The Texas Chiropractic Association represents chiropractic professionals throughout the state. First formed in 1916, this historic association has existed for nearly 100 years and has represented the interests of Texans who desire safe and effective health care from chiropractic professionals. TCA serves to protect chiropractic professionals, their patients, and the right for Texans to choose chiropractic as one of their health care options. ABOUT OUR COVER Notice anything new about our cover? Did you notice the NEW Texas Chiropractic Association Logo? It is time for CONVENTION! Come to Austin and learn, and fellowship, and dine, and play, and work to better your profession. It will all be there for the annual Texas Chiropractic Association Convention.
POLICIES Annual subscription to the Texas Journal of Chiropractic is included in TCA membership dues. subscription rates for non members.
Contact the TCA for
The print-format Texas Journal of Chiropractic is published up to six times per year by the Texas Chiropractic Association under the supervision of the TCA Communications 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. 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, or check online at www.chirotexas.org. All advertising material must be in graphics ready format and submitted as a .jpg, .jpeg, .gif, .swf, or .png file type.
Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVII, Issue 3
Texas Journal of Chiropractic The Official Publication of The Texas Chiropractic Association
1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296 E-mail: info@chirotexas.org www.chirotexas.org Executive Officers President: Jorge Garcia D.C. President Elect: Jack Albracht D.C. Secretary: James Welch D.C.
TCA Staff Membership Development: Amy Archer Editor: Chris Dalrymple D.C.
Board of Directors District 1! District 2! District 3! District 4! District 5! District 6! District 7! District 8! District 9! District 10! District 11! District 12!
Paul Munoz D.C. Jon Blackwell D.C. Jason Clemmons D.C. Mark Bronson D.C. Dr. John Quinlan D.C. Cody Chandler D.C. Lorin Wolf D.C. Shawn Isdale D.C. Mark Roberts D.C. Shane Parker D.C. Max Vige D.C. Yvonne Landavazo D.C.
Policies Annual 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 six times per year by the Texas Chiropractic Association under the supervision of the TCA Publication 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.
May/June 2012 Inside Proposed Chiropractic Specialty Drawing Opposition 3 Acupuncturists Protest at TBCE Meeting 5 TBCE Withdraws Acupuncture Specialty Proposal 6 First Chiropractic Residency Program at VA Hospital 7 TBCE Hints at Policy Change on Proof of CE Hours 7 Congressional Committee Calls Chiropractic "Key Benefit" in DoD, Urges Pay Equity 7 House Passes User Fee Bill 8 Control the Five “Rs” of Rehab Training 9 TBCE Updates Rule 80.1, Delegation of Authority 11 TBCE Updates Rule 77.5, Misleading Claims 13 7 Years Max to Call Yourself 'Board Eligible' 13 First Chiropractic Student to Be Awarded Albert Schweitzer Fellowship 14 Schwartzbauer Steps Down as Sherman College's Fourth President 15 Water May be Good but Watch the Bottle! 16 Pharma Scales Back Drug Samples to Physician Offices 17 When Costly Medical Care Just Adds to the Pain 18 Bone May Play Role in Diabetes 19 Hurricane Season is Here Time for Disaster Preparation 20 Diabetics on 'Biggest Loser' Shed Meds, Too 21 CDC Lowers the Bar for 'Lead Poisoning' 22 No New Name for High-Fructose Corn Syrup 22 FDA: Teething Pain Remedies Dangerous 23 Really? Never Brush Your Teeth Immediately After a Meal 24 Zinc Helps Fight Infant Infections 24 Bone Meds, Esophageal Cancers Linked 24 NSAID Bleeding Risk: Smoke But No Fire 25 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 2012 All Rights Reserved: Texas Chiropractic Association
Proposed Chiropractic Specialty Drawing Opposition The Austin AmericanStatesman reports that some Chiropractors “would be able to claim that they are specialists in acupuncture — placing needles in the skin to relieve pain — after 300 hours of [additional] training, according to a proposal that acupuncturists, who have many more hours of training [in acupuncture], oppose.” “Acupuncturists and others have sent a petition to the board said to contain more than 2,000 signatures against the designation.” The newspaper reports that the opponents’ chief concern “is that the rule would allow the chiropractors to claim the specialty [classification].” Opponents are upset that doctors of chiropractic, after receiving nearly 5000 hours of doctoral education, might be getting “less than a quarter of the 1,350 hours that acupuncturists must obtain, not counting another 450 hours in herbal studies. None of the 300 hours would have to be spent in a clinical setting — a key part of the training that acupuncturists get.” Indicating that the true nature of the complain is a “turf war” the newspaper notes: “Texas www.chirotexas.org
chiropractors can be certified to perform acupuncture on patients if they have had just 100 hours of training [in addition to their state mandated doctoral education]. But creating a specialty designation, the Texas State Board of Acupuncture Examiners [a subordinate board of the Texas Medical Board] says in a letter to the chiropractic board, would undermine its licensing standards, confuse the public by putting chiropractors ‘on equal footing‘ with acupuncturists and potentially endanger patients.” “The issue is one of the latest turf battles in health care and another involving chiropractors. [Medical] Doctors and [chiropractic doctors] have been embroiled in litigation over certain procedures that physicians say should be left to medical doctors.” “Critics from as far away as Europe have weighed in on the rule” with the TBCE which has “received many more negative comments than p o s i t i v e o n e s , ” Ye v e t t e Yarbrough, the executive director of the TBCE said.
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“William Morris, president and CEO of the AOMA Graduate School of Integrative Medicine … encouraged faculty and students” to attend the chiropractic board’s May meeting. “My concern is not hours, it’s competencies,” he said. “It’s real easy to teach to a test so you can pass a test, but with that clinical performance requirement missing, there’s no way they can guarantee public safety. And it’s misleading.” “ D r. J e ff r e y B r o w n , a semiretired chiropractor in College Station who practiced for 30 years in Austin, disagrees. Chiropractors are well-trained and “were the first profession to endear and embrace acupuncture in Texas in the 1970s” — about two decades before the Legislature created the Texas State Board of Acupuncture Examiners, said Brown ....” “In all of the years chiropractors have been practicing acupuncture, there have been no substantial complaints filed against a chiropractor for doing acupuncture” in Texas, Brown said.”
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“Those arguments do not sit well with Wally Doggett, p r e s i d e n t o f t h e Te x a s Association of Acupuncture and Oriental Medicine and owner of South Austin Community Acupuncture.” “If they wanted to raise the standard, that would be one thing,” said Doggett, an organizer of the petition drive. Instead, the chiropractic board is “acting more like a booster organization than a regulatory board. … I have not seen the acupuncture community this fired up in many, many years.“ “Some opponents mistakenly think chiropractors are trying to practice Chinese medicine or do acupuncture for any ailment, Yarbrough said. By l a w, c h i r o p r a c t o r s a r e authorized to treat the musculoskeletal system, the spine and nerves. Any acupuncture they do must be done in that context, Yarbrough said.” Says Ms. Yarborough: “To clarify a comment appearing in the Statesman attributed to me: The last paragraph states that I said ‘By law, chiropractors are authorized to treat the musculoskeletal system, the spine and nerves. (Note there are no direct quotes in the original article, thus signifying a paraphrasing of my original comments by the reporter.)” “The TBCE is not taking subluxation complex out of scope of practice. The r e p o r t e r s i m p l i fi e d Texas Journal of Chiropractic
‘subluxation complex’ down to ‘nerves,’ because their newspaper felt that the phrase ‘subluxation complex’ would not be understood by the average reader.”
complex … Please spread the word that the Board is NOT, r e p e a t N O T, t a k i n g t h e position that scope of practice eliminates subluxation complex and substituting the overly simplistic “nerves.”
I have received multiple emails and calls from concerned licensees who practice acupuncture for treatment of subluxation
Call for Keeler Award Nominations Established 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 McCubbin Secretary, Keeler Plaque Committee P. O. Box 272 Hunt, 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.
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Acupuncturists Protest at TBCE Meeting T h e Te x a s B o a r d o f Chiropractic Examiners Meeting on Thursday, May 24, 2012 had a surprise visit from disgruntled acupuncturists who objected to the TBCE considering acupuncture as a “chiropractic specialty.” Displaying posters claiming “Acupuncturists are the specialists” and “300 ‡ 3000″ and others, over 50 Acupuncturist school presidents, graduate students and students protested both on the street and in the meeting room the TBCE’s consideration of a “chiropractic specialty” for acupuncture. The specific complaint of the orderly demonstration was that whereas acupuncturists are required to have some 3000 hours of training, for the chiropractic board to consider 300 hours of training as sufficient to denominate one a “specialist” was offensive. The TBCE re-arranged its agenda to accommodate the demonstrators, opened its meeting and then took up the “recognized specialties” rule proposal and moved to withdraw consideration of the specialty rule to continue more public meetings on the issue. The TBCE then allowed the protesters to express their www.chirotexas.org
opinion regarding the rule that was not to be considered, and various presidents, graduate students, and students of acupuncture spoke for the next hour. The presidents or leadership of at least two acupuncture schools, an acupuncture student’s association, and several acupuncture associations presented their opinions to the TBCE.
speakers. He refused to yield the microphone stating he wanted more time to harangue the board. Dr. Tays let him have “one more minute” and he concluded his remarks. The remaining speakers were limited in the time allowed for their remarks and gradually toned down their rhetoric, some presenting very logical and reasonable points for the TBCE to consider. One acupuncture association president stated “she wanted double the allocated time because she wears two hats” as an association leader and a school leader.
Beginning with aggressive passion, the first speaker questioned the board “why do chiropractors want to do acupuncture?” His message centered upon the “public safety” mantra espoused by the medical profession, proposing that they are the true guardians of the public safety. He stated “acupuncture is very dangerous. People can die from acupuncture.“ After about 15 minutes TBCE President, Dr. Cynthia Tays sought to limit his speaking time to allow time for other 6
President William R. Morris, PhD, DAOM, LAc of the AOMA Graduate School of Integrative Medicine concluded the acupuncture leadership’s commentary and thoughtfully presented his points to the TBCE board members. There followed in succession, totaling an hour of public input, a number of acupuncture school graduates, and students each speaking their mind, desiring that “we should work together” to come to a resolution. Texas Journal of Chiropractic
withdraw and revise a proposal that would have allowed chiropractors to claim they are specialists in acupuncture after just 300 hours of training [above and beyond their state mandated doctoral level education].” I n t e r e s t i n g l y, t h e A O M president pointed out that “for p u b l i c s a f e t y, e f f e c t i v e practice goes equally to the efficacy of practice as well as to public harm.“ His point was that not only does a healing arts practice have to be safe from harm, but it needs to be effective as well. Gary Brettmann, D.C., President of the Chiropractic S o c i e t y o f Te x a s , a l s o presented his remarks to the TBCE board members chastising them for being more concerned with making rules to regulate “medical procedures” than they were in promoting chiropractic procedures and philosophy. Devin Pettiet D.C., spoke on b e h a l f o f t h e Te x a s Chiropractic Association. He noted that regarding the practice of acupuncture that public safety is a concern but not an issue, indicating that both professions are concerned with maintaining the highest level of safety possible, but that adverse health or safety reports were minimal. TCA urged that whenever rules were proposed that touched on or affected the scope of practice of other professions that the professions should work Texas Journal of Chiropractic
together to come to acceptable compromises for the betterment of the health and welfare of the public. The TBCE will continue to investigate the matter of “chiropractic specialties”, but the matter has been withdrawn from board consideration for now.
TBCE Withdraws Acupuncture Specialty Proposal The Austin-American Statesman reported in an article published May 25, 2012 that “The Texas Board of Chiropractic Examiners responded to the ire of acupuncturists, voting unanimously Thursday to
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“Acupuncturists receive at least 1,350 hours of training in Texas, much of it in a clinical setting with patients,” the newspaper reports. “About 70 acupuncturists, students and others jammed the chiropractic board's meeting room." " Yo u h a v e t o r e a l i z e acupuncture can be very dangerous," said Po Chang, an acupuncturist in Austin. With just 300 hours of training, "you can kill people." “Chang said. ‘What if we took 300 hours of training ... and called ourselves chiropractor specialists?’" The crowd of acupuncturists and acupuncture students applauded Dr. Gary Brettmann, president of the Chiropractic Society of Texas, after he pointed out that the
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TCA CONVENTION JUNE 7-9
AnDr.Abbreviated Schedule Kim Christensen DC, DACBR, CCSP, DSCS, CES, PES
Platinum Sponsor We have invited some of the state’s most knowledgeable and respected practitioners to speak. With one seminar you can fulfill your continuing education, Medicare and Ethics required TBCE hours. We also have sessions showcasing practical technique and chiropractic trends. We invite you to come, listen, learn and network with your colleagues from across the state at the greatest chiropractic event in Te x a s i n 2012. Come and enjoy the sights, tastes and sounds of the music capital of the world, Austin. TCA Convention headquarters are the downtown the Sheraton Austin. Come experience the bats, paddle Ladybird Lake, play some golf or just enjoy live music on 6th street after the sessions.
Thursday, June 7, 2012 Dynamic Spine Stabilization provides advance
knowledge and skills to successfully work with 12:00 pm – 5:00 pm Registration & Exhibits Open impairments, patients suffering from musculoskeletal imbalances or post-rehabilitation 7:00 pm – 10:00 pm Conference Welcome concerns.
Christopher Opening Kent and Exhibitor DC, JD Reception Learn how chiropractic care improves health, saves
Friday, June money 8, 2012 enhances quality-of-life and how scientific research supports chiropractic care.
Registration Open
7:00 am – 5:00 pm
Conference Welcome Dr. Matthew H. Sweat DC, BCAO Ethics, Everything Risk Management, Coding, you wanted toDocumentation & know about Atlas TBCE Required OrthogonalHours Chiropractic – an introduction, its
8:00 am – 12:00 pm
History, Biomechanics, Research, Testimonials, X-Ray 11:45 pm – 1:00 pm TCA Auxiliary and published articles.Luncheon
Special Announcement BrockADC, NP-C Future 1:00 pm – 3:00 pm Dr. Brandon Chiropractic: Glorious
Current neurological, physiological and 1:00 pm – 5:00 pm immunological Introduction tomechanisms, the Gonstead System disease how receptor and nutrition based therapy can have a positive 1:00 am – 5:00 pm impact Treatment on various Protocols pathologies. for Allergies &
Auto-immune Diseases & Special Treatment Techniques for Back Shu Points Susan McClellan 3:30 pm – 5:30 pm Medicare Chiropractic’s Three-Legged Stool-Made Simple--This comprehensive The Relationship of Philosophy, Science and Art training seminar has been designed specifically for Doctors of Chiropractic and their staff and
Saturday, June 9, 2012 provides the most accurate and current
information available to help you get it right
Medicare Made Simple Mark L. Hanson DC, Lac for Allergies & 8:00 am – 5:00 pm Treatment Protocols Treatment Protocols for Allergies(continued) & Auto-immune Auto-immune Diseases Diseases and Special Treatment Techniques for the 8:00 am – 5:00 pm
Shu Points. 8:00 am – 5:00 pm Back Dynamic Spine
Stabilization
The Impact of Chiropractic Care from a Neuroimmunological Model Larry Montgomery, DC 10:30 am –12:00 pmEthics, Atlas RiskOrthogonal Management, Chiropractic Documentation Program 8:00 am –10:00 am
Coding, TBCE Required 1:00 pm – 4:00 pm andThe Autonomic LinkHours 4:00 pm – 5:00 pm
The Thompson Technique System
7:00 pm –10:00 pm
President’s Banquet & Awards Ceremony
TBCE and medical doctors' groups have been in court for several years feuding over certain procedures chiropractors want to do. The p a p e r r e p o r t e d t h a t D r. Brettman stated: "It makes us weaker when we have to defend what we do." Others at the meeting criticized the TBCE claiming that acupuncturists were included in the rule making process two years ago and then have been excluded from continued work on the rules proposal. “Board President Cynthia Tays, a chiropractor in Austin, said the board will meet with acupuncturists in crafting a new rule,” the paper reported. "Hopefully, we can come to a compromise" that includes a chiropractic specialty for acupuncture,” [Dr.] Tays said.
First Chiropractic Residency Program at VA Hospital N e w Yo r k C h i r o p r a c t i c College (NYCC) announces that it has partnered with the Canandaigua VA Medical Center in Canandaigua, N.Y., to create an integrated care chiropractic residency program – the first such program to be established at a Veterans Administration www.chirotexas.org
health care facility, according to the college. NYCC residents will work alongside VA providers and experience rotations with specialists in neurology, orthopedics, physiatry, pain management, primary care and physical therapy at the medical center.
TBCE Hints at Policy Change on Proof of CE Hours T h e Te x a s B o a r d o f Chiropractic Examiners has announced that in the coming weeks they will announce that: “1. Licensees are required to submit to the Board proof of completion of ALL CE hours (including the 8 hours of Medicare CE) under Board rule 73.3. This can be done by sending a copy of the course completion certificate to the Board. (Make sure your license number is noted on all correspondence to the Board.) We are tracking each licensee’s compliance and will only make licensees eligible for renewal/relicensure if all CE requirements have been met. Consequences of failure to meet CE requirements can be found here.”
Board rule 75.21 to the Board. We are beginning to track the qualifications of each licensee to perform acupuncture. If you do not submit proof of qualifications, then you will not be considered ‘qualified’ to perform acupuncture.” “3. Licensees will soon be required to submit proof of chiropractic specialty qualifications under Board rule 71.13. As is the case with acupuncture qualification, if you do not submit proof of q u a l i fi c a t i o n a n d C E compliance for specialties, you will not be considered ‘qualified’ as a specialist.” It appears as if TBCE will be changing its policy of “provide when asked” to some form of regularly required proof of CE acquisition. Undoubtedly TBCE will be issuing clear instructions in the coming weeks, and we will report them as they become available.
Congressional Committee Calls Chiropractic "Key Benefit" in DoD, Urges Pay Equity
“2. Licensees are required to submit proof of eligibility to perform acupuncture under
Members of the House Armed Services Committee have approved the inclusion of a strong, pro-chiropractic directive in their official committee report
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accompanying the FY 2013 National Defense Authorization Act. The committee language asserts that services provided by doctors of chiropractic for our nation's men and women in uniform is of "high quality" and has become a "key" benefit within the military health care system. Read relevant pages from the committee report here. According to the American Chiropractic Association (ACA) and Association of Chiropractic Colleges (ACC), the language is significant for several reasons: "What we have here – and this is very important – is an official statement from one of the House's oversight committees with authority over the Pentagon that directly links the services of DCs to the treatment of conditions experienced as a result of combat operations. This is a huge validation that chiropractic services are of significant, direct value to a combat fighting force," said ACA President Keith Overland, DC. Equally significant, the thrust of the language is aimed at ensuring that DCs within the military achieve "pay equality" and appropriate "job classifications" that are on par with other health care providers with similar training, education and scopes of practice. Regarding that language, Dr. Overland noted: Texas Journal of Chiropractic
"Our advocacy efforts have not only been aimed at getting DCs into federal health care programs such as the DoD's, and expanding their presence there, but they also have been aimed at ensuring that DCs are provided with appropriate status, authority, salaries and other benefits equal to those enjoyed by comparable-level providers. This is a major step forward in this advocacy process. It demonstrates that Congress is not just interested in simple DC inclusion, but inclusion in the right way, which fully recognizes the status, training and professional capabilities of a DC. Part of the ACA's mission is to level the playing field down to every last detail." Inclusion of the language follows a bi-partisan letter sent last year to the assistant secretary of defense for health affairs, signed by 15 members of the House Armed Services Committee, requesting the Department of Defense take action to correct the wage rate disparity experienced by doctors of chiropractic within the DoD. Full congressional action on the Defense Authorization bill that includes the House committee language has not yet taken place, but enactment is expected later this year, according to ACA officials, and will be a positive indicator that Congress continues to support a robust chiropractic program within the DoD. 10
"The Association of Chiropractic Col l ege s i s gratified that the extensive education and training that doctors of chiropractic receive has been recognized and that appropriate compensation is vital," said ACC President Dr. Richard Brassard. Dr. Overland added, "I want to thank House Armed Services Committee Chairman Buck McKeon, Ranking Member Adam Smith, and especially Congressmen Mike Rogers of Alabama and Dave Loebsack of Iowa for moving this issue forward." For further information on chiropractic inclusion in the military or to learn more about ACA's ongoing legislative efforts, go to ACA's advocacy Web page at www.acatoday.org.
House Passes User Fee Bill The House of Representatives has voted 387-5 to reauthorize FDA user fee programs for the drug and device industries and create new programs for generic and biologic drugs. The Senate passed a similar version of the bill last week. The legislation now must be finalized by both chambers in a conference committee. House leaders have said they expect to get the final version www.chirotexas.org
of the bill to President Obama by July 4. The current user fee agreements with the drug and device industries are set to expire at the end of September, so a deal must be made by then. The user fee bill would reauthorize the Prescription Drug User Fee Act (PDUFA), the popular program that charges drug companies fees that help fund the FDA's drug approval programs. Since PDUFA was first passed in 1992, it has become the major revenue stream for the FDA's drug review programs, with user fees funding 62% of the agency's drug review expenses in 2010. The user fee legislation would reauthorize the Medical Device User Fee Act (MDUFA), under which device companies pay the FDA user
fees that cover about 20% of FDA's device review expenses. The updated MDUFA agreement would allow the FDA to more than double the user fees it collects from device manufacturers, giving it $595 million in user fees from 2013 to 2017. That money would go toward speeding the approval of new devices. The deal with the generic industry would allow the FDA to collect about $299 million a year from generic drugmakers. The user fee agreement with manufacturers of generic biologics, or biosimilars known as the Biosimilar User Fee Act would at first be funded with $20 million annually from the federal government to hire new FDA staff and assist in setting up a
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 or in active practice for fewer than 10 years at the time of the award’s receipt. Send nominations to 2011 recipient: Dr. John Quinlan D.C. 120 South Denton Tap Rd., Suite 410; Coppell, TX, 75019 Phone: 972-304-5900 Fax: 972-304-6047 drquinlan@quinlanchiropractic.com
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process to review and approve generic versions of biologics. It authorizes four types of fees. The bill also contains a provision that would require drug manufacturers to give the FDA early warning if the company foresees a potential drug shortage, something that the Federation of American H o s p i t a l s ( FA H ) c a l l e d "crucially needed."
Control the Five “Rs” of Rehab Training By Kim D. Christensen, DC, DACRB, CCSP, CSCS The human body reacts positively to the increased stresses placed upon it. As one of the basic tenets of physical rehabilitation, this is the whole reason we command muscles to lift more weight, tendons to pull more tension, and joints to undergo more movement. In order to develop and improve our physical capabilities, we place increased, yet controlled stresses on our bodies. P a r a d o x i c a l l y h o w e v e r, increased physical stress is often the cause of symptomatic conditions and physical breakdown. What is the difference? Actually, several have been identified.
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Progressive overloading of responsive tissues is, in essence, the principle that underlies the benefits of exercise training. Benefits which accrue as the body’s normal recuperative processes respond and improve in function include increased strength and endurance, better flexibility, and improved coordination. Our goal is to stimulate these beneficial improvements, while avoiding any errors which might place excessive strain on the involved tissues. Proper instruction, continued m o n i t o r i n g , a n d s p e c i fi c corrections are necessary factors preventing overload injuries. A Trio of Errors There are three categories of exercise errors that indicate excessive loading of involved tissues. Most problems with exercises are associated with a “loss of form.” (1) This somewhat nebulous phrase can be defined as consisting of three problems: Postural Imbalance, Misalignment, and Movement Restriction. By paying attention to our patients as they perform their exercises, we can identify these problems early on, and make appropriate recommendations. Postural Imbalance. Look for any abnormal orimbalanced postures during exercising. Whether the patient is strengthening, stretching, or walking, hyperextensions and Texas Journal of Chiropractic
lateral shifts indicate an overload situation. This is easily seen during cervical training, when patients strain and push their heads forward, instead of maintaining a balanced alignment throughout their exercise.
endurance, or proprioceptive exercises, is never helpful, and can be counterproductive. Five solutions all start with the letter “R.” They are: Rest, Range, Rate, Resistance, and Repetitions. (2)
Misalignment. The more subtle deviation of misalignment during exercising relates primarily to the extremities. This can be especially noticed in the feet (toe-out), ankles (excessive pronation), and knees (knockkneed). These are all indicators that additional exercising in these conditions will likely bring about a recurrence of symptoms, rather than improvement. Addressing the misalignments and asymmetries are paramount for progress, and may require custom-made stabilizing orthotics.
Rest. By increasing the rest period between exercises, or between sets, we allow the body to recharge and to better handle the overload. This is often the simplest of the solutions, as sufficient rest is frequently all that is needed to avoid rehab overload.
Movement Restriction. Any limitation in range of motion during an exercise should prompt a search for the underlying cause. This may be a reasonable selfprotective response due to r e c e n t i n j u r y, o r ( m o r e commonly) an inappropriate fear response. It is also possible that the patient is placing excessive loads on sensitive tissues that are incapable of handling that amount of stress in their current state. A Quintet of Solutions Excessive loading, whether of r e s i s t a n c e , fl e x i b i l i t y , 12
Range. Controlling the range of an exercise or a stretch may be needed, especially in the initial phases of rehab. Particularly after an injury, connective tissues may be easily aggravated by forcing too much range. This is where the body can often let us know when we have gone too far, since it will give us a pain message. Initially, we should recommend that exercises be performed only within a painfree range of motion. Rate. Slowing down the pace of an exercise and incorporating a relaxed breathing cycle will often reduce exercise stress significantly. In fact, slow and controlled exercising stimulates more neurologic control and re-training without overstressing tissues. Resistance. Whether using exercise bands, weights, or machines, careful control of the amount of resistance is www.chirotexas.org
important. Isotonic strengthening exercises that focus on the eccentric (negative) component have been shown to improve the healing of tendons and accelerate return to sports participation. (3) However, excessive resistance can quickly produce the problems in posture, alignment, and range of motion described above, resulting in a poor response to care. Repetitions. And finally, one of the easiest ways we can overload our patients is to recommend too many repetitions of too many exercises. It is far better that a few repetitions of a few exercises be done regularly and consistently, and be interspersed with sufficient rest. When we keep our eyes peeled for the three types of “loss of form,” and then carefully control the “five Rs” of rehab training, we can avoid exercise overload and ensure a smooth response to chiropractic rehabilitation training. References 1. M u l l i n e a u x M . S t r e n g t h conditioning: developing your teaching technique. Strength Cond J 2001; 23:17-19. 2. M u l l i n e a u x M , R o w e L . Manipulating training variables for safety and effectiveness. Strength Cond J 2003; 25:33-36. 3. Niesen-Vertommen Sl et al. The effect of eccentric versus concentric exercise in the management of Achilles
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tendinitis. Clin J Sport Med 1992; 2:109-113.
About the Author Kim D. Christensen, DC, DACRB, C C S P, C S C S , d i r e c t s t h e Chiropractic Rehab & Wellness program at PeaceHealth Hospital in L o n g v i e w, Wa s h . H e h a s participated as team chiropractor to high school and university athletic programs, a postgraduate faculty member at numerous chiropractic colleges, past-president of the ACA Rehab Council, and a lecturer and author of many musculoskeletal rehabilitation texts. Dr. Christensen can be reached via email: kchristensen@peacehealth.org.
TBCE Updates Rule 80.1, Delegation of Authority T h e Te x a s B o a r d o f Chiropractic Examiners REPORTS HERE that it has adopted final amendments to Rule 80.1, Delegation of Authority. The newly adopted rule now reads: (a) The purpose of this section is to encourage the more effective use of the skills of licensees by establishing guidelines for the delegation of health care tasks to a qualified and properly trained person acting under a licensee's supervision consistent with the health and welfare of a patient and with proper diligence and efficient practice of chiropractic. This section provides the 13
standards for credentialing a chiropractic assistant in Texas. (b) Except as provided in this section, a licensee shall not allow or direct a person who is not licensed by the board to perform procedures or tasks that are within the scope of chiropractic, including: (1) rendering a diagnosis and prescribing a treatment plan; or (2) performing a chiropractic adjustment or manipulation. (c) A licensee may allow or direct a student enrolled in an accredited chiropractic college to perform chiropractic adjustments or manipulations. (1) For students that have not completed an outpatient clinic at a chiropractic college, the chiropractic adjustment or manipulation must be performed as part of a regular curriculum; and the chiropractic adjustment or manipulation must be performed under the supervision of a licensee who is physically present in the treating room at the time of the adjustment. (2) For students that have completed an out-patient clinic at a chiropractic college, the chiropractic adjustment or manipulation must be performed under the supervision of a licensee Texas Journal of Chiropractic
who need not be physically present in the treating room at the time of the adjustment or manipulation, but must be on-site at the time of the adjustment or manipulation. (3) The requirement that the supervising licensee must be physically present in the treating room does not apply to chiropractic college clinics. (d) In delegating the performance of a specific task or procedure, a licensee shall verify that a person is qualified and properly trained. " Q u a l i fi e d a n d p r o p e r l y trained" as used in this section means that the person has the requisite education, training, and skill to perform a specific task or procedure. (1) Requisite education may be determined by a license, degree, coursework, on-the-job training, or relevant general knowledge. (2) Requisite training may be determined by instruction in a specific task or procedure, relevant experience, or on-the-job training. (3) Requisite skill may be determined by a person's talent, ability, and fitness to perform a specific task or procedure. (4) A licensee may delegate a specific task or Texas Journal of Chiropractic
procedure to an unlicensed person if the specific task or procedure is within the scope of chiropractic and if the delegation complies with the other requirements of this section, the Chiropractic Act, and the board's rules. (e) A licensee may allow or direct a qualified and properly trained person, who is acting under the licensee's supervision, to perform a task or procedure that assists the doctor of chiropractic in making a diagnosis, prescribing a treatment plan or treating a patient if the performance of the task or procedure does not require the training of a doctor of chiropractic in order to protect the health or safety of a patient, such as: (1) taking the patient's medical history; (2) taking or recording vital signs; (3) performing radiologic procedures; (4) taking or recording range of motion measurements; (5) performing other prescribed clinical tests and measurements; (6) performing prescribed physical therapy modalities, therapeutic procedures, physical medicine and 14
rehabilitation, or other treatments as described in the American Medical Association's Current Procedural Terminology Codebook, the Centers for Medicare and Medicaid Services' Health Care Common Procedure Coding System, or other national coding system; (7) demonstrating prescribed exercises or stretches for a patient; or (8) demonstrating proper uses of dispensed supports and devices. (f) A licensee may not allow or direct a person: (1) to perform activities that are outside the licensee's scope of practice; (2) to perform activities that exceed the education, training, and skill of the person or for which a person is not otherwise qualified and properly trained; or (3) to exercise independent clinical judgment unless the person holds a valid Texas license or certification that would allow or authorize the person to exercise independent clinical judgment. (g) A licensee shall not allow or direct a person whose chiropractic license has been suspended or revoked, in www.chirotexas.org
Te x a s o r a n y o t h e r jurisdiction, to practice chiropractic in connection with the treatment of a patient of the licensee during the effective period of the suspension or upon revocation. (h) A licensee is responsible for and will participate in each patient's care. A licensee shall conform to the minimal acceptable standards of practice of chiropractic in assessing and evaluating each patient's status. (i) It is the responsibility of each licensee to determine the number of qualified and properly trained persons that the licensee can safely supervise. A licensee must be on-call when any or all treatment is provided under the licensee's direction unless there is another licensee present on-site or designated as being on-call. On-call means that the licensee must be available for consultation within 15 minutes either in person or by other means of telecommunication. (j) A licensee's patient records shall differentiate between services performed by a doctor of chiropractic and the services performed by a person under the licensee's supervision.
TBCE Updates Rule 77.5, Misleading Claims T h e Te x a s B o a r d o f Chiropractic Examiners REPORTS HERE that it has adopted a final version of Rule 77.5, "Misleading Claims". The full text follows: (a) A person advertising chiropractic services shall not use false, deceptive, unfair or misleading advertising, including, but not limited to: (1) claims intended or reasonably likely to create a false expectation of the favorable results from chiropractic treatment; (2) claims intended or reasonably likely to create a false expectation of the cost of treatment or the amount of treatment to be provided; (3) claims reasonably likely to deceive or mislead because the claims in context represent only a partial disclosure of the conditions and relevant facts of the extent of treatment the licensee expects to provide; (4) claims that state or imply chiropractic services provide a cure for any condition; (5) claims that chiropractic services cure or lessen the effects of ailments, injuries
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or other disorders of the human body which are outside the scope of chiropractic practice as defined by Chapter 201 of the Occupations Code and Title 22, Part 3 of the Te x a s A d m i n i s t r a t i v e Code; (6) claims that state or imply the results of chiropractic services are guaranteed; or (7) claims that chiropractic services offer results that are not within the realm of scientific proof beyond testimonial statements or manufacturer's claims. (b) Subsection (a)(2) of this section is not meant to be applicable to circumstances where the cost or amount of treatment varies from an original quotation or advertisement by a reasonable amount. The standard to be used in determining whether a violation of this rule has taken place is the generally accepted standards of care within the chiropractic profession in Texas.
7 Years Max to Call Yourself 'Board Eligible' MedPageToday.com reports that “All but two of the 24 Texas Journal of Chiropractic
member boards of the American Board of Medical Specialties (ABMS) have finalized the time frame physicians have in which to become board certified, with 7 years after residency being the longest allowed.” “Nearly all chose 5 or 7 years. The American Board of Radiology set a 6-year interval, and the American Board of Surgery and the American Board of Thoracic Surgery have not yet established one.” “Three of the member boards also have a practice requirement. Both the American Board of Obstetrics and Gynecology and the American Board of Plastic Surgery have a board eligibility period of 7 years, plus 1 year in practice. The American Board of Urology has a board eligibility period of 5 years, plus 1 year and 4 months in practice.” “Physicians have typically used the term ‘board eligible’ to indicate that they planned on becoming board certified, but the term had not been recognized or defined before last September when the ABMS board of directors adopted a new policy setting a time limit for certification -- no fewer than 3 and no more than 7 years, plus time in practice if required.”
achieved ‘Board Certification,’ according to the policy.” “The member specialty boards had until this spring to set their own limits within that range. If physicians do not become board certified within the time limit, they must restart the process of certification required by the board for their specialty.” “Continuing to use the term ‘board eligible’ after the established interval will be considered ‘a breach of ethical standards of medical practice’ and will be met with sanctions, the policy stated.” “The new policy went into effect at the beginning of the year, but each member board will establish transition plans. Physicians not certified by Jan. 1, 2012, will have until at least Jan. 1, 2015, but no longer than Jan. 1, 2019, to achieve certification. After that date, the policy -- and established board eligibility intervals -- will be in full effect.” “The member boards may waive the rule in certain circumstances -- for example, in case of military deployment or acute illness.”
National University of Health Sciences student Dana Madigan is the first student in a chiropractic program to be awarded The Albert Schweitzer Fellowship. Dana was one of 243 multidisciplinary graduate students throughout the United States recently chosen as a 2012-13 Schweitzer Fellow. Upon completion of her one-year fellowship, Dana Madigan will become a "Schweitzer Fellows for Life" member, joining a network of over 2,500 Schweitzer alumni throughout the world. The fellowship program started in 1992 and supports graduate students in learning to effectively address the social factors that impact health, as well as developing lifelong leadership skills and living the famous physicianhumanitarian's message of service. While application to the fellowship is open to any professional degree student, Dana is the first in the program's history to be currently enrolled in a chiropractic degree program. Dana's approved project for The Albert Schweitzer Fellowship involves helping deepen connections between
"Allowing an unrestricted status of 'Board Eligibility' denigrates the status of those diplomates who have already Texas Journal of Chiropractic
First Chiropractic Student to Be Awarded Albert Schweitzer Fellowship
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the NUHS clinic in Lombard, Ill., and community organizations that help the medically underserved, specifically in regard to low back pain. "I chose the issue of low back pain, because addressing low back pain is one of our nation's 'Healthy People 2020' goals," said Dana. "I want to show how we can use our form of health care to help meet national priorities." "Usually community health programs offer no other choice for those with low back pain than to receive care from an MD or DO," says Dana. "Through this project, we are working to make chiropractic care for low back pain accessible for those who may not otherwise be able to receive it." Dana Madigan is also earning her Master of Public Health degree (MPH) at the University of Illinois at Chicago (UIC) through a coordinated degree program between NUHS and UIC that is partially funded through a grant from the National Institutes of Health. Dr. Jerrilyn Cambron is on the research faculty of NUHS as well as the teaching faculty of UIC's School of Public Health, and will be Dana's academic mentor for her project. "The big thing Dana is doing is trying to show the profession how we can get more involved with public health," said Dr. Cambron. "A lot of people with www.chirotexas.org
low incomes don't think they can afford chiropractic care, so we have to think of new pathways that give them access to our care." Dana's future goals after graduation are in the area of research. "I really want to work to get CAM practitioners involved in community organizations and advance integrative care through those avenues. I think everybody should be able to choose which kind of health care they receive." In addition to expressing her gratitude and honor in receiving The Albert Schweitzer Fellowship, Dana said she hopes this will encourage more students from NUHS and other chiropractic colleges to apply for the fellowship in the future.
Schwartzbauer Steps Down as Sherman College's Fourth President Sherman College's fourth president, Jon C. Schwartzbauer, DC, announced on May 24 that he i s s t e p p i n g d o w n . D r. Schwartzbauer has served as the college's president since 2007 and has been a member of the faculty and administration for 10 years.
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Schwartzbauer said he will oversee day-to-day operations and serve the college as needed while the Board of Trustees embarks on a search for the college's next president. The board is looking for a new leader to take the college through its next opportunities for growth. During his tenure as president, Dr. Schwartzbauer has seen Sherman College through reaffirmation of both its institutional and programmatic accreditation. He has improved student learning and led the implementation of a comprehensive chiropractic curriculum, enhancing the college's ability to graduate primary health care professionals who are highly skilled, compassionate, ethical and successful. In addition, Dr. Schwartzbauer managed the conversion of the college's on-campus Chiropractic Health Center to a patient-centered model, which has improved both patient care and student learning outcomes. Dr. Schwartzbauer took on the presidency during a tumultuous time as the college faced probation with the Southern Association of Colleges and Schools for its Quality Enhancement Plan and several student and academic policy issues. Through his leadership and the diligent work of the college community, the college was Texas Journal of Chiropractic
ultimately removed from probation and had its accreditation reaffirmed in 2009. In addition, the college received two commendations during its October 2011 team visit from the Council on Chiropractic Education– one specifically commending the doctor of chiropractic degree program for "the leadership, commitment and dedication of the [Sherman College] community regarding the cultural, mission and curricular changes." A 1997 Sherman alumnus, Dr. Schwartzbauer previously served the college as vice president for academic affairs, director of the Leadership and Practice Management Institute and a member of the Chiropractic Health Center faculty. He ran Schwartzbauer Straight Chiropractic Center in Mahtomedi, Minn., for five years before he joined the Sherman College faculty in 2002.
Water May be Good but Watch the Bottle!
the largest beverage type in the U.S. market, according to the Beverage Marketing Corporation." "In the first study of its kind, researchers determined just how much BPA you absorb when you drink bottled water." "Plastic water bottles have come under scrutiny in recent years for both their environmental and health e ff e c t s , i n c l u d i n g t h o s e surrounding the chemical bisphenol-A (BPA). That BPA can leach out of plastic during everyday use, causing health problems, is hardly news. It’s now widely known that BPA mimics the female hormone estrogen and may affect fertility and promote cancer. And just last year it came out that BPA may also lead to heart disease, diabetes and liver problems." "Studies have shown that detectable levels of BPA exist in more than 90 percent of the U.S. population, but exposure has been blamed on not only drinking water and food, but also on dental sealants, dermal exposure and inhalation of household dusts."
It is REPORTED HERE that "in just one year, Americans drank nearly 9 billion gallons of bottled water, which is second only to soft drinks as
"Researchers recruited Harvard College students for the study in April 2008, and all 77 participants then began a seven-day “washout” during which they drank all cold beverages from stainless steel bottles in order to minimize BPA exposure. For the next week, participants
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were given two polycarbonate bottles and asked to drink all cold beverages from them." "Urine samples were taken at the end of each week-long period, and the results that came back were shocking: levels of BPA rose 69 percent after just one week of drinking out of plastic bottles." "We found that drinking cold liquids from polycarbonate bottles for just one week increased urinary BPA levels by more than two-thirds. If you heat those bottles, as is the case with baby bottles, we would expect the levels to be considerably higher. This would be of concern since infants may be particularly s u s c e p t i b l e t o B PA ' s endocrine-disrupting potential." "While previous studies have found that BPA could leach from polycarbonate bottles into their contents, this study is the first to show the corresponding increase in BPA levels in humans. The end result is this: if you drink out of plastic water bottles, you can pretty much guarantee that you’re increasing your levels of BPA, which is very risky for your health." "Chronic exposure to very low levels of BPA, such as might occur when drinking bottled water, is potentially very harmful." "An expert panel of scientists has concluded that exposure www.chirotexas.org
to extremely low doses of bisphenol A is strongly linked to diseases such as breast cancer, prostate cancer, and diabetes, and to reproductive and neurological development." "BPA is so widely used that it may be nearly impossible to a v o i d e x p o s u r e e n t i r e l y, however you can greatly reduce your exposure by a v o i d i n g B PA - c o n t a i n i n g products as much as possible, including one of the biggest BPA predators: plastic water bottles." "If you want to avoid products with BPA, keep in mind the following: Plastic that contains BPA carries the #7 recycling symbol. Most clear plastic baby bottles and child cups are made of BPA-containing plastic. Dental sealant may leach BPA; this is being debated. You may want to avoid dental sealants on your children's baby teeth. You can minimize your BPA exposure by: Replacing plastic food and drink containers and utensils with glass, ceramic or metal varieties.
plastic (#1, #2, #4 recycling symbols) or polypropylene (#5) (these are usually colored, not clear, and should still not be heated). Not using canned foods or foods wrapped in plastic. Not letting children put plastic toys in their mouths. Being careful with BPAcontaining plastics, if you choose to use them. This means not exposing them to heat (microwave, dishwasher) or harsh detergents (bleach, etc.) and not letting food or beverages sit in the containers for too long." "Drinking plenty of pure water throughout the day is one of the best habits you can get into for your health. This is also what makes bottled water so convenient; simply throw a bottle in your purse, briefcase or gym bag and it’s easy to quench your thirst anytime." "Fortunately, there are options out there that give you the convenience of carrying water with you without risking the serious health effects of BPA." "One such option is to carry a stainless steel water bottle or one made of glass, covered in a protective glove to keep it from breaking."
Purchasing glass baby bottles. Using baby bottles and sippy cups made of polyethylene www.chirotexas.org
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Pharma Scales Back Drug Samples to Physician Offices The American Medical Association REPORTS HERE that "pharmaceutical companies have slashed their sales rep force by about 30% from a high of 105,000 five years ago, according to industry figures. And as the number of detailers has fallen, so, too, has another hallmark of pharmaceutical marketing: drug samples." "Drugmaker spending on the samples that drug reps leave behind in physician offices has gone down by 25% since 2007 …. In 2007, drugmakers spent nearly $8.4 billion on samples. That figure fell to about $6.3 billion in 2011, the most recent data available. The number of detailer visits that included samples has d r o p p e d e v e n f a s t e r, decreasing 35% from 116 million in 2007 to 76 million in 2011." "Drugmakers' decision to scale back their sales forces is the principal reason why sampling has declined, … The reduction in sales force is due in part to drugmaker consolidation and the need to cut costs, pharmaceutical industry experts said. ... With fewer big-name brands to b r i n g i n b i g p r o fi t s , drugmakers feel less need for
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sales reps and samples to promote them." "Also driving the move away from sales reps -- and, consequently, samples -- is that detailers find it harder than ever to visit physicians who are pressed for time or find little value in drug-rep visits." "As for samples, 23% of physicians refuse to take them … The rest of the surveyed doctors accepted samples, although their likelihood of doing so varied by specialty. The bigger the practice, the less likely it is to accept samples, the company said. Three-quarters of practices with three to five physicians took samples, compared with 54% of groups with 10 to 19 doctors."
When Costly Medical Care Just Adds to the Pain T h e N e w Yo r k T i m e s REPORTS HERE that “In talks about reducing the nation’s exploding health care costs, the “R” word — rationing — strikes fear into the hearts of both patients and doctors.
This is the philosophy under which our health care system operates, and it promises to bankrupt us without necessarily improving our health.”
insist on procedures that have little or no chance of success, including some very costly treatments not yet proved — or even disproved — to be beneficial.”
“In more instances than many people realize, doing more medically can be worse than doing less. Too often, costly, overly aggressive medical care causes more pain and suffering than if nothing had been done at all.”
“Spurred by the American Board of Internal Medicine Foundation, 17 medical specialty societies have been enlisted to discourage overuse of rarely productive tests and treatments. Nine of those societies have already weighed in, each with five practices that their elite members agreed were only sometimes helpful under special circumstances. To g e t h e r , u n n e c e s s a r y procedures like these currently waste an estimated $700 billion a year.”
“Our expectations and demands of health care must change, and we must reckon with the incentives for tremendous waste that are now built into the system.” “A growing body of research indicates that about 30 percent of what is now spent on medical tests and procedures is wasteful, unlikely to benefit anyone except those whose pockets are lined as a result. Unless this waste is curbed, rationing will almost certainly become a reality in the not-too-distant future.”
W h y, m a n y p e o p l e a s k , shouldn’t the richest country in the world spend whatever is necessary to protect and preserve its citizens’ health?
“Simple faith in a procedure’s effectiveness is not enough. Each medical decision should be based on the best available evidence, combined with the doctor’s best clinical judgment about what is right for each patient. Only then can we put an end to the current practice of doing whatever is possible, no matter what the odds of success. But too often, patients and their advocates
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“By establishing these recommendations as standards of care, the societies reduce the risk that doing less may spur malpractice suits, which currently prompt many doctors to overtest and overtreat — so-called defensive medicine.” “Of course, doctors are not the only ones who have to change. Patients, too, must accept the fact the more can be less and not demand procedures that are no longer recommended or shop around for doctors who will meet their ill-advised demands.”
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Bone May Play Role in Diabetes MedPage Today reports that “Bone is more than an inert repository for calcium and in fact may be an endocrine organ, researcher Clifford Rosen, MD suggested .… Bone may secrete bloodborne proteins that influence the function of other body organ systems at a distance from the bone compartment.” "We now know there are three bone-specific proteins that are just made in bone," Rosen said. These proteins are: •
Fibroblast growth factor 23 (FGF-23), which works to control homeostasis of phosphorus and vitamin D
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Sclerostin, which is produced by osteocytes in the bone and shuts down bone formation.
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Osteocalcin, which influences blood sugar levels and fat deposition”
“Amgen and several other companies are testing sclerostin antibodies as a potential remedy for osteoporosis or to help fractures or joint replacements heal faster.” “Companies also are working to commercialize osteocalcin for the treatment of diabetes. www.chirotexas.org
"The fact that osteocalcin can help diabetics actually is consistent with the idea that exercise improves insulin sensitivity," Rosen said. "Besides the obvious benefit of exercise to muscle, there may be a skeletal component to it as well," Rosen said. "As we exercise, we remodel our skeleton more frequently; we release osteocalcin from our bone and it has an effect on fat cells." “Rosen's own work has shed light on the dynamic process of bone remodeling. He and his colleagues have shown that bone loss is increased in cold temperatures, but not because of low vitamin D. In mice experiments, they found that insulin-like growth factor-1 (IGF-1) may be involved.” "Mice exposed to cold temperatures tend to lose bone very quickly. We're trying to understand if that environmental factor is influenced through the brain via sympathetic nervous system impulses, and if so, maybe that is part and parcel of why people in northern latitudes have a higher rate of bone osteoporosis," Rosen explained. “Cold temperatures also stimulate brown adipose tissue, or brown fat, which burns energy. But why does that lead to negative bone changes?” “The problem occurs when the body does not have 21
enough brown fat, such as in the obese or the elderly. The body will compensate by trying to make brown fat in other sites. It does this by increasing sympathetic impulses, which has a negative effect on bone.” "We initially reported that brown fat has a positive effect on bone," Rosen said. "But that is when the body has a lot of normal brown fat. When it doesn't have this and the body has to compensate, that is actually detrimental." “Studies have also demonstrated that proteins produced by bone cells modulate testosterone release from the testes, suggesting a possible role in reproductive biology.” “Rosen said that there's still some skepticism in the medical field about bone being an organ like the heart or kidney. His future research involves investigating the relationship between stem cells and bone cells.” “He has already shown that a connection exists in a preclinical experiment. Two groups of mice were fed the same amount of food and water for 12 weeks. One group of mice, however were on a vibrating table, which simulated a kind of low-impact exercise.” “The hypothesis was that through the low-impact exercise the stem cells would become bone rather than fat. Texas Journal of Chiropractic
In fact, they found that the vibrating mice had fewer fat cells and more bone density.”
Hurricane Season is Here, Time for Disaster Preparation With the official start of hurricane season on June 1 and an already active spring storm season, the Texas Department of Insurance encourages you to review your basic insurance needs to make sure you and your loved ones are financially protected from a disaster. Here are some steps to take to make sure you’re ready. Create a Home Inventory. Creating an inventory and storing it in a safe location away from home is a basic – and effective – disaster preparedness step. … more than half of Americans don't have a home inventory of their personal property. Not having an inventory to calculate the value of your property means you might be underinsured and not have enough money to replace your personal property if it’s damaged or destroyed.
In addition, NAIC has created a smart phone app that makes it easy to create a h o m e i n v e n t o r y. The myHOME Scr.APP.book app lets users capture and electronically store images, descriptions, bar codes, and serial numbers of your personal property. The app organizes information by room and creates a back-up file for email sharing. To download the free app, go to the iTunes or Android app stores and search "NAIC." Yo u s h o u l d r e v i e w y o u r inventory each year. Note the make, model, serial number, purchase price, and purchase date of any new items and keep copies of receipts for major purchases with your inventory. Check Your Policy. It’s important to know whether your policy includes coverage for replacement cost or actual cash value in case of a loss. Actual cash value (ACV) is the amount it would take to repair damage to your home or to replace its contents after allowing for depreciation. Replacement cost is the amount it would take to rebuild or replace your home and its contents with similar quality materials or goods, without deducting for depreciation.
You can download and print a home inventory checklist from the TDI website: w w w. t d i . s t a t e . t x . u s / p u b s / consumer/cb086.pdf.
Make sure your policy meets your needs and that you know your policy limits, deductibles, exclusions, and claim notification requirements. Store copies of your
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insurance policies with your inventory in a safe location away from your home so that you can easily retrieve them. Also consider scanning your policies and storing them electronically on a computer or server away from your home. Keep a list of contact details for your insurance agent and company with your policies. Include office phone numbers, mailing addresses, website addresses, and all of your policy numbers for quick reference. Email this information to yourself in case you’re separated from your hard copy list. M a k e S u r e Yo u H a v e Windstorm Insurance. If your property is in one of the state’s 14 coastal counties or parts of southeastern Harris County, your homeowners policy might not provide windstorm coverage. You may be able to obtain insurance coverage for windstorm or hail damage from the Texas Windstorm Insurance Association (TWIA). It’s important to know that you cannot buy or change TWIA coverage once a hurricane is in or near the Gulf of Mexico. For more information about windstorm coverage and inspection requirements, call your insurance agent or TWIA at 512-899-4900, or visit TWIA’s website at www.twia.org. If you’re a TWIA policyholder, be aware that your policy recently changed. For more www.chirotexas.org
information about the new TWIA claims process, call TDI’s Coastal Outreach and Assistance Services Team (COAST) at 1-855-35COAST (352-6278). Consider Flood Insurance. Most homeowners and commercial property policies exclude coverage for damage from flooding. To protect yourself from losses caused by rising water, you’ll need a separate flood insurance policy, typically from the National Flood Insurance Program (NFIP). NFIP is administered by the Federal Emergency Management Agency. Flood insurance policies usually have a 30-day waiting period after the purchase date before coverage takes effect on currently owned property, so don’t wait until a flooding threat is imminent. To get flood insurance, call your insurance agent or NFIP at 1-888-FLOOD 29 (356-6329) or visit www.floodsmart.gov. Make a Safety Plan. If a disaster threatens your area, you might have to decide whether to stay in your home or evacuate. Whenever local authorities recommend evacuation, you should leave. The advice of authorities is based on knowledge of the strength of the storm and its potential for destruction. Map out safe routes inland or to safer areas. If you live in a low-lying area, know where low-water crossings might make travel to safety more www.chirotexas.org
difficult and plan routes that avoid these areas. Find out the location of any nearby community shelters in case you must seek immediate shelter. Work out a way for family members to communicate in case you must leave your home or if there is a disruption in local phone service. For more specific information about safety planning and emergency preparedness, go to www.texasprepares.org
Diabetics on 'Biggest Loser' Shed Meds, Too MedPage Today reports that “Diabetic and prediabetic contestants on the TV show The Biggest Loser were off their medications within a few weeks of starting an intense exercise regimen, researchers reported.” “For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.” “In addition, the mean percentage of weight loss of 23
the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24….” “Before contestants went on the show, they averaged about 5 to 6 hours of TV watching a day and they were exercising about 120 minutes per week, close to the recommendations of the American Diabetes Association.” “The exercise regimen for those appearing on The Biggest Loser comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.” “Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.” “Within 1 week, biomarkers for those with prediabetes and diabetes had already improved …. A positive change in blood pressure was almost immediately noticeable, Huizenga said. By week 5, it had declined from 138/90 to 123/76 mm Hg and everyone was off their blood pressure medication.” “Interestingly, by week 5, ‘all diagnostic criteria for prediabetes, diabetes, and hypertension were absent in each participant, despite discontinuation of all diabetes and hypertension medications,’ according to the study.” Texas Journal of Chiropractic
“Huizenga and colleagues found that at 24 weeks, the percentage of body fat decreased from 48% to 30%, which Huizenga said is "somewhat more than is lost with Roux-en-Y gastric bypass surgery." "We know being active is good for you, but we also know that sitting for hours a day has a negative effect. We found that our participants tended to sit less after going through the program," Huizenga said.”
committee recommendations that the agency has accepted in principle.”
R e fi n e r s A s s o c i a t i o n t o change the name of highfructose corn syrup.”
“From now on, blood levels of lead exceeding 5 mcg/dL will identify children ‘living or staying for long periods in environments that expose them to lead hazards,’ according to a CDC statement.”
“The association, which represents the companies that make the syrup, had p e t i t i o n e d t h e F. D . A . i n September 2010 to begin calling the much-maligned sweetener “corn sugar.” The request came on the heels of a national advertising campaign promoting the syrup as a natural ingredient made from corn.”
“And the CDC now flatly states that any level of lead in the blood is a potential health hazard.”
“At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.”
“Starting in 1991, the agency had set 10 mcg/dL as the ‘level of concern’ for children's lead exposure.”
"I have a job and I work out from 90 to 100 minutes per day," he said. "It's about setting priorities. Time is not the issue; priorities are the issue."
“The American Public Health Association applauded the CDC's decision to accept the recommendations.”
CDC Lowers the Bar for 'Lead Poisoning'
“The committee's January report said that there is no blood lead level proven to be without damaging health effects.”
No New Name for High-Fructose Corn Syrup
MedPage Today reports that “the CDC has lowered by half the danger threshold for lead levels in children's blood, one of more than a dozen advisory
The New York Times reports that “The F.D.A. has decided that high-fructose corn syrup will keep its name. The United States Food and Drug Administration has rejected a request from the Corn
Texas Journal of Chiropractic
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“But in a letter, Michael M. Landa, director of the Center for Food Safety and Applied Nutrition at the F.D.A., denied the petition, saying that the term “sugar” is used only for food “that is solid, dried and crystallized.” “HFCS is an aqueous solution sweetener derived from corn after enzymatic hydrolysis of cornstarch, followed by enzymatic conversion of glucose (dextrose) to fructose,” the letter stated. “Thus, the use of the term ‘sugar’ to describe HFCS, a product that is a syrup, would not accurately identify or describe the basic nature of the food or its characterizing properties.” I n a d d i t i o n , t h e F. D . A . concluded that the term “corn sugar” has been used to describe the sweetener dextrose and therefore should not be used to describe highfructose corn syrup. The agency also said the term “corn sugar” could pose a risk www.chirotexas.org
to consumers who have been advised to avoid fructose because of a hereditary fructose intolerance or fructose malabsorption. “Because such individuals have associated ‘corn sugar’ to be an acceptable ingredient to their health when ‘highfructose corn syrup’ is not, changing the name for HFCS to ‘corn sugar’ could put these individuals at risk and pose a public health concern,” the letter stated. In a statement, the Corn Refiners Association said that F.D.A. officials had rejected the petition on “narrow, technical grounds.” “They did not address or question the o v e r w h e l m i n g s c i e n t i fi c evidence that high-fructose corn syrup is a form of sugar and is nutritionally the same as other sugars,” the statement said.
FDA: Teething Pain Remedies Dangerous M e d P a g e To d a y r e p o r t s “Rubbing topical anesthetics such as Anbesol or Orajel on the throbbing gums of a teething baby can lead to methemoglobinemia, a serious condition that leads to oxygen deprivation and -- in extreme cases -- death, the FDA warned.”
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“Products sold over-thecounter for teething and toothache pain contain benzocaine, and that is the source of the FDA's concern, said FDA pharmacist Mary Ghods, RPH, in a statement.” “The risk is greatest among children younger than 2, the age range at which most children experience teething pain.” “The FDA first warned about the products -- a list that includes Hurricaine, Baby Orajel and Orabase, as well as Orajel and Anbesol -- in 2006, and since then the agency has received "29 reports of benzocaine gelrelated cases of methemoglobinemia.”
symptomatic with first use or only after several uses.” “Symptoms of methemoglobinemia include: Pale, gray, or blue-colored skin, lips and nail beds Shortness of breath Fatigue Confusion Headache Light-headedness Rapid heart rate” “As an alternative to using numbing drugs on gums, the American Academy of Pediatrics recommends giving the baby a chilled teething ring or gently massaging the baby's gums with a finger.”
“Nineteen of those cases occurred in children, and 15 of the 19 cases occurred in children under 2 years of age," FDA pharmacist Kellie Taylor, PharmD, MPH, said in a statement.”
“The FDA noted that in addition to OTC sales of benzocaine products, physicians and dentists use benzocaine sprays to numb areas of the mouth and throat for procedures such as t r a n s e s o p h a g e a l echocardiograms, endoscopy, and feeding tube placements.”
“The FDA issued a second warning a year ago, but, Ta y l o r s a i d , t h e a g e n c y remains concerned about "the difficulty parents may have recognizing the signs and symptoms of methemoglobinemia when using these products at home."
“Adults -- especially those with heart disease, asthma, bronchitis, or emphysema, as well as smokers -- are also at risk from benzocaine p r o d u c t s , a n d Ta y l o r recommended that adults with those conditions have a preprocedure consult to discuss the risks.”
“Moreover, the symptoms can occur within minutes of use or may not manifest until hours after the drug is applied, and a child can become 25
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Really? Never Brush Your Teeth Immediately After a Meal
dentin loss when brushing in the 20 minutes after drinking soda. But there was considerably less wear when brushing took place 30 or 60 minutes afterward.”
The New York Times reports “Most of us believe that proper dental care means flossing and brushing often — at a minimum, twice daily, as the American Dental Association recommends. Those who are particularly diligent may brush more often, after meals, snacks or sugary drinks.”
“It is concluded that for protection of dentin surfaces,” the authors wrote, “at least 30 minutes should elapse before tooth brushing after an erosive attack.”
“But research shows that brushing too soon after meals and drinks, especially those that are acidic, can do more harm than good. Acid reflux poses a similar problem: While it might seem like a good idea to brush after a reflux episode, doing so can damage your teeth.” “Acid attacks the teeth, eroding enamel and the layer below it, called dentin. Brushing can accelerate this process, said Dr. Howard R. Gamble, president of the Academy of General Dentistry. ‘With brushing, you could actually push the acid deeper into the enamel and the dentin,’ he said.” “In one study, a group of volunteers were followed for three weeks as researchers examined the impact of brushing on their teeth after they drank diet soda. The scientists found an increase in Texas Journal of Chiropractic
“In the meantime, to get rid of acid, Dr. Gamble suggested rinsing the mouth out with water or using an acidneutralizing mixture: one part baking soda, eight parts water.”
Zinc Helps Fight Infant Infections MedPage Today reports “Zinc aided antibiotic treatment for serious infection in infants in developing countries, a randomized controlled trial showed.” “Adding oral zinc to standard antibiotics reduced the risk of treatment failure by 40% compared with standard antibiotics alone, Shinjini B h a t n a g a r, P h D , o f t h e Translational Health Science and Technology Institute in Gurgaon, India, and colleagues found.” “‘If further trials confirm a benefit, "the use of zinc as an 26
adjunct to antibiotic treatment might lead to substantial reductions in infant mortality, particularly in resourceconstrained settings where second-line antibiotics and appropriate intensive care might be unavailable,’ they wrote.” “The trial showed a signal for reduced mortality with zinc, with 10 deaths versus 17 in the placebo group for a 43% lower relative risk …. “Zinc deficiency is widespread in such areas -- documented in more than 40% of children in the trial …. Zinc syrup or dispersible tablets are already widely available in developing nations as a treatment for diarrhea, the researchers pointed out.” "’Zinc is important for mucosal barrier function and components of innate and adaptive immunity, such as lytic activity of phagocytes and natural killer cells, and expression of cytokines,’ they noted.” “Other potential mechanisms are modulation of inflammatory response and antioxidant properties, the editorial added.”
Bone Meds and Cancers Linked MedPage Today reports that “the esophageal cancer risk www.chirotexas.org
with bisphosphonate bone drugs may be a bigger problem than thought, particularly with use of alendronate (Fosamax), an adverse event surveillance study suggested.” “Overall, 128 cases of bisphosphonate-associated esophageal cancer were reported to the FDA's adverse event reporting system (AERS) from 1995 through 2010, Beatrice J. Edwards, MD, of Northwestern University in Chicago, and colleagues found.” “That risk appeared disproportionate with alendronate, the group reported in an abstract … That particular bisphosphonate accounted for 75% of the esophageal cancers seen with bisphosphonates in the FDA database -- 6.4 times more than with any other drug in the class.” “Alendronate likewise had an empiric Bayes geometric mean of 6.3, suggesting that the esophageal cancer cases were more common with bisphosphonates than with other drugs in the database.” "Our analysis of FDA AERS identifies a larger number of cases of esophageal cancer than previously described, and a significant safety signal with alendronate use," they noted. "Increased awareness and vigilance is needed for patients receiving oral bisphosphonate therapy." www.chirotexas.org
“The esophageal cancer events they found associated with bisphosphonate use were 96 cases with alendronate, 14 with risedronate, 10 with ibandronate, seven with zoledronic acid, and one with pamidronate (Aredia).”
issued that estimate back in 1998.”
"Esophagitis has been associated with oral bisphosphonates," Edwards' group noted. "Erosive esophagitis and persistent mucosal abnormalities have been noted with crystalline material (similar to ground alendronate)."
“Singh said his initial calculation of 16,500 annual deaths was based on early 1990s data.”
NSAID Bleeding Risk: Smoke But No Fire MedPage Today reports “one of the main arguments for initiating use of narcotic painkillers with older people with chronic, noncancer pain is the concern that the alternative treatment -nonsteroidal anti-inflammatory drugs -- can cause serious internal bleeding.” “But that concern appears to be based on an overblown estimate of NSAID risk …. The most frequently cited estimate of the risk, 16,500 deaths each year from NSAID-related GI bleeds -- is flat-out wrong, according to the researcher who first
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"That's an an old number," said Gurkirpal Singh, MD, an adjunct clinical professor of medicine at Stanford University. "That's history."
“The U.S. Centers for Disease Control and Prevention says the actual number of deaths in 2008, the most recent year available, is about 3,400, based on a review of death certificates. And that number includes all gastrointestinal bleeding deaths, not just those caused by NSAIDs.” “Singh noted that lower doses of the nonprescription drugs are used today. And they are often taken with proton pump inhibitors such as Prilosec and Prevacid, which reduce acid in the stomach and result in less bleeding.” “Nevertheless, opioid proponents continue to cite the 16,500 number.” “It was brought up at the American Geriatrics Society's annual meeting in 2009, when the group announced its new guidelines recommending opioids and said NSAIDs should be used rarely.”
Texas Journal of Chiropractic
The Texas Chiropractic Association represents chiropractic professionals throughout the state. First formed in 1916, this historic association has existed for nearly 100 years and has represented the interests of Texans who desire safe and effective health care from chiropractic professionals. TCA serves to protect chiropractic professionals, their patients, and the right for Texans to choose chiropractic as one of their health care options. Texas Chiropractic Association
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