Enter Into Academic PartnershipTexas Chiropractic College (TCC) and Texas Southern University (TSU) have entered into an academic partnership, s i g n i n g a n a r t i c u l a t i o n agreement. This agreement facilitates the admission and academic transfer of students from TSU to TCC ensuring a s e a m l e s s t r a n s i t i o n o f students seeking to complete their Bachelor of Science degree from TSU, while at the same time pursuing a Doctor o f C h i r o p r a c t i c d e g r e e through TCC.

The agreement will enable fu ture and current TSU students to complete both degrees in six years, with the first three occurring at TSU and the final three at TCC.

Palmer College President Retires After 50-Year CareerConcluding a career that has spanned more than 50 years, Donald P. Kern, D.C., Ph.C., president of the Davenpor t Campus o f P a l m e r C o l l e g e o f C h i r o p r a c t i c , h a s announced his retirement.

A 1958 graduate of Palmer College, Dr. Kern earned his Doctorate of Chiropractic Philosophy in 1959. His professional career with Palmer began in 1960 when he joined the B.J. Palmer Clinic staff. He served as a

faculty clinician until 1976 and also held the post of clinic director from 1965 to 1970. Dr. Kern held numerous administrative positions at Palmer. Dr. Kern was named senior campus administrator at Palmer Collegeʼs Florida Campus upon its opening in 2002. In 2004, he was named interim president of Palmerʼs D a v e n p o r t a n d F l o r i d a campuses. In 2005 when he was named president of the Davenport campus for an unprecedented second time.

"Five generations of the Kern family have graduated from Palmer College with Dr. Kern as part of the third generation. “My grandfather, Clyde G. Kern (ʼ21), and my father, Donald O. Kern (ʼ23), were both Palmer graduates, as well as my older brothers, Raymond T. (ʼ50) and James O. (ʼ52), so I was introduced to The Fountainhead early on,” said Dr. Kern. “I decided on a career in chiropractic as a teenager and it was a natural choice to come to Palmer.”

That pass ion has been passed on to his children and grandchildren. Dr. Kern and his wife of 53 years, Nancy, are parents of three children: G r e g o r y K e r n , D . C .

(Davenport ʼ84), Jeffrey Kern and Karen Onken, D.C. (Davenport ʼ97). Dr. Gregʼs son, Zachary, represents the fifth generation as a 2007 graduate of the Davenport Campus.

Parker in HaitiD r . F a b r i z i o M a n c i n i , president of Parker College of Chiropractic, and Dr. Gilles Lamarche, vice president of Parker Seminars traveled to Haiti where they served the

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people in the earthquake devastated country. The two provided much needed care for the people in the destitute country.

T h e t r i p w a s l e d b y C h i r o M i s s i o n ( C M ) c o -founders, Dr. Todd Herold, vice president and cultural liaison of CM, and Dr. JC Doornick, president of CM. The group included a team of 68 chiropractors, students, and volunteers. Dr. Doornick assembled a team of 11 and headed across the border from their entry point of Puerto Plata, Dominican Republic and began serving in Haiti. Meanwhile in Puerto Plata, Dr. Herold announced the coming a id through television and radio to prepare the northern coast of the Dominican Republic. Over the course of one week, the teams gave nearly 70,000 chiropractic adjustments.

During the trip, nearly $55,000 was raised by the doctors, their patients, and volunteers. Dr. Lamarche spearheaded 90 percent of the effort after visiting a dilapidated mosquito infested orphanage housing 25 children. Dr. Lamarche learned of the effort to move the children to safety and accommodate another 50 abandoned children with $30,000. Within three hours, Dr. Lamarche raised more t h a n $ 3 0 , 0 0 0 a n d t h e construction had already begun. The team will see the completion of the safe house on their next trip in March 2010.

The group also raised funds for food, clothing, and toy donations to people in the communities. In addition, notebooks, pencils, and other s c h o o l s u p p l i e s w e r e distributed to local schools. Teachers that have been working for free will also now receive a monthly donated salary.

ChiroMissionʼs goal is to promote chiropractic and adjust people throughout the world, especially in third world countries where resources are so limited. They also cultivate students of chiropractic from those deprived areas so they may return to their countries a n d w o r k i n o f fi c e s established by ChiroMission. They also raise necessary funds to help those in need reclaim their lives and gain a satisfactory standard of living.

NYCC Teams with Med SchoolG e o r g e t o w n U n i v e r s i t y Medical School has selected N e w Yo r k C h i r o p r a c t i c College (NYCC) to assist it in training licensed professionals

in the complementary and a l t e r n a t i v e h e a l t h c a r e disciplines.

Said the medical school:

".... the academic affiliation is intended to “… break down the s i l os tha t ho ld the disciplines apart and create relationships between the d i s c i p l i n e s a n d t h e educational institutions that prepare the nationʼs future healthcare providers.”

".... Georgetownʼs unique M a s t e r o f S c i e n c e i n Physiology program that emphasizes complementary and alternative medicine in an effort to provide instruction in three areas: grounding in science (especially systems a n d c e l l p h y s i o l o g y ) , introductory exposure and u n d e r s t a n d i n g o f C A M disciplines and philosophies, and the ability to rigorously

assess the state of evidence regarding safety and efficacy of various CAM therapies. With this education in hand, students may then pursue career options related to research (advanced study leading to the doctorate d e g r e e ) , p o l i c y a n d administration (in government or the non-profit sector), or

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continue their training in one of the health professions."

"NYCC ʼs robust research program and widespread reputat ion for academic excellence among chiropractic a n d a c u p u n c t u r e professionals made it an attractive candidate for the affiliation. Pleased with the new collaboration, NYCC Executive Vice President and Provost Dr. Michael Mestan sa id , “We we lcome the opportunity to partner with a university the cal iber of G e o r g e t o w n , a n d a r e enthused at the prospect of t r a i n i n g s u c h c a p a b l e students with expressed interest in natural healthcare.”

Physician-Pharma Industry Contact Remains HighPhysicians are reporting fewer r e l a t i o n s h i p s w i t h t h e pharmaceutical industry and the frequency of all types of such relationships has fallen significantly since 2004, yet more 80% of doctors still report at least one connection.

The results of a recent study showed " tha t 83 .8% o f respondents reported at least one type o f 'phys ic ian-industry' relationship, down from 94% in 2004."

The study found that

• 63.8% said they received drug samples, compared with 78% in 2004.

• 70.8% said they received any gifts, down from 83% in 2004.

• 18.3% said they had received reimbursements for such things as meeting attendance, down from 2004's 35%.

• 14.1% said they had been given payments for such th ings as serv ing on adv i so ry boa rds and enrolling patients in clinical t r i a l s . I n 2 0 0 4 , t h e comparable figure was 28%.

• T h e r e w a s a l s o a decrease in the number of m e e t i n g s b e t w e e n p h y s i c i a n s a n d d r u g representat ives in an average month from three per month to only two per month.

T h e s t u d y f o u n d t h a t p e d i a t r i c i a n s , i n t e r n a l medicine specialists, family pract ice physicians, and cardiologists all saw fewer

drug reps per month, but that there was no change for a n e s t h e s i o l o g i s t s a n d surgeons.

27% of Hospitalized Medicare Patients Experience Adverse EventsThe Office of the Inspector General in the Department of Health and Human Services reports that "An estimated 1 3 . 5 % o f h o s p i t a l i z e d Medicare patients experience adverse events ranging from pulmonary embolisms to wrong-body-part surgery, and such events result in the d e a t h o f 1 . 5 % o f a l l h o s p i t a l i z e d M e d i c a r e patients.”

Another 13.5% of hospitalized Medicare patients experience minor adverse events such as excess ive b leed ing and prolonged nausea that cause temporary harm.

Of the major and minor adverse events combined, 44% are preventable, and all these events accounted for an estimated $4.4 bil l ion in Medicare inpatient spending in fiscal year 2009 the OIG reports.

"On the bas is o f these fi n d i n g s , t h e O I G recommends that the Centers for Medicare and Medicaid

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In Other News...

Services and the Agency for Healthcare Research and Q u a l i t y b r o a d e n t h e i r definition of adverse events and work harder to identify them. In addition, the Centers for Medicare and Medicaid Services should expand the list of adverse events for which it will not foot the bill a n d s h o u l d l o o k f o r opportunities to hold hospitals accountable for adopting evidence-based pract ice guidelines, according to the OIG."

Pharmaceutical Company Hit with $750 M PenaltiesT h e A m e r i c a n M e d i c a l Association REPORTS HERE that "Attorneys representing t he Hea l t h and Human Services Dept., states and a whistle-blower announced on Oct. 26 that pharmaceutical m a n u f a c t u r e r GlaxoSmithKline will plead guilty to selling faulty drugs to Medicare and Medicaid and pay $750 million in penalties. The agreement is the latest milestone in a federal effort to c o m b a t M e d i c a r e a n d Medicaid fraud."

"The GSK payments will be spl i t among the federa l government, an undetermined number of states and a former G S K e m p l o y e e - t u r n e d -whistle-blower."

" W h i s t l e - b l o w e r C h e r y l Eckard, a former GSK quality assurance manager, wi l l receive about $96 million of the $436.4 million federal share. The award is the largest to an individual under t h e F a l s e C l a i m s A c t , according to Justice Dept. spokesman Charles Miller. The act 's whist le-blower prov is ions a l low pr ivate citizens to sue on behalf of the United States and share in any recovery. Eckard filed the original complaint in February 2004 , accord ing to her attorneys, Getnick & Getnick

of New York."

"The previous overall largest False Claims Act whistle-blower payment was more than $100 million to two individuals as part of a $1.7 billion Medicare and Medicaid fraud settlement with hospital chain HCA Inc., announced in June 2003."

"States will receive up to $163.6 million in the GSK case."

"The case is also the latest Medicare and Medicaid fraud

recovery under an effort by HHS and the Dept. of Justice, known as Health Care Fraud Prevention and Enforcement Action Team, or HEAT Task Force. The team, unveiled in May 2009, helped recover nearly $3 billion in Medicare and Medicaid fraud in fiscal 2009. The national health reform law includes $350 m i l l i on du r ing the nex t d e c a d e , a m o n g o t h e r measures, to combat fraud in the health system."

"The $750 mi l l i on GSK penalty is based on the net sales of four drugs .... GSK will admit to selling limited numbers of faulty batches of the drugs to Medicare and Med ica id . The d rugs - - manufactured at GSK's Cidra, Puerto Rico, facility between 2001 and 2005 -- were anti-nausea medication Kytril, topical antibiotic Bactroban, antidepressant Paxil CR, and t y p e 2 d i a b e t e s d r u g Avandamet."

"Federal attorneys said they will pursue similar cases. 'The knowing, unlawful distribution of drugs whose strength, purity and quality are not re l iab le undermines the integrity of our health care system, and we will continue to pursue these types of violations,' said Tony West, assistant attorney general for the Justice Dept. 's Civi l Division."

"The investigation did not find any evidence that the faulty drugs harmed consumers, sa id Chr i s t ina S te r l i ng ,

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spokeswoman for the U.S. Attorney's Office for the District of Massachusetts. The investigation also involved the FDA, the FBI and the Office of Inspector General, among others."

"GSK sent Eckard to the Cidra factory in August 2002 to lead a team of scientists and q u a l i t y e x p e r t s t o fi x manufacturing violations cited by the FDA, according to her attorneys. Eckard discovered manufacturing problems not i d e n t i fi e d b y t h e F D A , including mixed-up products, diabetes drugs with too much or too little of the clinically e f f e c t i v e i n g r e d i e n t , a nonsterile area of the facility that was used to make injectable drugs and a water system contaminated with microorganisms."

"Eckard urged GSK managers to fix the problems at the C id ra fac i l i t y, i nc lud ing shutting down the plant, accord ing to Getn ick & Getnick. GSK fired Eckard in May 2003. The FDA seized $2 billion worth of drugs from the Cidra facility in October 2003 and February 2005, according to Eckard's attorneys."

Antidepressant Approved to Treat Back Pain

The FDA has now approved an antidepressant, duloxetine hydrochloride (Cymbalta), to treat chronic back pain and osteoarthritis pain.

The FDA granted the new indication based on results of four double-blind, placebo-controlled, randomized clinical t ra i l s in wh ich pa t ien ts randomized to duloxetine reported a greater reduction compared with the placebo group. The approved dose is 60 mg/daily.

"In addition to its use for treatment of depression, duloxetine is approved for t r e a t m e n t o f d i a b e t i c p e r i p h e r a l n e u r o p a t h y, generalized anxiety disorder, and fibromyalgia."

"The most common side effects reported in the back pain and osteoarthritis trials were nausea, dry mouth, i n s o m n i a , d r o w s i n e s s , constipation, fatigue, and dizziness. Other serious side effects, which occurred in less than 1% of patients, included l i v e r d a m a g e , a l l e r g i c reactions such as hives, rashes and/or swelling of the face, pneumonia, depressed mood, suicide, and suicidal thoughts and behavior."

Antibiotics for Ear Infections Adversely Effective up to 10% of the TimeA r e c e n t r e p o r t i n MedpageToday.com states that "The meta-analysis of 135 studies conducted among children ages four weeks to 18 years, also suggested that a n t i b i o t i c s w e r e o n l y "modestly effective" in treating the infection -- while causing adverse effects in 4% to 10% of pediatric patients ...."

"At the same time, the review revea led l a rge gaps i n knowledge about the common condition ....The researchers noted the lack of a "gold standard" for diagnosing otitis media -- which means that clinical methods based on otoscopy (findings of tympanic m e m b r a n e b u l g i n g a n d redness) and symptoms are the only way to diagnose the common childhood condition."

"Background provided in the review noted that acute otitis media is the most common childhood infection for which antibiotics are prescribed in the U.S. The authors cited a 2006 study which estimated the average cost of treating a chi ld wi th a middle ear infection at $350 -- adding up to $2.8 billion in annual medical expenses."

"The researchers were able to pool data from seven placebo-

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c o n t r o l l e d s t u d i e s o f amoxici l l in or ampici l l in, compr is ing about 2 ,000 patients. Clinical success rates at day 14 were 12 percentage points higher with the antibiotics relative to placebo. But the average success rate with placebo was 60%, raising questions as to whether adverse events -- chiefly rash and d i a r r h e a - - o f f s e t t h e benefit."

"The resea rche rs c i t ed government data indicating that 14% of children with otitis media receive cefdinir. 'If just half of [these patients] were to receive amoxicillin instead of cefdinir ... the estimated annual savings would exceed $34 million,' they wrote."

School-based Health CentersThe Department of Health and Human Services announced grants for doctors' offices that usually are based on school g r o u n d s a n d p r o v i d e comprehens ive medica l , d e n t a l , m e n t a l a n d community-based services to students and families. HHS calls the centers 'a major component of the nation's health care safety net.'"

"The additional money will help children with acute or chronic i l lnesses at tend school and improve their health through screenings and disease prevention."

There are about 1,900 school-b a s e d h e a l t h c e n t e r s nationwide, according to the National Assembly on School-B a s e d H e a l t h C a r e , a n o n p r o fi t b a s e d i n Washington, D.C. A majority of the centers -- 96% -- are in school buildings, and the r e m a i n i n g o n e s a r e i n separate facilities on school properties or are mobile programs.

"The majority of students helped by school -based centers fall through the cracks of the health care system … and are not covered by Medicaid, school medical services or a primary care physician."

School-based health centers are health clinics that:

Use physicians and other hea l th p ro fess iona ls t o provide primary health care se rv i ces t o ch i l d ren i n accordance with state and local laws.

Are located in or near a school facility of a school district or board, or an Indian tribe or tribal organization.

Organize through school, community and organized medicine relationships.

A r e a d m i n i s t e r e d b y a sponsoring facility, such as a h o s p i t a l , p u b l i c h e a l t h department, community health center, nonprofit health care agency, loca l educat ion agency or the Indian Health

Service or the Bureau of Indian Affairs.

Obesity is a $30.3 Billion Workplace ProblemData from two large national surveys indicated that obesity is associated with $30.3 billion in direct medical costs, $12.8 b i l l i o n i n w o r k p l a c e absenteeism, and $30.0 billion in "presenteeism" -- at work but less productive because of health problems.

"Between excess medical costs and lost workplace productivity, individuals with body mass index values of 30 o r m o r e c o s t t h e U . S . economy about $73.1 billion annually, researchers said.”

Women who were overweight had 1.1 more days of missed work annually, 0.9 days of lost productivity while on the job and $529 o f add i t i ona l medical expense.

For those with grade I obesity: 3.1 more days of missed work, 6.3 days of lost on-the-

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job productivity, and $1,274 in additional medical costs.

Those with grade III obesity r e p o r t e d m e a n s o f 9 . 4 additional days of missed work, 22.7 days of lost productivity, and $2,395 more in medical expense.

The values for men were smaller. The extra annual medical expense for grade III obese men was $1,269 and addit ional lost workdays numbered 5.9.

Men who were classed as overweight rather than obese did not have significantly higher medical costs than those of normal weight, and they actually had fewer days of presenteeism. Among women, direct medical costs tended to be affected most strongly by excess weight.

When extrapolated to the entire population -- taking into account that grade I obesity is more common than grade III, and that more men than women hold jobs -- the aggregate economic impact was about the same across all three levels of obesity and for men versus women."

" F o r m e n a n d w o m e n combined, the total economic cost of grade I obesity was $29.4 billion, compared with $23.1 billion for grade III obesity. Across all levels of obesity, the total cost was $33.8 billion for men and $39.3 billion for women."

Changing Dogma of MedicineG e o r g e Lundberg, MD, Editor-at-Large, f o r M e d P a g e T o d a y , i n a November 10, 2010, editorial FOUND HERE makes several o b s e r v a t i o n s regard ing what sc ience assumes to be "state of the art". He observes "once an erroneous 'fact' becomes established dogma in the mind and actions of the profession and the public, it is very hard to change that belief and those pract ices. Of c o u r s e , a c h a n g e a l s o in ter rupts many income streams."

Final ly! Someone in the medical profession is realizing that medical dogma is hard to change and that income is a p r i m a r y i m p e d i m e n t t o p romot ing tha t change . Scientists in the chiropractic profession have been trying to point this out to our profession for years now. It is unusual to see the editor of a large medical publication stating virtually the same message.

The point of Dr. Lundberg's editorial, however, was not to highlight medical dogma, but to il lustrate that science outpaces dogma. He states that "One by one, the big-time screening tests for dread

diseases, begun w i t h g o o d intentions, the best science known at the time, and a mass public health campaign, bite the dust." "Sometimes the most intuitive a n d s e e m i n g l y l o g i c a l observations and conclusions are simply wrong."

O b s e r v e s D r . Lundberg: "Real science, that of statistically and clinically valid outcomes over time, obviously takes time to be r e a l i z e d . I t a l s o t a k e s unbiased sc ient is ts and physic ians wi th min imal conflicts of interest to study, deduce, report and then take the heat while putting change into practice." It seems that the key obstacle is the avai labi l i ty of "unbiased scientists and physicians."

The purpose of Dr. Lundberg's editorial was his call to "Stop p u s h i n g s c r e e n i n g mammograms now. " He reports that "The new large study out of Norway reported in the Sept. 22, 2010 issue of NEJM again documents that any benefits of mammography are so smal l . [And] We already know that the harms and costs [for the procedure] are not small."

He reports that "Finding a breast cancer or a prostate cancer early so it can be treated when tiny seems so logical. However, such an

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approach has always meant also finding "cancers" that are not going to hurt the patient even if untreated." He notes that "in the 1960s, I worked for a while as a pathologist in west Texas. One hospital there was famous for its very high breast cancer cure rate. Then someone looked at some of those 'cured breast cancers.' Guess what; on [a] pathologist second opinion, many were not cancers in the first place."

He reports "The strangely c o n t r o v e r s i a l 2 0 0 9 recommendation of the U.S. Preventive Services Task Force, which downplayed the value of mammograms is looking better all the time. It further said that the patient and the physician together should consider the data and share in deciding about mammography. I like that, especially if both the patient and phys i c ian a re we l l i n fo rmed. S top push ing screen ing mammograms now."

It may be difficult, if not sometimes impossible, to change the dogmatic mindset of a healing arts professional, b u t a t l e a s t o n e M D recognizes that "once an erroneous 'fact' becomes established dogma in the mind and actions of the profession and the public, it is very hard to change that belief and those practices" and that it "interrupts many income streams." Now, if we could JUST change the dogma of political medicine.

Documentation of Supplement Usage Lacking 73% of the Time.M e d p a g e T o d a y . c o m R E P O R T S H E R E t h a t "Although nearly half of older adults take some kind of herbal or dietary supplement, most of them don't tell their healthcare provider -- or are n o t e v e n a s k e d a b o u t supplement use, researchers reported here."

"A survey of 100 patients taking the ant icoagulant warfarin (Coumadin) found that 69% took some kind of herbal or dietary supplement, but only 35% reported that their healthcare provider asked them about supplement use ...."

"The survey noted that 63% of warfarin-treated patients had used a supplement without first consulting their provider, despite the fact that 54% recognized herbal and dietary supplements can act as drugs. Only 33% of patients in the study learned about herbal or dietary supplements f r o m a h e a l t h c a r e professional."

"Information on supplement or herb use was not noted in the medical records of 73% of patients. Supplement use is going up, patients are using them more and more, and

they often don't talk to their doctors about it for various reasons. ... [Patients] don't see herbal supplements as drugs; they don't think about the supplements they're taking because they think they're natural, they're safe, and they're not medications."

Stated one cardiologist in the report : "As a pract ic ing c a r d i o l o g i s t , p a t i e n t s f requent ly ignore l is t ing supplements when filling out medication history for their physicians, and physicians, pressed for time, do not routinely spend time exploring this. Yet, literally millions and millions of Americans take various dietary and nutritional supplements on their own, not p r e s c r i b e d b y, a n d s o unknown to, their physician." It appears as if the medical physician is falling down on t h e j o b o f s e e k i n g t o document these chemical supplements. The authors note "that doctors should prompt patients to disclose supplement use, that the supplement industry should provide labeling that lists potential drug interactions, and patients should not balk at talking to their doctors a b o u t n o n p r e s c r i p t i o n remedies they use."

T h e s t u d y ' s a u t h o r s "concluded that unrecognized interactions between warfarin a n d h e r b a l o r d i e t a r y supplements could cause b l e e d i n g o r s t r o k e complications. They cited increased stroke risk from reduced INR in patients taking

29 Texas Journal of Chiropractic

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