Health Care Update
Institute of Medicine
Committee on CAM Holds Second Meeting
The Institute of Medicine held the second meeting of its Committee on the Use
of Complementary and Alternative Medicine on Sept. 22 in the Arnold and Mabel
Beckman Center at the National Academy of Sciences in Irvine California.
The meeting included presentations to the committee and panel discussion on
the issues of successful integration of CAM programs in a variety of settings
including hospitals and HMOs. There were also presentations on certifying medical
doctors and doctors of osteopathy as holistic practitioners, the effect of licensure
on professions offering CAM services, and how best practices are identified
and communicated to those practicing in the field.
There was also a discussion held on how to generate knowledge about health outcomes
of CAM modalities, and it included discussions from participants on knowledge
generation and research in their own CAM modality or discipline. The discussion
focused on how each field generates and shares knowledge about treatment effectiveness.
Other discussions centered on outcome concepts and measures. The Committee was
interested in how practitioners and researchers in various fields determine
whether or not a treatment was effective and what outcomes the practitioner
would look for.
The chiropractic profession was represented at the committee meeting by Dr.
Matthew McCoy, acting director of the Office of Sponsored Research at Life University
and board member of the World Chiropractic Alliance, Dr. William Lauretti of
the American Chiropractic Association and Dr. Reed Phillips of the American
Academy of Chiropractic Physicians.
The IOM convened this study committee to explore scientific, policy and practice
questions that arise from the significant and increasing use of CAM therapies
by the American public. The committee is charged with describing the use of
CAM therapies by the American public; providing a comprehensive overview, to
the extent data are available, of the therapies in widespread use; describing
the populations that use them; and explaining what is known about how they are
provided. They will also identify major scientific, policy and practice issues
related to CAM research, and are charged with the translation of validated therapies
into conventional practice and the development of conceptual models or frameworks
to guide public and private sector decision-making as research and practice
communities confront the challenges of conducting research on CAM. The committee
will also address the distinct policy and practice barriers inherent in that
translation.
The next committee meting is scheduled for Dec. 11 in Washington, D.C.
ChiroSecure To Sponsor New Scholarship Program
The International Chiropractor’s Association’s exclusive malpractice
carrier, ChiroSecure, is sponsoring a new scholarship program, offering awards
of $1,000 for the winners of a writing competition. Students are invited to submit
essays of no more 1,500 words on the topic, “The Safety and Effectiveness
of Chiropractic Care.”
ChiroSecure has established this new program as part of their commitment to a
strong and growing chiropractic profession and as a means of giving back to the
chiropractic community. The panel of judges for this program includes Dr. Gerry
Clum, president of Life Chiropractic College West, Dr. Robert Hoffman, president
of The Masters Circle consulting group and Dr. Elliot Foster, chairman of the
ICA’s board of directors.
This competition is open to all U.S. students currently enrolled in any chiropractic
college. Essays must be received via e-mail by Feb. 1, 2004 and the winners will
be announced at the ICA’s Annual Meeting in April of 2004. The winning
essays will also be published in an official ICA publication and the successful
authors will have the opportunity to present their work at the Annual Meeting
of the ICA Council on Applied Chiropractic Sciences scheduled for Feb. 20-22,
2004, in California.
Entries are to be submitted online to drhoffman@chirosecure.com.
Flu Vaccine Recommendations Guarantee More MD Visits Says CDC Study
In October, the Centers for Disease Control and Prevention (CDC) released results
from a study which indicated that the latest recommendations for flu vaccines
will significantly increase the visits to primary care physicians. The research,
as reported by Reuters Health Information, was conducted by Peter Szilagy, M.D.,
and others from the University of Rochester School of Medicine and Dentistry.
Szilagy’s study pointed out that if the influenza vaccine is administered
from October to December, 34 percent of children would require one extra visit
per year, and 12 percent would require two extra visits per year.
On Oct. 16, the CDC published a press release announcing that otherwise healthy
children from ages 6 months to 23 months were advised to receive the flu vaccine.
The recommendation came from the Advisory Committee on Immunization Practices
(ACIP) of the CDC. The ACIP’s recommendations suggest that two doses of
inactivated influenza vaccine be administered more than one month apart for previously
unvaccinated children less than nine years of age. If possible, says the ACIP,
the second dose should be administered before December. All subsequent annual
influenza vaccinations require only one dose of vaccine. The Rochester study points
out that the ACIP recommendations may not be financially sound due to insurance
costs.
NCCAM Announces New Research Fellowship Program
The National Center for Complementary and Alternative Medicine (NCCAM), a component
of the National Institutes of Health, announces the creation of a new NCCAM Director’s
Fellowship in Complementary and Alternative Medicine Research.
The new fellowship program will add measurably to NCCAM’s ongoing training
activities by sponsoring outstanding research fellows to work in its Division
of Intramural Research, based at the NIH in Bethesda, M.D. A selection committee
comprising leaders from the CAM and scientific communities will choose the recipient
of the fellowship from a highly competitive international pool of applicants.
Applicants must possess an M.D., D.O., Ph.D., D.C., D.M.D., N.D., D.V.M., or other
equivalent degree, and have a record of excellence and promise in clinical and/or
laboratory-based research—preferably related to CAM.
“This prestigious new fellowship is made possible by a generous donation
from the Prince of Wales Foundation to which we are grateful for its vision and
support,” said Stephen E. Straus, M.D., NCCAM director. “The fellowship
constitutes an important new mechanism by which NCCAM can recruit and train the
next generation of leaders in CAM research.”
The primary goal of the training program is to prepare the fellow for a career
as an independent CAM investigator. The fellowship includes full salary, benefits,
professional travel, and research support for 2 to 3 years. The fellow will undertake
clinical, translational and/or laboratory research in NCCAM’s Division of
Intramural Research (DIR). The DIR provides state-of-the-art research facilities
as well as access to the extensive clinical research infrastructure of the NIH
Clinical Center. The deadline for receipt of applications is Nov. 24, 2003.
The Prince of Wales Foundation opened its Washington, D.C., offices in 1997. It
distributes funding each year to benefit a wide range of causes throughout the
world, including supporting research in CAM and integrative health care.
For more information about the fellowship, applicants should contact: Christopher
Baron, human resources specialist, Office of Human Resources, NIH 31 Center Drive,
Room 2C12 Bethesda, MD 20892, email: baronch@mail.nih.gov.
Guidelines Revision Completed
The Council on Chiropractic Practice announced recently that they have completed
their review and revision of their Clinical Guideline Number 1: Vertebral Subluxation
in Chiropractic Practice. The review and revision spanned approximately two years
and involved over 250 people who served in various capacities to complete the
project. Several additional recommendations were added in the 2003 update including
recommendations dealing with maternity care, peer review, open adjusting rooms,
heart rate variability, radiographic digitizing, record keeping, and patient privacy.
In addition, commentary was added to many of the previous recommendations to bring
them up to date with the current literature.
According to Dr. Christopher Kent, president of the Council on Chiropractic Practice,
“We completed an exhaustive review of the literature since the last review
and also included a thorough review of the guideline development literature that
was published since the first publication of the Guidelines in 1998. This is a
document the whole profession can be proud of.”
Following publication of the CCP Guidelines in 1998, the document was submitted
to the National Guideline Clearinghouse (NGC) for consideration for inclusion.
The NGC is sponsored by the U.S. Agency for Health Care Research and Quality (AHRQ)
and is in partnership with the American Medical Association and the American Association
of Health Plans. Their mission is as follows:
“The NGC mission is to provide physicians, nurses, and other health professionals,
health care providers, health plans, integrated delivery systems, purchasers and
others an accessible mechanism for obtaining objective, detailed information on
clinical practice guidelines and to further their dissemination, implementation
and use.”
The AHRQ contracts with ECRI, a nonprofit health services research agency, to
perform the technical work for the NGC. ECRI is an international nonprofit health
services research agency and a Collaborating Center of the World Health Organization.
In November 1998, following review by ECRI, the CCP Guidelines were accepted for
inclusion within the National Guideline Clearinghouse and are presently the only
chiropractic guidelines listed by the NGC.
The next scheduled review and updating of the CCP Guidelines is scheduled for
August 2008. For more information visit the CCP website, ccp-guidelines.org
United Nations Sounds Alarm Over Drugs
Party drugs like Ecstasy and amphetamines have overtaken heroin and cocaine as
the fastest-growing global narcotics menace, according to a recent report unveiled
in Italy from the United Nations Office on Drugs and Crime. The reports estimated
more than 40 million people around the world had taken synthetic drugs in the
last year, more than the combined number of cocaine and heroin users.
Ecstasy abuse spiraled by 70 percent and amphetamines, such as speed, by 40 percent
between 1995 and 2001. By contrast, cocaine and heroin abuse worldwide grew less
than 1 percent each.
The Netherlands is the largest Ecstasy producer, accounting for 23 percent of
laboratory seizures in 2000-2001, the report said. Abuse is highest in East and
Southeast Asia, in countries such as Thailand, followed by Europe and Australia.
New Heart-Healthy Corn Due in Stores by 2007
A new breed of corn that mixes the conventional seed with a bright-blooming relative
offers the promise of helping prevent clogged arteries and reducing harmful cholesterol.
Corn oil and other food products with this heart-healthy strain as an ingredient
could appear on supermarket shelves in the world within four years.
The breakthrough after 10 years of research could lead plant breeders to develop
other healthy varieties such as popcorn and yellow sweet corn.
Scientists bred corn with Eastern gama grass, a purple or orange-bloomed plant,
and came up with a corn high in oleic fatty acid—a type of unsaturated fat
that raises levels of good cholesterol to prevent arteries from clogging. Oleic
acid also lowers the bad cholesterol that damages the heart.
Susan Duvick, a plant biologist at the U.S. Agriculture Department who led the
project, said conventional corn contains about 20 percent oleic acid and 60 percent
polyunsaturated fat, which is considered healthy by nutritionists, although not
as beneficial as oleic. Conventional corn also has 10 percent of the harmful saturated
fat.
The new corn lines contain less polyunsaturated fat—just 20 percent—while
the oleic acid content climbs to 70 percent, said Duvick, who works in the department’s
Agricultural Research Service. The new breed still contains 10 percent saturated
fat.
Duvick worked on the corn lines with Linda Pollak, a geneticist at the department,
and Pamela White, an Iowa State University food scientist.
White said she expects the flavor from the new corn to be similar to conventional
corn oil, which is bland. Also, corn with high oleic acid will have a longer shelf-life
than conventional corn oil, she said.
New Diplomate Exam for Orthopedics
Doctors of chiropractic who are interested in achieving a diplomate of chiropractic
orthopedics will have an additional opportunity to sit for new certification exam
at the annual conference of the American College of Chiropractic Orthopedists
on May 27, 2004, in Orlando, Fla.
The exam is sponsored by a coalition of chiropractic organizations composed of
the American College of Chiropractic Orthopedists, the Council on Chiropractic
Orthopedics and the Academy of Chiropractic Orthopedists.
This new orthopedic credentialing examination provides an alternative opportunity
for doctors to become diplomates in chiropractic orthopedics. Eligibility for
the diplomate examination includes those who have valid transcripts of successful
completion of a chiropractic orthopedic course within the last 20 years or completion
of an orthopedic residency program.
The certification examination will be offered twice annually. A spring examination
is presented in conjunction with the ACCO annual convention, with a second examination
set for fall 2004. The examination will consist of multiple-choice questions,
imaging studies and practical stations simulating in-office clinical situations.
General topics addressed in the examination will be published prior to the exam
and will be included in an information packet sent to candidates.
For an application or more information on the examination, contact the ACCO office
at Foundation for Chiropractic Education and Research at (515) 981-9654.
Parker Seminars Announces January Show in Las Vegas
Chiropractic and wellness leaders will converge on Las Vegas Jan.15-18, 2004,
for a stop on the Parker Seminars schedule, a leading chiropractic trade show
and professional growth program.
Last year’s seminar drew more than 8,000 attendees, and according to organizers,
this year’s initial registration indicates that the 2004 seminar will easily
surpass that number.
The schedule for the seminar includes chiropractic programs and presentations
on professional growth, practice success and scientific research and personal
growth track sessions featuring speakers such as Dr. Patrick Gentempo, Dr. Arlan
Fuhr, Dr. Bob Hoffman, Dr. Dan Murphy, Dr. Mark Sanna and Chicken Soup co-creator
Mark Victor Hansen. This year’s seminar also will offer a new chiropractic
assistant program that begins on Friday.
Bob Eubanks of Dating Game fame will be the master of ceremonies and will kick
things off at 9 a.m. Thursday. The opening night ceremony will feature surprise
guests and live entertainment. Later that day, more than 40 chiropractic professionals
will gather for the technique program.
Saturday’s events include a slate of Parker System of Professional Success
courses, the continuation of the CA program, and an awards ceremony featuring
Vegas entertainment, guest speakers and much more.
Parker seminars also are kid-friendly. The Parker Seminars Kids Club is a program
designed for children ages 5-10 so that seminar attendees do not have to leave
their children at home for this Vegas conference.
Chiropractors interested in registering for the 2004 Las Vegas Parker Seminars
can call (888) 727-5338 or can visit parkerseminars.com.
Chiropractors Contest Claim that Osteopathic Adjustments Are “More
Gentle”
A Sept. 24 broadcast of the “Today in New York” show on WNBC-TV made
the statement that osteopathic manipulation is “much more gentle”
than chiropractic manipulation regarding a story about childhood otitis media.
The program focused on the role of the adjustment in helping drain fluid from
the ears and to prevent ear infections.
The controversial statement that osteopathic manipulation is more gentle than
chiropractic generated a number of responses from the chiropractic community,
pointing out that the WNBC-TV had failed to back up the statement with research
and that, in fact, the chiropractic adjustment is just as gentle and effective
as the osteopathic adjustment. In a response letter to WNBC-TV, American Chiropractic
Association President Donald J. Krippendorf, D.C., responded by noting that Yonkers,
N.Y.-chiropractor Joan Fallon has been a leader in the study of adjustments on
the ability to correct ear problems and that the chiropractor will be the doctor
with more experience in caring for the condition.
Relationships Between Doctors and Drug Companies Under Scrutiny
An estimated 80,000 drug company representatives with more than $19 billion of
promotional budgets, are pushing drugs on doctors every day. This was one of the
conclusions of an article published in the May 2003 issue of the British Medical
Journal. In the article titled, “Who pays for the pizza? Redefining the
relationships between doctors and drug companies,” Ray Moynihan writes,
“There is a brewing conflict between the world’s leading medical campuses
and big pharmaceutical companies. Twisted together like the snake and the staff,
doctors and drug companies have become entangled in a web of interactions as controversial
as they are ubiquitous.”
Discussing studies from around the world the article revealed that 80-95 percent
of doctors regularly listen to drug company representatives’ advice and
information on drugs, “despite evidence that their information is overly
positive and prescribing habits are less appropriate as a result.” The article
revealed that doctors receive multiple gifts from drug companies every year, and
that medical doctors tend to deny the influence this might have on their judgment.
Moynihan wrote, “Many professional societies rely heavily on industry sponsorship,
just as their medical journals rely on drug company funded trials, company advertisements,
company purchased reprints, and company-sponsored supplements, despite the consequent
conflicts of interest and evidence that sponsored supplements are more promotional
than other articles.”
According to the article there is considerable evidence that research sponsored
by drug companies tends to produce favorable results. The article went so far
as to state that “finding senior medical researchers or clinicians without
financial ties to pharmaceutical companies has become exceedingly difficult.”
The article listed several ways that doctors and drug companies become entangled:
- Face-to-face visits
from drug company representatives;
- Acceptance of direct
gifts of equipment, travel, or accommodation;
- Acceptance of indirect
gifts, through sponsorship of software or travel;
- Attendance at sponsored
dinners and social or recreational events;
- Attendance at sponsored
educational events, continuing medical education, workshops, or seminars;
- Attendance at sponsored
scientific conferences;
- Ownership of stock or
equity holdings;
- Conducting sponsored
research;
- Company funding for
medical schools, academic chairs, or lecture halls;
- Membership of sponsored
professional societies and associations;
- Advising a sponsored
disease foundation or patients’ group;
- Involvement with or
use of sponsored clinical guidelines;
- Undertaking paid consultancy
work for companies;
- Membership of company
advisory boards of thought leaders or speakers’ bureau;
- Authoring ghostwritten
scientific articles; and
- Medical journals’
reliance on drug company advertising, company purchased reprints, and sponsored
supplements.
The article revealed that drug companies often sponsor professional societies
and the writing of their guidelines and noted that a quarter of university researchers
receive industry funding and a third have personal financial ties to sponsors.
The article quoted Arnold Relman, a Harvard professor and former editor of the
New England Journal of Medicine, who stated: “The medical profession is
being bought by the pharmaceutical industry, not only in terms of the practice
of medicine, but also in terms of teaching and research. The academic institutions
of this country are allowing themselves to be the paid agents of the pharmaceutical
industry. I think it’s disgraceful.”
According to Dr. Dan Murphy, vice president of the International Chiropractor’s
Association: “The medical profession is being bought by the pharmaceutical
industry, not only in terms of the practice of medicine, but also in terms of
teaching and research.” As of 2001, US consumers spent $154.5 billion
on prescription drugs, a 100 percent increase as compared to four years prior.
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