April 2003 Issue


In this issue:

US Supreme Court Opens Networks For ChiropracticSupreme Court Building

On April 2, 2002 the US Supreme Court ruled unanimously to uphold a Kentucky law known as an "Any Willing Provider Law".  Although this ruling did not get much press coverage, this ruling will have a profound effect on how health care is offered to the general public.  Additionally, the law will have a considerable impact on the availability of chiropractic care in managed care programs. 

This ruling upholds state laws that force HMOs to open up their doctor networks, allowing regulations in about half the states to give patients broader health care choices. The ruling is a blow to the managed care industry, which argued that closed networks are more cost-effective because doctors and hospitals that join agree to accept lower fees in return for a guaranteed stream of patients.

State "Any Willing Provider" laws basically allow all licensed doctors who agree to the terms of the HMO to become participating doctors in the HMO.  This prevents HMO's from limiting the number of doctors in their network.  According to many state laws HMO's are not allowed to discriminate against chiropractors.  This ruling upholds those laws and opens up networks allowing more chiropractors to participate in various health plans.

The laws affect HMOs in all areas, but are particularly helpful to patients in rural areas or small towns, where health care choices are limited. In those areas, patients sometimes have to drive many miles to see an in-network health care provider. The Kentucky statutes were challenged by a group of HMOs and an industry trade association. The case turned on whether the laws regulate insurance, which states are allowed to police, or regulate employee benefits, an area reserved for Congress. The Bush Administration, had asked the court to uphold the Kentucky laws.


Medical Errors Make News More Than Ever

Numerous articles recently in the press have dealt with the issue of Medical mistakes.  The articles center around the growing numbers of errors, damage and death due to those errors, and attempts at reducing them.  The reactions to these problems have prompted congressional action and activity by government agencies to track the incidence of medical errors.

The March 5, 2003 issue of the Journal of the American Medical Association published a report entitled, "Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting".  In this study researchers evaluated the records of more than 27,000 patients seen in a large, multi-specialty group practice in New England over a 12 month period between July 1, 1999, and June 30, 2000. The results showed that there were 1523 identified adverse drug events, of which 27.6%(421) were considered by the researchers to be preventable.  The overall rate of adverse drug events was 50.1 per 1000 persons, per year.  Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal.

The researchers also projected these figures nation wide.  Using these calculations they concluded that with the total number of Medicare enrollees in the U.S. being approximately 38 million people, it would be estimated that  there would be more than 1.9 million adverse drug events each year, with more than one quarter being preventable. Researchers further stated, " there are in excess of 180,000 life-threatening or fatal adverse drug events per year, of which more than 50% may be preventable" they further noted that, "these estimates are likely to be conservative."

The Ivanhoe Newswire ran a story on March 14, 2003 that stated that the US Food and Drug Administrations (FDA) proposes rules to curb medical errors.   The new rules will require bar coding on medications and improved reporting requirements for safety problems that involve medicine.  The required bar code would contain a National Drug Code number, identifying information about the drug. The proposed rule would apply to all prescription drugs, over-the-counter medicines and vaccines.  Another proposed amendment by the FDA would require companies to submit all reports they receive of actual and potential medication errors to the FDA within 15 calendar days.

News from Mar. 12, 2003 that appeared in numerous reports including the Associated Press reported from Washington DC that the US House of Representatives passed a bill to create a voluntary system to track medical errors.  It also promises confidentiality to hospitals and doctors and assurances the information will not go to lawyers for use in malpractice suits. The US Senate has not acted on a similar measure.  The article also noted that the Institute of Medicine has said that medical errors contribute to more than 1 million injuries and up to 98,000 deaths annually.


Water Fluoridation Issue Draws Action

Opposition to the mass fluoridation of drinking water continues to grow. A March 16, 2003 article in the Environmental News Network reports on a story from the town of Canton New York which has stopped mass Fluoridation of the water system.  According to the story, one hundred and thirty faculty and staff members of Canton's St. Lawrence University and 300 students petitioned the village trustees to ban fluoride from its water supply. As a result village trustees voted, on February 18, 2003, to halt fluoridation in Canton, New York.

Trustee Stephen Putnam, who voted against fluoridation, said he spent much of December and January reading articles about fluoride and was concerned that fluoride accumulates in the bones, particularly for menopausal women who drink fluoridated water over many years.

According to the article, Paul Connett, PhD, led the campaign to rid fluoride from Canton's tap water. Dr. Connett, is a Chemistry Professor at St. Lawrence University and is also the co-founder of the, Fluoride Action Network, an International Coalition to End Water Fluoridation. He stated, "An independent review of the literature finds that fluoridation is:

Paul Beeber, President, New York State Coalition Opposed to Fluoridation concluded the article by saying, "New York City has temporarily halted fluoridation. We hope City residents take the lead from the people of Canton, New York, and demand their water remain fluoride-free."  The article offered the following websites for more information.


Medical Journal, "Orthopedics Today" Touts Chiropractic

Praise for chiropractic recently came from an unlikely source. In the February 2003 issue of the magazine "Orthopedics Today", there appeared a feature article titled,  "Time to Recognize Value of Chiropractic Care? Science and Patient Satisfaction Orthopedics TodaySurveys Cite Usefulness of Spinal Manipulation."

In the article, Jack Zigler, MD, orthopedic spine surgeon with the Texas Back Institute, states, "There are a lot of myths about chiropractic care. I decided to look into each of these myths, and what I found is that chiropractic education, side-by-side, is more similar to medical education than it is dissimilar. Chiropractors work for us as screeners for surgical pathology. They can do the same work-up and send the patient who has already gone through his conservative treatment and had all his diagnostic work done to the surgeon."

Additionally, Scott Haldeman, DC, MD, PhD stated, "About 10 to 12 international guidelines have suggested that there is some benefit to manipulation. If we look at their basic guidelines, manipulation has consistently been accepted by independent government and scientific bodies as being a valid form of treatment."

Andrew Cole, MD, associate clinical professor of rehabilitation medicine at the University of Washington and recent past president of the American Academy of Physical Medicine and Rehabilitation gave the strongest overall endorsement when he said, "Overall, manipulation has the advantage of reducing pain, decreasing medication, rapidly advancing physical therapy and requiring fewer passive modalities."


Many Patients With Brain Injuries Find Success with Non-Medical Care

From an April 2, 2003 article from "Health Scout News" and published on Drkoop.com comes the headline, "Alternative Medicine a Plus for Brain Injuries". This article reported on findings presented at the American Academy of Neurology's annual meeting.  The findings showed that many people with "traumatic brain injuries" were also using, what the researchers referred to as "alternative medicine".  For the purposes of this study, the researchers considered all non-medical care to be "Complementary and Alternative Medicine" or "CAM".

Researchers interviewed 130 people with traumatic brain injury treated at the University of Michigan's Trauma Burn Center. They were asked if they'd used alternative health care to help them with their injuries.  More than half of them said they'd used at least one form of alternative healthcare, while more than a third said they'd used at least two.

According to the study the most commonly used procedures used by the people interviewed were massage therapy, meditation, herbal medicine and chiropractic care. Massage therapy and chiropractic care were used by the brain injury patients to treat their pain, while meditation was used for affective disorders and herbal medicines for cognitive defects.

Interestingly enough, the study showed that  the majority of these patients are not discussing that with their medical doctors. "A lot of patients are embarrassed to tell their doctors, while others don't even realize that the vitamin supplements and other substances they are using can be as active as drugs, which can affect their medical treatment. As a physician, this makes me more aware of the fact that I need to ask my patients about any possible CAM use," study author Sharon McDowell, MD.  Regardless of medical concerns, the study clearly reported that 80 percent of the people interviewed believed that the non-medical care they received was effective.


White-Coat Hypertension

White-Coat Hypertension is the name given to a phenomenon whereby people visiting a doctor, and having their blood pressure checked, experience an abnormally high blood pressure reading only while at the doctor's office.  An article discussing this condition appeared in the March 25, 2003 edition of the Atlanta Journal Constitution.

In the article, William B. White, MD. professor and head of the hypertension and clinical pharmacology program at the University of Connecticut Health Center said, "This alarmingly high blood pressure occurs only when the patient is in a physician's office. The patient's blood pressure is remarkably higher when measured by a doctor but lower when measured in a different setting, such as a senior center or at home."  Dr. White also estimated that one-third of senior citizens with mild hypertension suffer from the condition and are often treated with unneeded medications.

''I was treating a gentleman for uncontrolled and resistant [to medication] high blood pressure,'' says White. ''One day he walked in, jumped up on the table and mentioned he'd just come from playing nine holes of golf. He looked great and felt great. I took his blood pressure and it was 298 over 100. [Normal is 130/90.] I asked him how he felt, and he said terrific. It just didn't make any sense, until he mentioned that his blood pressure was always lower when it was measured anywhere other than a doctor's office.''

Most folks admit to feeling nervous during a doctor's visit. But for some, the stress of being in a medical setting goes well beyond being anxious about an exam or a shot. The article offered two suggestions to those who feel they might be a candidate for this phenomenon.  First they recommend that you also have your blood pressure monitored somewhere other than the doctors office, and secondly if you've noticed a persistent discrepancy between your blood pressure readings at your doctor's office and those taken elsewhere, you should let your health care provider know.


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