Con
2011 T vent CA ion I ssue
Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVi, Issue 1 July/ August 2011
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Texas Chiropractic Association
Texas Journal of Chiropractic Volume XXVI, Issue 1
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 Executive Director: Chip Kent 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. David King 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 four 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.
July/August 2011 Inside Chiropractors Work Together on Scope Rule! ! 4 TCA Convention ! ! ! ! ! ! 6 Supreme Court Strikes Commercial Speech Restriction 10 Supreme Court Rejects Generic Drug Labeling Suits ! 10 Suit Upholds Telemarketing Limitations! ! ! 11 TBCE Publishes New Rules! ! ! 11-16 TBCE Proposes Rules Changes 16-18! Out with the Pyramid, In with the Dinner Plate! ! 18 Use of Research to Substantiate Health Claims!! 19 CMS to Release Medicare Data to Rank Docs! ! 20 No Pay for "Reasonably Preventable Conditions" ! 20 U.S. 36th in World Life Expectancy! ! ! 20 Key Components of the E/M Guidelines! ! ! 21 TMA Hails its Discriminatory Attitudes! ! ! 24 Medicaid for the middle class?! ! ! ! 25 Insurer Errors Cost Billions Annually! ! ! 25 Gov. Report Notes Benefits of Spinal Manipulation 26 "Principles of Conservative Prescribing"! ! ! 27 Financial Conflicts of Interest Linked to Outcomes! 27 Chiropractic a Concise History! ! ! ! 28 Chiro Care Valuable for Work Related Back Pain! 32 New Vitamin D Guidelines! ! ! ! ! 33 College News! ! ! ! ! ! 34 Other News! ! ! ! ! ! 35-38
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
Chiropractors to Work Together on Scope of Practice Rule
Rule 75.17 Scope of Practice; •
Consideration to propose amendments to Rule 71.13 regarding Chiropractic Specialties and Rule 75.7 regarding Required Fees and Charges;
•
Consideration to propose amendments to Rule 71.15 regarding Recognized Specialties to outline the specialty requirements for Chiropractic Neurology, Acupuncture, and Nutrition;
T h e Te x a s B o a r d o f Chiropractic Examiners met on Thursday, July 28, 2011. Included on the agenda for this meeting were: •
The election of a Board Vice-President and Secretary/Treasurer;
•
Consideration to recommend changes to R u l e 7 1 . 1 5 t o r e fl e c t requirements for Chiropractic Nutrition as a recognized chiropractic specialty;
•
Consideration to adopt proposed amendments to Rule 74.3 to clarify that operating a facility without a current certificate of registration constitutes operating a facility without a certificate of registration;
•
Consideration to adopt proposed amendments to Rule 80.3 regarding use of letters of protection;
•
Consideration to adopt proposed amendments to Rule 75.2 Proper Diligence and Efficient Practice of Chiropractic;
•
Consideration to adopt proposed amendments to
Texas Journal of Chiropractic
TBCE •
Consideration to propose amendments to Rule 75.1 regarding Grossly Unprofessional Conduct prohibiting overtreating/ overcharging, to make the rules on sexual misconduct more clear, and to add a requirement that licensees provide gowns/draping for patients disrobing;
•
Consideration to propose new Rule 75.27 regarding Animal Chiropractic; consideration to propose amendments to Rule 77.2 regarding Publicity and to Rule 77.5 regarding Misleading Claims to make the rules regarding advertising more specific; 4
•
Consideration to propose amendments to Rule 80.1 regarding Delegation of Authority to clarify that while a DC does not need to be in the treatment room, he/she needs to be on-site, and to define "oncall";
•
Consideration to propose amendments to Rule 80.11 regarding Code of Ethics;
•
Consideration to propose new Rule 81.1 regarding Definitions, and new Rule 81.3 regarding Petition for Adoption of Rules to promulgate rules;
•
and more.
In attendance were nearly 30 visitors in addition to board members and staff. The TBCE allowed for 30 minutes of public comment on the proposed rule, in addition to the four hour public hearing the TBCE held on Tuesday. There were two members of the general public and nine doctors of chiropractic who offered thoughtful and well reasoned points of information regarding the proposed scope of practice rules for over 30 minutes. Dr. Cynthia Tays, TBCE President reported that a "Scope of Practice History" had been prepared by staff. Regarding a Scope of Practice Rule, she stated that while she is in favor of thoughtful deliberation, she does not recommend "waiting www.chirotexas.org
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until all appeals are finalized" because "history demonstrates a negative outcome" when other professions have attempted to wait until "all appeals are finalized." Retiring TBCE Executive Director Glenn Parker presented his final report and reported that there are 4979 current licensees, 227 new DCs the past year, and 3734 facilities currently registered. Dr. Tays then moved to the election of executive officers for the TBCE. Dr. Pat Thomas was elected to be Vice-president and Dr. Larry Montgomery was elected to be Secretary-Treasurer. The Rules Committee presented its recommendations: The committee recommended to amend Rule 74.3 Annual Renewal of Chiropractic Facilities, to clarify that operating a facility without a c u r r e n t c e r t i fi c a t e o f registration constitutes operating a facility without a certificate of registration. The board voted to approve the recommendation. The committee recommended the adoption of proposed amendments to Rule 80.3 Request for Information and Records from Licensees regarding use of letters of protection. The board voted to approve the recommendation.
Texas Journal of Chiropractic
The committee recommended to table proposed amendments to Rule 75.2 Proper Diligence and Efficient Practice of Chiropractic, and the proposed amendments to Rule 75.17 Scope of Practice. The board voted to table consideration of the scope of practice rule and will continue to work upon it in the coming months in stake holder meetings. The committee further recommended amendments to Rule 71.13 regarding Chiropractic Specialties and Rule 75.7 regarding Required Fees and Charges to eliminate the fee charged in an application for recognition of a specialty. The board approved the amendments to be published for public comment. The committee moved to table amendments to Rule 71.15 regarding Recognized Specialties to outline the specialty requirements for C h i r o p r a c t i c N e u r o l o g y, Acupuncture, and Nutrition. The board moved to table consideration. The committee proposed amendments to Rule 75.1 regarding Grossly Unprofessional Conduct prohibiting overtreating/ overcharging, and to make the rules on sexual misconduct more clear to add a requirement that licensees provide gowns/draping for patients disrobing. The TBCE moved to publish the p r o p o s a l t o t h e Te x a s 6
Register for public comment. The committee considered proposal of a new Rule 75.27 regarding Animal Chiropractic and will continue to do committee work to determine what procedures are required when working with a veterinarian. The committee recommended amendments to Rule 77.2 regarding Publicity and the board adopted the recommendation. The amendments to Rule 77.5 regarding Misleading Claims to make the rules regarding advertising more specific was tabled by the board. The committee recommended amendments to Rule 80.1 regarding Delegation of A u t h o r i t y . Item (1) consideration of an amendment to (c)(2) to clarify that while a DC does not need to be in the treatment room, he/she needs to be on-site was p a s s e d . I t e m (2) consideration of an amendment to (i) to define "on-call" will continue to be investigated by the committee. The full board moved to table consideration of amendments to Rule 80.11 regarding Code of Ethics and will continue to work on the issue. The committee recommended and the board passed proposal of new Rule 81.1 regarding Definitions and new Rule 81.3 www.chirotexas.org
regarding Petition for Adoption of Rules to promulgate rules required the Administrative Procedures Act, §2001.021 outlining the form of such a petition and the procedure for its submission, consideration, and disposition. The committee presented several questions regarding scope of practice, specifically regarding the interpretation of blood chemistry and recommendations based on those interpretations, as well as advertisement for said i n t e r p r e t a t i o n / recommendations; the performance of and use of computerized posturography; and the online advertisement of the sale of nutritional products and whether this implies a "diagnosis". The committee reported that the committee found that these issues were within the scope of chiropractic practice as presented. The Chiropractic Society of Texas had requested that "the rule regarding additional Medicare documentation CE hours be reconsidered." The Committee voted to deny the request for reconsideration of Medicare hours, and the full board concurred. Following a brief recess the TBCE resumed consideration of the various recommendations from the Enforcement Committee regarding various enforcement actions. www.chirotexas.org
The board retired to executive session to discuss legal matters at about 4:30 pm. At about 5:00 pm the board resumed in open session and it was moved and passed that current legal c o u n c i l Y v e t t e Ya r b r o u g h be hired as the next Executive Director of the TBCE. Upcoming meeting dates for the TBCE are November 17, 2011, February 23, 2012, May 24, 2012, August 16, 2012, and November 15, 2012. The board adjourned at about 5:30 pm
☆☆☆ TCA CONVENTION The Annual Convention of the Te x a s C h i r o p r a c t i c Association was held in Austin, Texas with several hundred in attendance. Doctors Jorge Garcia, Jack Albracht, and James Welch were installed as the new executive officers for the association. The annual banquet saw the presentation of awards to those who worked hard during 7
the year on behalf of the TCA and for chiropractic in Texas. The TCAʼs most prestigious award, the Keeler Award, was presented to TCA Past President, and long-time chiropractic advocate Dr. George Aubert. The Young Chiropractor of the year award was presented to Dr. J. P. Quinlan. The Ford Johnston Memorial Aw a r d t o r e c o g n i z e t h e person who best represents s e r v i c e t o t h e Te x a s Chiropractic Associationx was presented to Dr Dan Petrowsky. The P. A. Wilmon Memorial award to recognize a recipient from, or serving the people of, a rural area was presented to Dr. Kevin Raef. The Presidentʼs Award was presented by Outgoing TCA President Dr. Ed Fritsch to all those serving at TCA State Directors and Department Coordinators.
☆☆☆ Supreme Court Strikes Down Commercial Speech Restriction Data on which doctors are prescribing which drugs is speech that is protected by the First Amendment, and Texas Journal of Chiropractic
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☆☆☆
pharmaceutical companies have every right to buy that information and use it to target their marketing efforts, the Supreme Court has ruled. In the Sorrell v. IMS Health case, the Supreme Court struck down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining -- the sale and use of p r e s c r i b e r - i d e n t i fi a b l e information for marketing or promoting a drug, including drug detailing -- unless a physician specifically gives his or her permission to use the information. The Supreme Court ruled that "the creation and dissemination of information are speech for First Amendment purposes." When filling prescriptions, Vermont pharmacies collect information, including the prescribing physician's name and address; the name, dosage, and quantity of the medication; the date and place where the prescription was filled; and the patient's age and gender. Pharmacies sell this "prescriber information" to data-mining companies. Writing for the majority, Justice Anthony Kennedy said the goal of lowering the costs of medical services and protecting public health are laudable goals, but that the law doesn't advance those goals. “Vermont seeks to achieve those objectives through the indirect means of restraining certain Texas Journal of Chiropractic
Supreme Court Rejects Generic Drug Labeling Suits speech by certain speakers -- i.e., by diminishing detailers' ability to influence prescription decisions," he wrote. "But 'the fear that people would make bad decisions if given truthful information' cannot justify content-based burdens on speech." Justices John Roberts, Clarence Thomas, Sonia Sotomayor, Antonin Scalia, and Samuel Alito joined Kennedy in the majority opinion. The Supreme Court's decision upholds an appeals court decision that found Vermont's Prescription Confidentiality Law is a violation of First Amendment rights because it restricts commercial speech, and that it is a violation of the Commerce Clause of the Constitution because it impinges on interstate commerce, since data-mining companies sell the prescriber information in states other than Vermont.
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The Supreme Court ruled that generic drug companies cannot be sued under state law over allegations that they failed to provide adequate label warnings about potential side effects. By a 5-4 vote, the justices overturned U.S. appeals court rulings that allowed such lawsuits. The companies argued that federal law barred such lawsuits because the drug had been approved by the U.S. Food and Drug Administration (FDA). Federal law requires generic drugs to have the same labels as their brand name equivalents. Generic drugs account for more than 70 percent of all prescriptions filled in the United States.
☆☆☆ Suit Upholds Telemarketing Limitations The 5th U.S. Circuit Court of Appeals delivered an opinion Wednesday that could silence some telemarketers. The court reversed a lower court www.chirotexas.org
decision by U.S. District Judge Lee Yeakel of Austin that had prevented the enforcement of an antitelemarketing measure that passed the Texas Legislature in 2009. Yeakel cited First Amendment issues. That legislation, by Rep. Todd Smith, R-Euless, prohibited solicitation of accident victims for the first 30 days after an accident. Mark Hanna, a spokesman for the Insurance Council of Te x a s a n d t h e Te x a s Committee on Insurance Fraud, said justice prevailed. “Telemarketers ... will have to seek another way of soliciting business rather than chasing ambulances and contacting crash victims at home,” he said in a statement. “This ruling allows prosecutors to go after this illegal solicitation which has become rampant in every major city in Texas.”
☆☆☆
( 1 ) A PA - - A d m i n i s t r a t i v e Procedure Act, Government Code, Chapter 2001; (2) Board--Texas Board of Chiropractic Examiners; (3) Chiropractic Act or CA-Occupations Code, Chapter 201 (formerly Texas Civil Statutes, Article 4512b); (4) HPCA--Health Professions Council Act, Occupations Code, Chapter 101; (5) HRC--Human Resources Code; (6) Licensee--A person who is licensed by the board to practice chiropractic in the State of Texas; (7) MRTCA--Medical R a d i o l o g i c Te c h n o l o g i s t Certification Act, Occupations Code, Chapter 601; (8) Occ. Code--Occupations Code;
TBCE Publishes New Rule 75.11
(9) Respondent--an individual or facility regulated by the board against whom a complaint has been filed;
The Texas Register reports that the TBCE has adopted a final version of Rule 75.11.
(10) SOAH--State Office of Administrative Hearings;
The new rule reads:
(11) DSHS--Department of State Health Services.
(a) The following words and terms, when used in this c h a p t e r, s h a l l h a v e t h e following meanings, unless the context clearly indicates otherwise:
(b) The table contains maximum sanctions that may be assessed for each category of violation listed in the table [See the following pages.]
www.chirotexas.org
11
REGULARLY check the TCA Website at www.chirotexas.org and catch up on the latest news by clicking on the Online Journal link (c) In a case where a respondent has committed multiple violations or multiple occurrences of the same violation, board staff, the enforcement committee or an administrative law judge may recommend and the board may impose sanctions in excess of a maximum sanction specified in the maximum sanction table provided by subsection (b) of this section, if otherwise authorized by law. For the fourth and subsequent offenses of any violation listed in the maximum sanction table with three levels of sanctions, the maximum sanction is revocation and/or $1,000 administrative penalty. (d) An administrative penalty may not exceed $1,000 per day for each violation. Each day a violation continues or occurs is a separate violation for the purposes of imposing an administrative penalty. (e) For violation of a statute which is not listed in the maximum sanction table and for which the board is authorized to take disciplinary action, the maximum sanction is revocation and/or $1,000 administrative penalty.
☆☆☆ Texas Journal of Chiropractic
CATEGORY I
1st Offense: $1000*; 2nd Offense: $1000* ; 3rd Offense: $1000*
Violation
Practicing without a chiropractic license
*and/or revocation
Reference:
22 TAC §75.10(d) CA §201.301
Practicing with an expired license (nonrenewal due to default student loan) 22 TAC §73.2(c)(6) and (e) CA §§201.301, 201.351, 201.354(f) Practicing with an expired license (nonrenewal)
22 TAC §73.2(i) CA §§201.301, 201.351, 201.354(f)
Practicing while on inactive status
22 TAC §73.4(f) CA §§201.301, 201.311(b)(2)
Practicing in non-compliance with continuing education requirements
22 TAC §§73.3, 73.5(g) CA §§201.301, 201.354(f)
Improper control of patient care and treatment
Grossly unprofessional conduct
22 TAC §75.1 CA §201.502(a)(7)
Lack of diligence/gross inefficient practice
22 TAC §75.2
22 TAC §§75.2, 75.17 CA §§ 201.002, 201.502(a)(1) and (18)
Practicing outside the scope of practice of chiropractic
22 TAC §74.5(c) CA §201.502(a)(18)
Performing radiologic procedures without registering, with an expired registration, or without DSHS approval; failure to renew (including non-payment of fees) 22 TAC §78.1(a), (d), (h) MRTCA, DSHS rules or order
22 TAC §78.1(h), (j), (o)
Performing (1) radiologic procedures without supervision, or (2) cineradiography or other restricted procedure
22 TAC §78.1(g), (k), (l), (m)
Permitting a non-registered or non-DSHS approved person to perform radiologic procedures or CRT to perform procedures without supervision 22 TAC §78.1(k), (n) Delegating to a non-licensee authority to perform adjustments or manipulations 22 TAC §80.1(a) Failure to supervise a student
22 TAC §80.1(b)
Delegating authority to a licensee whose license has been suspended or revoked 22 TAC §80.1(d) Failure to comply with the CA, other law or a board order or rule
22 TAC §75.10(c) CA §§201.501, 201.502(a)(1)
Failure to comply with down-time restrictions
Medicaid fraud
Default on Student Loan
22 TAC §75.10(f)
CA §201.502(a)(2), (7); HRC §§36.002, 36.005 Solicitation Occ. Code §§102.001, 102.006
Occ. Code Chapter 56 22 TAC §80.2
Failure to comply with requirements/restrictions on prepaid treatment plans
22 TAC §80.13
Failure to respond to board inquiries
22 TAC §§73.3(1)(C), 75.3(h), 75.6, 80.3(g)
Failure to report criminal conviction
Other statutory violations
CA §201.502(a)(2) - (8), (10), (12) - (17), (19) - (20)
http://info.sos.state.tx.us/fids/201101996-1.html
22 TAC §75.3(f)
TBCE Penalty Matrix CATEGORY II
1st Offense: $500; 2nd Offense: $750*; 3rd Offense: $1000* *and/or suspension
Violation
Reference:
Submitting an untrue continuing education certification
22 TAC §73.3(1)(E) CA §201.502(a)(2)
Operating a facility without a certificate of registration or with an expired registration
CA §201.312 22 TAC §§74.2(a), 74.3(e), 74.5(a)
Practicing in a facility without a certificate of registration or with an expired registration
CA §201.312 22 TAC §74.2(k)
Unauthorized disclosure of patient records
22 TAC §80.3 CA §§201.402, 201.405
Overtreating/overcharging a patient
22 TAC §75.1(a)(4) HPCA §101.203
Deceptive advertising and other prohibited advertising 22 TAC §77.2 CA §201.502(a)(2), (9), (11); HPCA §101.201 CATEGORY III
1st Offense: $250; 2nd Offense: $500*; 3rd Offense: $1000*
Failure to furnish patient records
22 TAC §80.3
Overcharging for copies of patient records
CA §201.405(f)
Failure to disclose charges to patient
22 TAC §§75.1(a)(6), 77.3(a) HPCA §101.202
Failure to submit to medical examination
22 TAC §80.3(h)
Failure to maintain patient records
22 TAC §80.5
CATEGORY IV
*and/or suspension
1st Offense: $250; 2nd Offense: $500; 3rd Offense: $1000
Failure to display public interest information
22 TAC §§75.7(d), (e), 75.8
Displaying an invalid license or renewal card
CA §201.502(a)(2), (9)
Failure to complete CRT continuing education
22 TAC §78.1(i)
CATEGORY V
1st Offense: $250; 2nd Offense: $400; 3rd Offense: $500
Failure to report change of address
22 TAC §73.1
Failure to report change of facility address/ownership
22 TAC §74.5(d)
Failure to report locum tenens information
22 TAC §73.2(b)
Use of the term "physician," "chiropractic physician"
CA §201.502(a)(22)
Failure to use "chiropractor," "D.C." in advertising
22 TAC §75.1(a)(2)
http://info.sos.state.tx.us/fids/201101996-1.html
TBCE Announces New Rule 77.2 The TBCE has finally adopted a new version of Rule 77.2. The new Rule reads: (a) A registered facility or licensee shall not, on behalf of himself, his partner, associate, or any other licensee or facility affiliated with him, use or participate in the use of any form of public communication which contains a false, fraudulent, misleading, deceptive, or unfair statement of claim, or which has the tendency or capacity to mislead or deceive the general public. (b) In any form of public communication, a licensee or registered facility shall not describe services that are inconsistent with the practice of chiropractic as described under §75.17 of this title, relating to scope of practice. (c) A licensee or registered facility engaging in, or authorizing another to engage in telemarketing of prospective patients shall not misrepresent to the person called any association with an insurance company or another doctor of chiropractic or another chiropractic group or facility. (1) A licensee, registered f a c i l i t y, o r t h e i r a g e n t , engaging in telemarketing shall not promise successful chiropractic treatment of injuries or make any other communication which would Texas Journal of Chiropractic
be prohibited under subsection (a) of this section.
from publication of the testimonial.
(2) A licensee, registered f a c i l i t y, o r t h e i r a g e n t , engaging in telemarketing are required, at the start of each call, to inform the person called who they are (caller's name) and who they represent (clinic/doctor).
(e) Licensees or registered facilities shall clearly differentiate a chiropractic office, clinic, or facility from another business or enterprise in any form of public communication. (f) Licensees shall identify themselves as either "doctor of chiropractic," "DC," or "chiropractor" in all forms of public communication. If each licensee that practices in a registered facility has identified themselves as required above, then the facility name need not include "chiropractic" or similar language.
(3) A licensee or registered facility engaging in telemarketing, either directly or through an agent, shall keep a copy of each script used for calling and a log of all calls made that shall include the date, telephone number, and the name of each person called. Such scripts and logs shall be maintained for a minimum of two years. (d) Licensees or registered facilities that intend to include a testimonial as part of any form of public communication shall maintain a signed statement from that person or group to support any statements that may be used in any public communication for a minimum of two years
14
(g) In any form of public communication using the phrase "Board Certified" or similar terminology associated with any credentials, a licensee must identify the board certifying said credentials.
☆☆☆ TBCE Announces New Rule 78.1 T h e Te x a s R e g i s t e r REPORTS HERE that the TBCE has adopted a final version of Rule 78.1. The new Rule reads: (a) Registration required. Any person performing radiologic procedures in a chiropractic facility must register with the www.chirotexas.org
board, on a form prescribed by the board. This section does not apply to registered nurses or to persons certified under the Medical Radiologic Technologist Certification Act.
Required Fees and Charges); and
(b) Eligibility. An applicant for registration must either:
(e) Expired registration.
(1) submit proof of the applicant's registry with the Texas Department of State Health Services (DSHS) and completion of training and instruction as required by 25 TAC ยง140.518 (relating to Mandatory Training Programs for Non-Certified Technicians); or (2) perform radiologic procedures for a licensee to whom a hardship exemption was granted by DSHS within the previous 12 months under 25 TAC ยง140.520 (relating to Hardship Exemptions). (c) Application submission. An applicant shall submit an application for registration, proof of status as provided in subsection (b) of this section, along with the radiologic technologist application fee as provided in ยง75.7 of this title (relating to Fees and Charges for Public Information). (d) Renewal. On or before January 1 of each year, a CRT shall renew his or her registration, by submitting: (1) a registration application; (2) the radiologic technologist application fee as provided in ยง75.7 of this title (relating to www.chirotexas.org
(3) proof of renewal status as provided in subsection (b) of this section.
(1) A CRT registration expires on January 1 of each year if it is not timely renewed. (2) If a CRT's registration has expired, a person may renew his or her registration by submitting to the board all of the items required by subsection (d) of this section and a late fee of $25.
provide to the board a copy of a hardship exemption granted by DSHS within five days of its issuance if the exemption is granted prior to the registration renewal deadline. (h) Disciplinary sanctions. The board may refuse to issue or renew, suspend, or revoke a C RT r e g i s t r a t i o n a n d / o r impose an administrative penalty for the following: (1) violation of the rules or an order of the board; (2) violation of the Medical R a d i o l o g i c Te c h n o l o g i s t Certification Act;
(3) A person who fails to renew his or her registration on or before the expiration date may also be subject to an administrative penalty and other disciplinary sanctions as provided in subsection (h) of this section.
(3) violation of the rules or an order of DSHS;
(f) Incomplete applications. No registration will be issued on an incomplete submission. Application or renewal packages that are submitted without all of the required documents or fees will be deemed incomplete and returned to the applicant.
(i) DSHS compliance. All registrants shall comply with the rules of DSHS for the control of radiation.
(g) DSHS authorization. A person may not perform radiologic procedures if that person is removed from the DSHS registry or the hardship exemption under which the person is working is expired or revoked even if the person holds a valid CRT registration with the board. A CRT must 15
(4) violation of the Texas Chiropractic Act; or (5) nonpayment of registration fees.
(j) Supervision required. A CRT shall perform radiological procedures only under the supervision of a licensee physically present on the premises. ( k ) C i n e r a d i o g r a p h y. Procedures that include cineradiography are limited to use by a licensee who has passed a course in its use, approved by the board.
Texas Journal of Chiropractic
(l) Non-static procedures. Any non-static procedure has the potential to be more dangerous and hazardous and by definition may only be performed by a licensee or a certified medical radiologic technologist. (m) Licensee responsibility. A licensee shall not authorize or permit a person: (1) who is not registered under this section to perform radiologic procedures on a patient unless otherwise authorized under the Medical Radiologic Technologist Act or 2 5 TA C C h a p t e r 1 4 0 , Subchapter J (relating to Medical Radiologic Technologists); or (2) to perform radiologic procedures on a patient if that person has been removed from the registry of DSHS or the licensee's hardship exemption has been revoked or has expired. (n) Licensee compliance. A licensee shall comply with the Medical Radiological Technologist Certification Act and all applicable rules of DSHS.
Chiropractic Act, Occupations Code, Chapter 201, including Subchapters K through M.
☆☆☆ TBCE Announces New Rule 77.5 T h e Te x a s B o a r d o f Chiropractic Examiners has adopted a final version of rule 77.5. The new rule reads: A person advertising chiropractic services shall not use false, deceptive, unfair or misleading advertising, including, but not limited to, claims that chiropractic services: (1) cure or lessen the effects of ailments, injuries 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 these rules; or offer results that are not within the realm of scientific proof beyond testimonial statements or manufacturer's claims.
(o) L a w s governing disciplinary action. Disciplinary action against a C RT, i n c l u d i n g t h e imposition of administrative penalties, is governed by the Administrative Procedures Act, Government Code, Chapter 2001, and applicable enforcement provisions of the Texas
TBCE Proposes Change to Rule 80.3
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☆☆☆
T h e Te x a s B o a r d o f Chiropractic Examiners has
proposed a change to Rule 80.3, Request for Information and Records from Licensees. The proposal would only change subsection (d) of this rule by adding the portion in italics and underlined to read: "Denial of request. If the licensee denies the request under subsection (a) of this section for a copy of chiropractic records or a summary or narrative of the records, either in whole or in part, the licensee shall furnish the patient a written statement, signed and dated, stating the reason for the denial. Chiropractic records requested pursuant to subsection (a) of this section may not be withheld based on a past due account for care or treatment previously rendered to the patient or based on the lack of a letter of protection or other similar document."
☆☆☆ TBCE Proposes Change to Rule 80.3 T h e Te x a s B o a r d o f Chiropractic Examiners has proposed a change to Rule 80.3, Request for Information and Records from Licensees. The proposal would only change subsection (d) of this rule by adding the portion in italics and underlined to read:
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Texas Chiropractic opractic A Association
The STARS of TCA
The Stars of TCA Program gives special recognition to those who generously contribute to TCA. Their contributions fund special initiatives that advance the Chiropractic Profession in Texas.
Star Levels Diamond Sapphire Platinum Gold TCA’s Top Donor receives The TCA’s Gavel Award in appreciation of noteworthy financial support.
Call TCA: 512-477-9292 and the details will be handled for you.
Thank You for Your Contributions!
"Denial of request. If the licensee denies the request under subsection (a) of this section for a copy of chiropractic records or a summary or narrative of the records, either in whole or in part, the licensee shall furnish the patient a written statement, signed and dated, stating the reason for the denial. Chiropractic records requested pursuant to subsection (a) of this section may not be withheld based on a past due account for care or treatment previously rendered to the patient or based on the lack of a letter of protection or other similar document."
☆☆☆ TBCE Proposes Addition to Rule 75.2 T h e Te x a s B o a r d o f Chiropractic Examiners has proposed an addition to Rule 75.2, Proper Diligence and E f fi c i e n t P r a c t i c e o f Chiropractic. Text that is underlined is new text. [Text in colored brackets and italics are to be deleted]. Text in bold are used by the editor for emphasis. The proposed rule, PUBLISHED HERE states: §75.2 Proper Diligence and E f fi c i e n t P r a c t i c e o f Chiropractic
Texas Journal of Chiropractic
(a) A lack of proper diligence in the practice of chiropractic o r t h e g r o s s i n e f fi c i e n t practice of chiropractic when applied to a licensee or chiropractic facility includes but is not limited to the following: (1) failing to conform to the minimal acceptable standards of practice of chiropractic, regardless of whether or not actual injury to any person was sustained, including, but not limited to:
requires treatment outside the chiropractic scope of practice a s a u t h o r i z e d b y Te x a s Occupations Code §201.002 or §75.17 of this title. (2) (No change.) (b) (No change.) TBCE states that the "earliest possible date of adoption [is] July 24, 2011." For further information, please call: (512) 305-6716
(A) - (C) (No change.) (D) causing, permitting, or allowing physical injury to a patient or impairment of the dignity or the safety of a patient [or]; (E) abandoning patients without reasonable cause and without giving a patient adequate notice and the opportunity to obtain the services of another chiropractor and without providing for the orderly transfer of a patient's records; or[.] (F) failing to refer a patient to an appropriate health care provider when the licensee determines or should have determined within the limitations of the chiropractic scope of practice that the patient may suffer from a condition that requires a diagnosis outside the chiropractic scope of practice a s a u t h o r i z e d b y Te x a s Occupations Code §201.002 or §75.17 of this title (relating to Scope of Practice), or that 18
☆☆☆ TBCE Proposes Addition to Rule 74.3 T h e Te x a s B o a r d o f Chiropractic Examiners is proposing an addition to Rule 74.3. The rule proposal would add the sentence underlined and italicized to subsection (f) to read: (f) A facility shall not provide chiropractic services without a c u r r e n t c e r t i fi c a t e o f registration. Operating a facility with an expired certificate of registration constitutes operating a facility w i t h o u t a c e r t i fi c a t e o f registration.
☆☆☆ www.chirotexas.org
Out with the Pyramid, In with the Dinner Plate
get the recommended fruits, vegetables, and whole grains. There's plenty of work to be done."
The federal government released its new health icon to replace the confusing food pyramid. After nearly two decades, the U.S. Department of Agriculture is turning from the familiar food pyramid to illustrate healthy food choices to a dinner plate -- a relatable visual meant to more easily conjure appropriate portion sizes and food selection, the agency says. They state "Government officials are abandoning a triangle for a circle in order to help shape Americans' decisions about how to make their square meals healthier." "The colorful graphic, which can be seen at choosemyplate.gov, is divided into four wedges -- fruits, vegetables, grains, and protein -- with another small circle next to the plate representing dairy (a glass of milk, perhaps, but make it fatfree or low-fat, the website says)." "Fruits and vegetables take up more than half the plate, adding grains covers about three-quarters, reflecting a shifting emphasis toward plant-based diets." "Evidence continues to mount on the benefits of a plantbased diet ... Despite this, the vast majority of adults don't www.chirotexas.org
The 1992 version of the food guide pyramid illustrated a hierarchy in which grains accounted for the majority of the diet. The USDA spent $2 million to develop the logo, which included research, focus groups, and a new website.
☆☆☆ Legislation to Allow Use of Research to Substantiate Health Claims Legislation that allows the use of credible scientific research to substantiate health claims in the labeling and promotion of foods and supplements (HR 1364) was reintroduced to the US House of Representatives. 19
A similar bill was introduced in March of 2010 but failed to make it out of committee. As before, Congressman Jason Chaffetz (R, Utah) sponsored the bill, which does not include any substantial changes from the previous version. The bill cites the plethora of marketing messages received by consumers regarding drugs that target illnesses and their symptoms, stating that many such illnesses can be prevented or reversed through diet and lifestyle changes. HR 1364 seeks to level the playing field in that regard. According to the billʼs language, by allowing food and supplement producers to cite “legitimate scientific studies” published in peerreviewed media, consumers will receive the information they need to make informed choices and take steps that ultimately lower health care costs and improve the quality of life. Specifically, the bill • allows producers of foods and supplements to cite legitimate scientific research, • clearly defines allowable research that may be related to claims, • prevents the FDA from reclassifying food or supplements as “unapproved drugs” because of the citations used, and Texas Journal of Chiropractic
•prohibits the use of fraudulent or misleading c l a i m s a n d a f fi r m s t h e authority of the US Food and Drug Administration and the Federal Trade Commission in these cases."
☆☆☆ CMS to Release Medicare Data to Rank Docs Medicare claims data would be used to compare physician performance under new rules proposed by the Centers for Medicare and Medicaid Services (CMS). The proposal -- which was part of the Affordable Care Act (ACA) -- would give certain organizations access to Medicare claims data starting in 2012 that they could combine with claims data from private insurers to paint a more accurate picture of how physicians, hospitals, and other providers are performing. That means that information on how individual doctors in a given location are performing on specific quality and patient care measures will soon be public information. Currently, Medicare claims data isn't publicly available, so if an organization wants to compare physicians performance in given area, they generally rely on data Texas Journal of Chiropractic
from a single private insurance company, which may not provide the most accurate sample. The Medicare data would be stripped of personal information about specific patients, but organizations would still need to prove they are capable of accurately using and keeping secure the information, which would be culled from Medicare Parts A, B, and D claims data. CMS is accepting comments on the proposed rule until the beginning of August."
☆☆☆ CMS: No Pay for "Reasonably Preventable Conditions" The Centers for Medicare and Medicaid Services (CMS) announced that hospitals and healthcare providers will no longer be reimbursed for treating their Medicaid patients for illnesses, injuries, or readmissions that should have been prevented. A fi n a l r u l e a n n o u n c e d Wednesday enacts a portion of the Affordable Care Act (ACA) that prohibits states from making Medicaid payments to providers for conditions that are deemed "reasonably preventable," including transfusing the wrong blood type; falls that result in dislocation, fractures, 20
or head injuries; burns and electric shocks; catheterassociated urinary tract infections; surgical site infections after bariatric surgery or coronary artery bypass; and manifestations of poor glycemic control. States can identify additional preventable conditions for which Medicaid payment will be denied. In 2008, Medicare stopped reimbursing hospitals for treating conditions, infections, or illnesses that were acquired in the hospital, and for any readmissions associated with treating those hospital-acquired conditions.
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Weʼre 36th! U.S. 36th in World Life Expectancy Life expectancy at birth for American men was 75.6 years and 80.8 for women in 2007 -36th and 33rd in the world -with wide variation from county to county. County-level life expectancies for men ranged from 15 years ahead of an international average of top-performing nations to more than 50 years www.chirotexas.org
behind. The range for women was 16 years ahead to more than 50 years behind. "The U.S. picture, with its remarkable combination of poor health outcomes despite the highest levels of health spending per capita, is even more stark and disturbing when examined at the local level," authors wrote. At the county level, life expectancy in 2007 ranged from 65.9 years to 81.1 years for men and 73.5 to 86 years for women. The lowest life expectancies were in counties in Appalachia, the deep South, and across northern Texas, the researchers said. When compared against an average of 10 nations with the best life expectancy (the "international frontier"), U.S. numbers were lower by 3.2 years -- 13 years behind for men and 16 years behind for women. "... some [U.S.] counties have a life expectancy today that nations with the best health outcomes had in 1957," authors said. Overall, more than 85% of U.S. counties have fallen further behind the international life expectancy frontier, the researchers said. “Despite the fact that the U.S. spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That's a www.chirotexas.org
staggering statistic," the medical author said.
☆☆☆ Key Components of the E/M Guidelines Chiroeco.com REPORTS HERE on the three key components of the E/M Guidelines. The article points out the three key components of the E/M Guidelines as One: P a t i e n t h i s t o r y ; Tw o : Examination; Three: MDM (medical decision-making) and, in this article, focuses on the key components of a patient history. "According to the 2009 OIG report, 83 percent of all chiropractic claims submitted failed to meet documentation requirements. ... Faced with the failing grades theyʼve received, there are only two choices for DCs: seriously improve documentation practices or face the possibility of having payments withheld when documentation is absent. Worse yet, chiropractors could risk having prepayment reviews on all of their claims ..." "Chiropractic is one of the only medical professions that consistently obtains optimal patient results. ... it is your duty and responsibility to the patient, in addition to the standard of care, to accurately document in the patient 21
record. ... the patientʼs health record must also tell a documented story. If an auditor were to come to your office today and look at one of your patientʼs files, would there be a clear picture? Is there an obvious differentiation between your active, medically necessary care and your wellness or maintenance care?" "It all begins with solid documentation of your E/M service. Divided into the patientʼs history, examination, and doctorʼs clinical decisionmaking, this service leads the way for you to lay down foundational documentation for this episode of care. Donʼt forget the auditorʼs credo: 'If itʼs not in the record, then it didnʼt happen.'” "In order to correctly select the appropriate level of an E/ M service, all patient information must be must be properly documented and meet AMA Current Procedural Te r m i n o l o g y ( C P T ) requirements. So, if selecting the correct levels of the E/M service has you wishing you were back in chiropractic college, fear not. The following will help you be part of the solution in transforming OIG failing grades into golden stars for chiropractic." "First, relax: Itʼs not that difficult to document correctly. In fact, itʼs much easier than making a spinal adjustment. By documenting correctly you can accurately and with confidence choose the correct Texas Journal of Chiropractic
levels of E/M service to submit to your third-party payers. Itʼs time to start getting it right — and be appropriately paid — for what youʼre really worth." "The chief complaint (CC); history of present illness (HPI); review of systems (ROS); and past, family and/ or social history (PFSH) are the four components of patient history as required by the E/M documentation guidelines." "Chief complaint: The CC is generally the patientʼs stated reason for the encounter." "History of present illness: The HPI is a chronological description of the development of the patientʼs present illness from the first sign or symptom or from the previous encounter to the present. The HPI includes location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms."
"Review of symptoms: The ROS is a system-by-system review of body functions that begins during the initial patient interview and is completed during the physical exam. ... The ROS is usually a list of questions grouped by organ systems that should be part of your patient intake forms, and cover all of the following: Constitutional; Eyes; Ears, nose, mouth and throat; Cardiovascular; Respiratory; Gastrointestinal; G e n i t o u r i n a r y ; M u s c u l o s k e l e t a l ; Integumentary; Neurologic; Psychiatric; Endocrine; Hematologic/lymphatic; Allergic/immunologic."
"Tip 1: Only the provider may obtain and document the HPI. This is also where you want to start counting as the eight elements of HPI will often determine the level of history you are able to report." These eight elements are listed in this article to be: Location; Quality of the symptom; Severity; Duration; Timing (when it occurs); Context of onset (what triggers it); Modifying factors (what makes it better, worse, or different]); Associated signs/ symptoms.
"Past, family, and/or social history: Past history is the patientʼs previous experience with illnesses, injuries, hospitalizations, surgeries, treatments, allergies, age appropriate immunizations, diet restrictions, and current medications. Family history is the review of the patientʼs family members and includes important information about the health status or cause of death of parents, siblings, and c h i l d r e n ; a n y s p e c i fi c diseases that would relate to the problem of the patientʼs CC, HPI, or ROS; and any hereditary diseases that might place the patient at risk. Social history covers the patientʼs past and current information relating to marital status/living arrangements; current employment; occupational history; use of drugs, alcohol, or tobacco;
Texas Journal of Chiropractic
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level of education; and sexual history." "Tip 2: The patient and ancillary staff may record and document ROS and PHSH. The provider must review and sign both the ROS and PHSH to indicate he or she has evaluated the information. Make sure your intake paperwork does most of the heavy lifting for you and that a team member has reviewed it for completeness." "Tip 3: For re-exams — whenever a doctor chooses to refer to an ROS or PFSH for a re-exam — it must be referenced by date (e.g., “ROS and PFSH were reviewed from February 24, 2011; no changes or change was noted at ...”)" "Determining the correct level of history: The health history you take from the patient is t h e fi r s t k e y c o m p o n e n t required in selecting the appropriate level of the E/M service. Once you have obtained information from the four elements of the patientʼs history — CC, HPI, ROS, and PFSH, the next step is assigning the correct level of history: Problem focused; Expanded focus; Detailed; Comprehensive."
www.chirotexas.org
It’s Time. . .
For All Texas D.C.’s to Pull Together.
Everyone has something to give. Give Your Talent and Time. Right now, Doctors, your time and talents are needed in massive “Grass Roots” campaigns for both political and public action. Serving in the areas of Fundraising, Vendor Relations, Public Relations, and Insurance can help advance the Chiropractic Profession in Texas. Doctors should reach out by phone calls, emails, social media or all of the above to their colleagues, friends, peers, and patients to make sure they know what’s going on. While it’s on your mind, take action to volunteer by emailing pr@mytexasdoctor.org or call Texas Chiropractic Association (TCA) at 512-4779292. It is also a good time to make sure your TCA membership is current. If it has lapsed, or you would like to become a member now, please contact TCA or follow this link: http://www.chirotexas.org/node/451
Give Your Patients the Information and Get Them Active. Your patients choose you for your level of education, training, and expertise. Help them ensure that right! Sign them up by going to MyTexasDoctor.org and clicking the “Take Action” link. By quickly entering their contact information, it immediately informs their legislators and key officials that YOUR Patients value YOUR Chiropractic Care. It is that simple and it also signs them up for important email updates, as well as information about how to donate.
Give Your Money. The greatest challenge right now is raising adequate funds. This battle will not be fought with money, but it takes money to fund the cause. Donations to the Defense Fund from Doctors, Vendors, Businesses, and Patients make this possible. Give what you can and give often. Some will give extravagantly. Encourage your patients, friends and peers to give. Remember, no donation is too small and no donation will go un-noticed.
Here’s how to donate by credit card. 1. Go to: http://www.chirotexas.org/donate 2. Choose Defense fund 3. Fill out required information 4. Enter donation (nothing is too small) 5. The option of a Recurring Monthly Donation is available
Here’s how to donate by mail. 1. Go to: http://www.chirotexas.org/sites/default/files/AUTO_DRAFT_FORM.pdf 2. Print out form / fill in info. (Attach voided check or fill in Credit Card information.) 3. Fax it to: 512-477-9296 or mail it to: TCA, 1122 Colorado St., Suite 307, Austin TX 78701
Here’s how to donate by phone or in person. 1. Call TCA at 512-477-9292, and the details will be handled for you.
Texas Chiropractic Association
It’s Time… To Move Forward
The article points out that the following descriptors determine the level of history:
and aggressive advocacy by TMAʼs lobby team, the association won a major scope battle."
LEVEL OF HISTORY HPI
ROS
PFSH
Problem focused Brief NA NA Brief
Expanded focus Prob focus NA
Extend
Detailed Extend Pertinent
Comprehensive Extend Complete Complete "Obtaining and documenting as much information from the patient history as possible is a very important aspect of the patientʼs evaluation;" it will also allow you to bill the level of E/M service appropriate to the work you are performing. "Making sure you have met and documented all the E/M requirements before selecting the code is the first step toward improving your documentation."
☆☆☆ TMA Hails its Discriminatory Attitudes T h e Te x a s M e d i c a l Association states" "Thanks to the hundreds of physicians, medical students, and TMA Alliance members who contacted their senators ... Texas Journal of Chiropractic
One of the TMA's chief concerns was "As approved by the committee Monday, Senate Bill 1001 by Sen. John Carona (R-Dallas) would have prevented the Texas Medical Board from taking legal action to stop an individual chiropractor from violating the Medical Practice Act if the chiropractic board said the chiropractor was practicing within his or her scope." Perhaps the primary motivator for TMA's fear, however was their opinion that "the bill also would have circumvented current insurance code provisions concerning nondiscrimination against nonphysicians, which would allow more than 30 nonphysician health care groups to get paid for more services ... And lastly, the bill would have allowed a number of these groups to create partnerships and other professional structures with physicians..." Heaven forbid that DCs and MDs should become "partners" in healthcare! Heaven forbid that discrimination against "nonMDs" should cease! The Texas Tribune reported, “After a fierce fight, the stateʼs leading physician groups won a change in legislation backed p r e d o m i n a n t l y b y Te x a s chiropractors that could have 24
prevented one health care licensing agency from challenging the ruling of another in court. The bill reached final passage on the Senate floor today after addition of an amendment added by Sen. John Carona, R-Dallas, who authored the bill, reflecting a compromise between the Texas Medical Association and the Texas Chiropractic Association.” Unfortunately the end of the legislative session occurred before the chiropractic sponsored non-discrimination bills could be finally voted upon. Therefore medical discrimination continues, and medical-chiropractic partnerships are "still forbidden". In a related story the AMA REPORTS HERE that "The AMA, along with the Texas Medical Association and the American Association of Physicians of Indian Origin, filed an amicus brief June 7 in the U.S. Court of Appeals in support of the cardiologists. This amicus brief demonstrates organized medicine's stand against discrimination based on a physician's ethnicity." When "organized medicine" learns to overcome its bigotry and can see its way clear to to avoid supporting discrimination in every venue then the public will be better off.
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www.chirotexas.org
Medicaid, said officials for the Health and Human Services department.
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Medicaid for the middle class?
government number crunchers say they discovered only after the complex bill was signed.
The new health reform law would let several million middle-class people get nearly free insurance meant f o r t h e p o o r, a t w i s t
The change would affect early retirees: A married couple could have an annual income of about $64,000 and still get
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"Up to 3 million more people could qualify for Medicaid in 2014 as a result of the anomaly. That's because, in a major change from today, most of their Social Security benefits would no longer be counted as income for determining eligibility. It might be compared to allowing middle-class people to qualify for food stamps." Early retirees would be a new group for Medicaid. While retirees can now start collecting Social Security at age 62, they must wait another three years to get Medicare, unless they're disabled. Some early retirees might see it as a relatively painless way to satisfy the new law's requirement that most Americans carry health insurance starting in 2014. It would help tide them over until they qualify for Medicare. The actuary's office said the early retirees eligible for Medicaid would be on top of an estimated 16 million to 20 million new people that new law already brings into the program, by opening it to childless adults with incomes near the poverty level.
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Texas Journal of Chiropractic
companies, according to the AMA.
Insurer Errors Cost Billions Annually insurers incorrectly process more than 19% of all medical claims, which wastes about $17 billion annually, according to the American Medical Association (AMA).
•
The AMA found that insurance companies have an overall claims processing accuracy rate of about 81%. The private insurer that was the most accurate at processing claims was United, with an accuracy rate of 90%.
The AMA's fourth annual National Health Insurer Report Card reports that insurers got a little worse in their accuracy of paying claims over the past year. Last year's report card found that commercial health insurers incorrectly processed about 18% of medical claims.
The AMA also looked at Medicare's accuracy rate, and the public insurer bested the private companies with an accuracy rate of 96%.
Doctors' offices spend an average of 10% to 14% of their total operating costs dealing with insurance
The report card also found:
The company with the lowest accuracy rate paid just 61% of claims accurately, which is a notable decline from its 74%.
•
Doctors received no payment for 23% of claims submitted
Response time varied from a median of six to 15 days.
☆☆☆ Government Report Notes Benefits of Spinal Manipulation The National Prevention Council (NPC), recently called for the development of a National Prevention Strategy to outline goals and recommendations for improving health and wellness for all Americans. The National Prevention Strategy highlights several preventative measures throughout the report
Texas Journal of Chiropractic, Online CLICK HERE Premium Placement $450 per month Average Ad $300 per month Economy Rate $175 per month
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26
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including alternative therapies for back and neck pain. According to the report, one key aspect of expanding preventive services is to “enhance coordination and integration of clinical, behavioral and complementary health strategies.” The report also specifically touts the benefits of spinal manipulation stating, “Complementary and alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability.”
☆☆☆ Harvard Establishes "Principles of Conservative Prescribing" Researchers from Harvard and the University of Illinois at Chicago have published Principles of Conservative Prescribing in the Archives of Internal Medicine. They state: "The concept sums up lessons from past experience as well as from recent studies demonstrating that medications are commonly u s e d i n a p p r o p r i a t e l y, overused, and associated with significant harm -suggesting the need to more www.chirotexas.org
thoughtfully weigh claims for drugs, especially new drugs. ...These principles urge clinicians to
unneeded medications; and respect patients' reservations about drugs); and
(1) think beyond drugs (consider non-drug therapy, treatable underlying causes, and prevention);
(6) consider long-term, broader impacts (weigh longterm outcomes and recognize that improved systems may outweigh marginal benefits of new drugs)."
(2) practice more strategic prescribing (defer non-urgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only one new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to a regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with 27
☆☆☆ Financial Conflicts of Interest Linked to Outcomes “Randomized controlled trials involving the payment of author consultancy fees are more likely to generate a positive outcome when compared with trials that do not involve such conflicts of interest”, according to a recently presented study. The findings ... demonstrated that 91% of randomized controlled trials that recorded these conflicts of interest achieved positive results. Around 66.7% of similar trials without the c o n fl i c t s w e r e f o u n d t o achieve positive results. “The number of pharmaceutical treatment options ... has increased remarkably in recent years, partly as a result of increased funding from pharmaceutical companies,” lead study author Nasim A. Khan, MD, stated .... “Our study has shown that certain [financial conflicts of interest] among study authors Texas Journal of Chiropractic
have an increased likelihood of positive outcomes favoring the sponsor's drug.”
Chiropractic a Concise History
“The study authors searched Medline and the Cochrane Central Register of Controlled for eligible randomized controlled trials from 2002 to 2003 and 2006 to 2007. They disclosed financial conflicts of interest by at least one author in 55 of the 103 eligible trials. They found that 49 authors were employed by the industry sponsor, 29 received consulting fees or honoraria, 14 received research grants and 13 owned shares in the pharmaceutical company."
The American Medical Association HERE REPORTS on the History of Medicine.
"The correlation of positive outcome reporting and financial conflicts of interest in the study was found to only be present in one group: those authors who received consulting fees or honoraria f r o m t h e i n d u s t r y. T h e frequency of positive outcomes – 72% in the overall study and approximately 90% for randomized controlled trials receiving consultancy fees, honoraria or a research grant from the industry – could potentially indicate ethical issues..."
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TCA… Helping chiropractic professionals Nearly 100 years!
Texas Journal of Chiropractic
Dr. Steve Agocs, D.C. reports in an article titled Chiropractic's Fight for Legitimacy that "although the chiropractic profession now occupies a largely mainstream place in the health care spectrum of the United States, this has not always been the case. From its formation in 1895 by founder Daniel David (D. D.) P a l m e r, t h e c h i r o p r a c t i c profession faced a plan of containment and elimination by the American Medical Association (AMA) that continued for nearly a century. It took an antitrust lawsuit filed against the AMA in 1976 to reveal the magnitude and scope of the AMAʼs plan. Despite generations of organized medical opposition, chiropractors did what most other groups of professionals failed to do: they maintained a separate and distinct identity from the practice of medicine while growing in an otherwise hostile environment created by the AMA and its component state associations." "During the 1800s, there were a variety of medical sects vying for market share in the United States. Homeopaths, eclectics, naturopaths, and osteopaths, as well as the socalled “regular” orthodox 28
medical practitioners, all had a stake in shaping the dominant health care paradigm.” “The medical practitioners organized the American Medical Association in 1847 with the primary goals of standardizing medical education and instituting a program of medical ethics. By 1849, the AMA had taken on the role of investigating the various competing sects of medicine and challenging them on the basis of their ethics.” “The AMA took the position that the other forms of medicine, including the newly discovered chiropractic profession, were unethical a n d “ u n s c i e n t i fi c . ” M a n y authors, however, have made the argument that the AMAʼs intent was to decrease competition for financial reasons rather than to protect the public from unethical practitioners." "Medical doctors from this fledgling group broadcast the message that their practice alone was scientifically based, despite the fact that their approach to medicine was no more scientific than that of the professions they were competing with. This claim, however, was an important first step in marginalizing other professions as “ u n s c i e n t i fi c ” or “pseudoscientific” and allowed this sect of medicine to organize and professionalize quickly and eventually exert a massive influence on all www.chirotexas.org
aspects of health care policy in this country for generations. Not coincidentally, the AMAʼs efforts resulted in the transformation of American medicine from a modest, even menial profession into one of sovereignty, power, and financial affluence."
antimedical platform to advertise his practice. Neither endeared him to the medical authorities in Iowa or Illinois."
“Recognizing the need for a protective organization of their own, chiropractic leaders founded the Universal Chiropractorsʼ Association in 1906, primarily to provide legal representation for chiropractors facing legal persecution."
"By convincing state legislators that their profession was scientific while all others were not, the AMA and its state member associations were able to gain protection in the form of endorsement for educational programs and laws that limited “irregular” practice.” “The system of schools and hospitals, as well as the legislation protecting them, led to a “golden age of doctoring” that lasted until the 1970s. Orthodox, or “allopathic” medicine enjoyed virtually complete dominance of the health care market in the United States. With the exception of chiropractors, competing professions shrank to nonexistence or were absorbed into the orthodox medical profession, as in the case of osteopaths." "From its inception, chiropractic was looked upon as a menace by medical authorities. Palmerʼs first chiropractic patient was a partially deaf janitor named Harvey Lillard, whose hearing improved dramatically under Palmerʼs care. Following his development of chiropractic, Palmer used both incredible claims of cures as well as an www.chirotexas.org
most states chiropractors faced the possibility of arrest and imprisonment for “practicing medicine without a license.” D. D. Palmer himself spent 23 days in Scott County jail ... in Iowa in 1906.”
"Palmer intended to keep chiropractic techniques a family secret, but a near-fatal railroad accident caused him to change his plans, and he e s t a b l i s h e d t h e fi r s t chiropractic school, now known as Palmer College of Chiropractic, in 1897. A good number of Palmerʼs early students were medical doctors or had been trained in other health care disciplines prior to learning chiropractic. Palmer established a unique theory about the nature of disease and emphasized the role of the patientʼs body and its innate healing ability, rather than doctorsʼ treatments, as the key to health." "Chiropracticʼs first challenge as a profession was the licensure laws that protected medical practice. While there were provisions in some states for chiropractors to practice as “irregulars,” in 29
"In 1907, however, Wisconsin v. Morikubo found the first gap in organized medicineʼs armor. Chiropractor Shegataro Morikubo was arrested for practicing osteopathy and medicine without a license. ... The trial ended in the legal establishment of chiropractic as a separate and distinct profession from medicine and osteopathy, largely on the basis of chiropracticʼs unique philosophy." "Despite this legal precedent, thousands of chiropractors throughout the country were arrested and jailed for the practice of “medicine without a license” over the next several decades. Records exposed during the discovery phase of the Chester C. A. Wilk et al. v. AMA et al. case showed that medical doctors were encouraged by the AMA to accuse chiropractors of ethical violations. There was Texas Journal of Chiropractic
the additional problem that no state had established an o f fi c i a l l i c e n s e f o r chiropractors, so in many cases chiropractors were harassed for practicing without a license that did not exist." "This changed in 1913, when Kansas became the first state to establish a separate chiropractic board and fully legalize the practice of chiropractic. Other states quickly moved in the same direction. By the end of the 1920s, more than half of the states had legalized chiropractic. Louisiana was the last state to do so in 1974. Even the state chiropractic boards, however, were not safe from the pressures of the medical associations. State boards were routinely challenged and sometimes dissolved due to pressures on state legislators from the AMA and its state member associations. All the while, the AMA waged an ongoing campaign against chiropractors, using the popular media, medical journals, and any other source that could be used to describe chiropractic as a 'cult'."
procedures such as surgery and obstetrics. Chiropractors found it nearly impossible to pass the exams or gain licenses in states that adopted them. ... It was not uncommon for chiropractors to practice without licenses in states with such restrictions, creating additional opportunities for charges against them." "Morris Fishbein, AMA secretary and editor of the Journal of the American Medical Association from 1924 to 1949 adopted a relentless antichiropractic stance. Fishbein described chiropractors as “rabid dogs, playful and cute, but killers”. In 1932, Louis Reedʼs The Healing Cults stated, “Eight years ago officials of the American Medical Association met in secret conclave in Chicago and adopted the slogan, ʻChiropractic must die.ʼ They gave themselves ten years in which to exterminate it”.
"Now that chiropractors could legally practice in most states, the AMA advocated adoption of “basic science” examinations that all doctors had to meet to qualify for a license. These exams were biased heavily toward those with standard medical training —since chiropractors received no training in medical
"The AMAʼs plan to “contain and eliminate” chiropractic became even more organized with the establishment of the Committee on Quackery in 1963. This committee put its antichiropractic plan into writing as the “Iowa Plan,” the mission of which was “first the containment of chiropractic and, ultimately, the elimination of chiropractic”. The committee set about doing this by lobbying for the denial of chiropractic inclusion in Medicare, lobbying to prevent the approval of a national chiropractic accrediting
Texas Journal of Chiropractic
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agency, and encouraging further separation of the main national chiropractic organizations, the American Chiropractic Association and the International Chiropractors Association." "AMA writers ghostwrote television and movie scripts, as well as Ann Landersʼ widely read newspaper column and any other media outlet that could be used to tarnish the reputation of chiropractic in the public eye. The AMA even encouraged the distribution of antichiropractic materials to high school guidance counselors so they would dissuade interested students from pursuing careers in it." "The massive scope and methodical nature of this plan were exposed in hundreds of thousands of pages of AMA documents that were brought to light in the 1976 trial Chester C. A. Wilk et al. v. AMA et al. The trial and its appeals were an 11-year battle that concluded in 1987. Federal Judge Susan Getzendanner found the AMA and its codefendants guilty of violating the Sherman Antitrust Act. In her decision, Getzendanner asserted that “the boycott was intended to contain and eliminate the entire profession of chiropractic” and that it was the AMAʼs “intent to destroy a competitor”. The ruling forced the AMA to lift its ban, allowing medical practitioners to interact professionally with chiropractors without the risk www.chirotexas.org
Texas Chiropractic Association
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of being ostracized or penalized for ethical violations.” "The great irony of this long story of persecution at the hands of the American Medical Association is that it is questionable, particularly from the 1960s and forward, whether the AMAʼs antichiropractic stance was even representative of the common medical professionalʼs attitude. Since the Wilk et al. trial concluded, the chiropractic profession has enjoyed greater collaboration with other health professions, but the fight for equal rights as primary care providers continues to this day." As an example it is REPORTED HERE by the Texas Medical Association "Thanks to the hundreds of physicians, medical students, and TMA Alliance members ... and aggressive advocacy by TMAʼs lobby team, the association won a major scope battle." One of the TMA's chief concerns was reported to be "As approved by the committee ... Senate Bill 1001 by Sen. John Carona (RDallas) would have prevented the Texas Medical Board from taking legal action to stop an individual chiropractor from violating the Medical Practice Act if the chiropractic board said the chiropractor was practicing within his or her scope." Texas Journal of Chiropractic
before the chiropractic sponsored non-discrimination bills could be finally voted upon. Therefore medical discrimination continues, and medical-chiropractic partnerships are "still forbidden."
☆☆☆ Perhaps the primary motivator for TMA's fear, however was their opinion that "the bill also would have circumvented current insurance code provisions c o n c e r n i n g nondiscrimination against nonphysicians, which would allow more than 30 nonphysician health care groups to get paid for more services ... And lastly, the bill would have allowed a number of these groups to create partnerships and other professional structures with physicians..." Heaven forbid that DCs and MDs should become "partners" in healthcare! Heaven forbid that discrimination against "nonMDs" should cease. These statements from the Texas Medical Association itself demonstrate that discrimination is alive and well. The Texas Tribune reported, “After a fierce fight, the stateʼs leading physician groups won a change in legislation backed p r e d o m i n a n t l y b y Te x a s chiropractors …. Unfortunately the end of the legislative session occurred 32
Chiropractic Care Most Valuable for Work Related Back Pain A study administered by medical and healthcare professionals outside the chiropractic profession concluded that “chiropractic care had more effectiveness for common work related low back pain in comparison to treatments by physicians or physical therapists. In total chiropractic patients demonstrated lower medical expenses, less disability recurrences and shorter initial periods of disabilities." The study Health Maintenance Care in WorkRelated Low Back Pain and Its Association with Disability Recurrence, appears in Journal of Occupational and Environmental Medicine, April 2011, volume 53. Researchers had compared incidents across health care providers who treat claimants with new incidents of work related lower back pain. The www.chirotexas.org
conclusion reached: “that preventive healthcare, mainly and specifically recommend by doctors of chiropractic, is linked with lower disability recurrences. As defined in this study recurrent disability is the renewal of at least 15 consecutive days of temporary total disability payments after the health maintenance stage which is the period after a patientʼs recovery and patient restored to optimal health." In this study ten percent of the worders endured recurrent disability due to lower back pain. Researchers compared the recipients care: “Those who had been treated mainly by chiropractors had shown frequently better outcomes, less use of opioids (narcotic pain relievers), had less surgeries along with lower medical expenses." Notes this medical Journal "Chiropractors treat a host of numerous diseases and conditions besides back pain. Among them are arthritis, crohnʼs disease, carpal tunnel, spinal curvatures, RA, headaches, migraines, premenstrual syndrome, scoliosis and fibromylagia.” The Center for Disease Control and Prevention had noted “that a minimum of three percent of all children in the United States now have regular chiropractic care. Many parents are adding chiropractic care to their regular childrenʼs wellness checkups. Chiropractic care www.chirotexas.org
does not replace pediatricians but in all reality work well together to provide children overall good health. They aide childrenʼs health in many areas including asthma, bed wetting, sports injuries and more. Chiropractic care has also benefited children with learning disorders and dyslexia." "Chiropractic care not only relieves back pain during pregnancy but has been demonstrated to decrease the average time spent in labor. One of the greatest benefits a chiropractor can give a woman during pregnancy is that regular chiropractic care provides a properly balanced and open pelvis. This allows for greater room in which the fetus can turn into the correct position that eases labor." "Chiropractic care is over a hundred year old profession, is safe, effective and boosts the immune system. There is ongoing mounting evidence in science to prove the abilities of chiropractic care."
☆☆☆ New Vitamin D Guidelines Patients who may be at risk for vitamin D deficiency -including the obese, African Americans, and pregnant women -- should be screened for the condition, according to a newly released guideline. "We don't recommend screening for the general 33
population, but we recommend it for adults and children who are at risk for deficiency...." "That also includes lactating women, patients with malabsorption problems, and patients on anti-seizure medications..." ".... to prevent vitamin D d e fi c i e n c y i n a t - r i s k populations, the guidelines suggest that infants up to a year old should get 400 IU per d a y, a n d c h i l d r e n a n d adolescents through age 18 should get 600 IU per day. However, doses as high as 1,000 IU may be needed to achieve those higher serum levels, the researchers said." "Adults ages 19 to 50 should get at least 600 IU per day, although, again, higher doses -- up to 1,500 to 2,000 IU a day -- may be necessary to get levels consistently above 30 ng/mL." "Patients ages 50 to 70 should get 600 IU a day, and those above than 70 need 800 IU, with the same caveat as in younger adults for increased doses to achieve higher levels." "Pregnant and lactating women should get 600 IU per day (or 1,500 to 2,000 for higher serum levels), while obese patients and those on a n t i c o n v u l s a n t s , glucocorticoids, antifungals, and AIDS medications need two to three times the standard dose for their age group." Texas Journal of Chiropractic
"In terms of treating deficiency, the guideline suggests that children and adolescents should get 2,000 IU per day for at least six weeks, while adults need 50,000 IU once a week for eight weeks." "Again, obese patients, those with malabsorption problems, and those on medications that affect vitamin D metabolism need two to three times the dose for their age group." "For both treatment and prevention, the guidelines suggest using vitamin D2 or D3." "The guideline committee also concluded that there's sufficient evidence to suggest that vitamin D be prescribed to prevent falls. On the other hand, there's not enough evidence to recommend higher doses of the vitamin to protect against cardiovascular disease."
Medical Center in Tulsa, Oklahoma to provide a student internship program for Parkerʼs chiropractic students where they will work alongside doctors and specialists to provide expert care for the patients they serve. Representatives from CTCA held a ceremony to introduce the new collaboration between the two integrative health care leaders. “This new internship program provides Parkerʼs students with a unique educational experience through exposure to a diverse cancer patient population,” said Steve Mackin, president and chief executive officer of CTCA at Southwestern Regional M e d i c a l C e n t e r. “ W e ʼ r e pleased to offer these learning experiences to future doctors interested in integrative health care approaches.” CTCA provides integrative
☆☆☆ Parker University Launches Intern Program with Cancer Treatment Centers of America Parker University, College of Chiropractic has partnered w i t h C a n c e r Tr e a t m e n t Centers of America (CTCA) at Southwestern Regional Texas Journal of Chiropractic
cancer care all under one roof, combining conventional treatments such as radiation therapy, chemotherapy and surgery with supportive therapies like pain management, nutrition, chiropractic care, naturopathic medicine, and more. CTCA has board-certified physicians who have extensive experience in treating all cancer types, including advanced-stage diseases, as 34
well as physicians who specialize in other fields, such as p u l m o n o l o g y, g a s t r o e n t e r o l o g y, a n d neurology. Parker students participating in the 11-week rotating internship will be exposed to these treatments as well as the hospitalʼs cutting-edge technology. “Internship opportunities like this are extremely important in furthering the education of our students,” said Dr. Fabrizio Mancini, president of Parker U n i v e r s i t y. “ C T C A ʼ s commitment to developing customized treatment plans for each patient is in alignment with what we teach at Parker and what we provide in our chiropractic wellness clinics, which is another reason this partnership is such a great fit.” In addition, students will work closely with Dr. John Sibley, a chiropractor at CTCA and private-practice owner in Tulsa, where they will shadow him and gain hands-on experience with patients from his practice and at CTCA. “Through the internship at CTCA, students will acquire insight of how chiropractic care benefits cancer patients and will have the opportunity to see the results firsthand,” said Dr. Sibley. Chiropractic care can be beneficial to many cancer patientsʼ overall health. The CTCA chiropractors help cancer patients find relief from the pain and discomfort related to cancer treatments www.chirotexas.org
and provide care to help reduce stress and increase mobility, flexibility, strength, function, as well as improve quality of life.
AMA Membership Drops, Fewer MDs Choose AMA
“This internship is designed to best prepare Parker students for clinical practice within integrated health care settings,” said Dr. Patrick Bodnar, assistant dean of clinics at Parker University. “It
The American Medical Association lost about 12,000 members or 5% of its total membership this past year.
will expand the clinical portion of the studentʼs education and will b e n e fi t them tremendously.”
☆☆☆ Palmer Rugby Qualifies for USA Rugby Final Four The Palmer College of Chiropractic Menʼs Rugby team made school history Sunday, May 22, when it qualified for the USA Rugby Final Four championship for the second year in a row. Unfortunately they were knocked out of the finals after a defeat in the last minutes of their hard fought game.
☆☆☆ www.chirotexas.org
"Individual membership in the AMA continues to plummet as physicians see less value in their AMA membership, and increasingly perceive the AMA to be a less responsive organizational bureaucracy..." the District of Columbia delegation wrote in a resolution it introduced to reorganize the group's House of Delegates.” Like it or not, the AMA is the voice of doctors, at least in the minds of the public, and they're better off having their voices heard. The organization should have a diversity of opinions. If more keep quitting, the AMA "will just be a bunch of people who think exactly the same," one medical doctor noted. The AMA reported that membership dues revenue decreased by $4.2 million in 2010 -- down nearly 10% from 2009. Annual dues for active physician members are $420. Despite the drop in revenue from dues, AMA brought in an additional $5.2 million in total revenue in 2010, largely due to stronger publishing and business revenues, such as royalties paid by ALL health 35
care providers for insurance coding books. In an associated Medpagetoday.com editorial by Dr. George Lundberg he wonders "I am trying to figure out why so many American physicians say that they hate the American Medical Association and act out their feeling by not being a member." "The AMA's percentage of U.S. MDs who are members is at an all-time low and has dropped every recent year. Are the AMA haters unhappy because the AMA successfully fought off national health insurance in 1948, unsuccessfully opposed Medicare in 1966, or successfully supported the Affordable Care Act of 2010?" "Are they upset because the AMA collaborated with politicians from tobacco growing states to successfully block anti-tobacco legislation for decades as a trade-off for Congress going easy on physicians, or because the AMA participated actively in successful anti-tobacco efforts in the 1980s and '90s?" "Are they angry because physician average income rose from three times to only seven times that of average U.S. workers after enactment of Medicare and then the corporatization of medicine, but rose unevenly by specialty?"
Texas Journal of Chiropractic
"Perhaps many physicians believe that an effective AMA should have been able to prevent or solve the malpractice problem after all these years." "Could it be that many physicians blame the AMA for longstanding disparities of representation by age, gender, and ethnicity in the medical workforce, or blame it for promoting equality of a c c e s s f o r a l l q u a l i fi e d persons to medical school and for patients?" "Maybe some AMA haters are angry that the AMA was in cahoots with Big Pharma for decades so as to gain advertising mega-dollars for their journals and newspaper, or angry because those dollars were not enough to keep annual dues low." "Maybe they reject the ethic that physicians should care for all in need, regardless of their ability to pay, an AMA position since 1846." "Who knows? I don't." "That leads to the next logical question. Why are so many American physicians so angry?" Good question.
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Texas Journal of Chiropractic
Practices Behind in Crucial ICD-10 Transition Step Many medical groups have not completed software upgrades, nor have they scheduled testing with health plans regarding transitioning to the new 5010 protocol for electronic transactions standards. The 5010 protocol, required to be in place by Jan. 1, 2012, is necessary to accommodate the new ICD-10 codes, which must be implemented by Oct. 13, 2013. A mere 29% of respondents said their current practice management system software would permit them to use version 5010; 50.3% indicated a need to upgrade their current software, and 4.5% need to replace it. Fully 14.5% of respondents didn't know the status of their system. More than 40% of respondents said their vendors would charge them to upgrade or replace their current system. Yet, 35.5% of practices indicated they have not yet been contacted by their vendors regarding the change to version 5010. Only 2% of practices reported completing 5010 implementation, while 45.2% have not even started, with the remaining 45.9% having partially completed implementation.
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Practices also need to test their systems internally and with their major health plans to iron out any bugs before the deadline. Yet, less than 10% of respondents had started internal testing of their system. And nearly half (49.7%) indicated that external testing had not yet been scheduled with major health plans.
☆☆☆ Few High School Kids Meet Exercise Targets Only about 12% of teens get a sufficient combination of aerobic and musclestrengthening exercise to meet the physical activity goals of the federal government's Healthy People initiative, CDC researchers have found. Although 51% of high school students did enough muscle toning, just 15% got the requisite levels of a moderateintensity workout. For high school students, Healthy People 2020 recommends at least 60 minutes of aerobic exercise every day and musclestrengthening exercises on at least three days. The initiative sets percentage goals for achieving the two types of exercises and a combination of the two.
www.chirotexas.org
Researchers "found that a total of just 15.3% of high school students met the target for aerobic exercise; boys were more likely to do so than girls (21.9% versus 8.4%). Younger students were also more likely to attain them: 18.5% of freshmen did, 15.3% of sophomores 13.3% of juniors, and 13.1% of seniors. Whites were more likely to reach the goal than Hispanics (16.9% versus 11.8%) as were more normal weight or overweight students compared with obese ones (16.3% and 16.5% versus 10.7%)." Students fared better on the recommendation for muscle toning activities, with just over half -- 51% -- getting requisite levels. Again, more males than females achieved the goal (65% versus 36.6%), as did more younger students and normal and overweight ones. But only 12.2% of the students met goal in both types of activity.
☆☆☆ Medical Screening Fails to Lower Mortality While "preventive screening" is widely touted as the next medical miracle, M e d p a g e To d a y. c o m REPORTS HERE that "Dual screening for ovarian cancer failed to reduce women's risk of death from the disease .... www.chirotexas.org
In fact, patients screened annually with CA-125 antigen testing and transvaginal ultrasound had a slightly higher ovarian cancer mortality risk as compared with usual care." "Moreover, screening was associated with increased use of invasive procedures and avoidable complications related to workup following false-positive results, investigators reported here at the American Society of Clinical Oncology (ASCO) meeting." "It is possible that even an optimized program of annual screening may be insufficient to detect cancers early enough to reduce mortality. ... Evidence from modeling suggests that aggressive cancers progress rapidly through the early stages, limiting the ability to detect these cancers with yearly screening." "Screening led to detection of 20% more cancers, 'suggesting that some of the additional cancers detected by screenings were not clinically important and, if left undetected, may never have caused any symptoms or affected the women during their lifetimes.'" "Screening yielded falsepositive results for 3,285 women, of whom 1,080 subsequently underwent surgical follow up. ... authors found that 163 (15%) women 37
had at least one serious complication attributable to the surgical intervention."
☆☆☆ New Evidence for Innate Knowledge It is REPORTED HERE that "We have known for a long time that neuronal circuits become established and get reinforced via experience – itʼs a phenomenon known as “synaptic plasticity.” For example, this is how memories become anchored in the brain."
Now, however, "the team working on the Blue Brain Project ... however, is offering radically new evidence that this may not be the whole story. The researchers were able to demonstrate that small clusters of pyramidal neurons in the neocortex interconnect according to a set of immutable and relatively simple rules." "These clusters contain an estimated fifty neurons, on average. The scientists look at them as essential building blocks, which contain in Texas Journal of Chiropractic
themselves a kind of fundamental, innate knowledge – for example, representations of certain simple workings of the physical world. Acquired knowledge, such as memory, would involve combining these elementary building blocks at a higher level of the system. “This could explain why we all share similar perceptions of physical reality, while our memories reflect our individual experience." "The principle determining the formation of these microcircuits is astonishingly simple. Basically, when two neurons are each connected to the same neighboring neuron, the probability that they are also interconnected is greater than average. The researchers were able to build a statistical model based on this observation. When the scientists tested in vitro neuronal circuits from different rats, they all presented very similar characteristics. If the circuits had only been formed from the experiences lived by the different animals, the values should have diverged considerably from one individual to the next. Thus, the neuronal connectivity must in some way have been programmed in advance." "There is no question that knowledge, in the sense that we typically understand it (reading and writing, recognizing our friends, learning a language), is the result of our experiences. But the EPFL teamʼs work Texas Journal of Chiropractic
demonstrates that some of our fundamental representations or basic knowledge is inscribed in our genes. This discovery redistributes the balance between innate and acquired, and represents a considerable advance in our understanding of how the brain works."
☆☆☆ Olive Oil Protects Against Stroke Consuming copious amounts of olive oil may dramatically reduce stroke risk for older adults, according to a p o p u l a t i o n - b a s e d s t u d y. “Heavy use in cooking and dressings was associated with a 41% lower stroke incidence compared with never using olive oil..." "The top one-third on intake by serum measures had a 73% lower stroke risk than those in the bottom third among older adults living in three cities in France." "Because these results controlled for other dietary and stroke risk factors, olive oil may be considered a major protective component of the Mediterranean diet for stroke...." "Intensive olive oil intake could find a place alongside more fruits and vegetables and less salt in the dietary recommendations to prevent
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stroke in populations ...."
elderly
"Moderate intake showed a 20% reduced incidence of stroke compared with no olive oil intake but the association was not significant."
The world of chiropractic is changing. New lawsuits regularly challenge the ☆☆☆ profession; new research regularly demonstrates the effectiveness of the chiropractic profession and also demonstrates the lack of effectiveness for more “popular” health care approaches. Rules are changing; laws are changing; yet the ever present discrimination against a minority profession that seeks to focus upon health rather than pathology does not seem to be changing. Who is your voice? Who keeps you informed? Who supports your profession so that you may support your family and your patients? Are you a part of your professional association? www.chirotexas.org
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Texas Chiropractic Association Serving Texas Chiropractors and their patients for nearly 100 years! Are YOU supporting YOUR profession? Are YOU supporting YOUR Doctor of Chiropractic? www.chirotexas.org 1122 Colorado, Suite 307 Austin, TX 78701 Phone: 512 477 9292 Fax: 512 477 9296