The Missouri Chiropractor - Febraury 2007

President’s Report

by Edward A. Hengel, DC, MSCA President

United We Stand

Every chiropractic physician in the State of Missouri is feeling the economic strain of ever-shrinking reimbursement from health carriers.  Every chiropractic physician in the State of Missouri is suffering from the humiliation of having their professional judgment, regarding the appropriateness of their patient care, second-guessed by computer databases.  Our patients, who depend on us for their health and well-being, are finding that the chiropractic limitations and excessive co-pays make access to chiropractic care more and more difficult.

In every Missouri chiropractic office, doctors sign provider contracts that are unconscionable, and are subjected to terms that are heavily weighted in favor of the financial interests of the managed care company, and against the financial interests of the chiropractic physician and the health interests of his or her patient.  To continue along this path will result in dire consequences for the chiropractic physician, as well as the chiropractic patient in the State of Missouri.

While litigation is one method of stemming these abuses, it is expensive, time consuming, and issue-specific.  The survival of our profession depends upon a profession that is unified in protecting the rights of its doctors and patients.

Missouri law mandates every health carrier must provide chiropractic coverage, and there can be no term, or condition, that makes access to chiropractic coverage more financially burdensome to patients than access to any other type of healthcare.  Without the chiropractic component in their plans, the health carriers cannot do business in Missouri.  The time has now come for us, as a profession, to take advantage of Missouri’s legal landscape and unify to prohibit the systematic devaluing of chiropractic care by the insurance industry.

We must understand that if we stand together we ensure the survival of our profession.  However, if we continue to exist as a splintered and fractured profession, the consequences may be dire.

PAC Report  

by Phillip Prater, DC
PAC President

 
Attention All Chiropractors

Legislative Day, one of the most important days for Missouri chiropractic, is approaching very soon.  The date is March 6, 2007, at the State Capitol in Jefferson City at 10:30 a.m.

This is the time that you should call your senator and representative to invite them to our function for lunch  at 11:30 a.m. in the Capitol Rotunda.  Lunch will be provided again this year by Wanda Munson withKey Company.

We will be providing lumbar supports to all senators and representatives this year and the charge to doctors will be $40 each.  You may fill out the form below or go to www.mscainfo.com.

I know this is a work day for many, but it is very important day to be present in Jefferson City.

Hope to see you there!

Committee Report

by Margaret Freihaut, DC, Insurance Committee Chair

INSURANCE REPORT

Iwould like to begin this report by saying there are so many things happening inworld of insurance that affect us and our patients.  I really appreciate the calls I receive concerning all of these issues, because the information helps me to know and investigate the insurance complaints and concerns of Missouri chiropractors. 

I see many places where we are being affected in higher co-pays, higher deductibles and more hoops to jump through to get reimbursed for the services we perform.I see companies requiring paperwork take longer and longer to process, and doctors’ staff spending more and more time on the phone and computer, trying to get claims, which should have already been paid, paid.  I know I do not have to tell you this is happening, but I do need to hear about it from you.  You can email me at freihaut@ruralcom.net,call me at 636-305-3400.  Due to the volume of calls, I will usually return them at lunch, or at the end of the day, so please leave a message if I am unavailable.  Please continue to send complaints and documentation of abuses and problems to my office.If you file a complaint with theof Insurance, make sure to send me a copy at: 500 Mae Court, Fenton, MO 63026.

MEDICARE
Check the CMS website for the current fee schedule.  There will be a decrease in February.

GHP
I have had calls and received a copy of the letter, that GHP has sent out to its members concerning notification requirements for out-of-network providers.  The letter tells them it is the patient’s responsibility to make sure that the notification process is followed.

BLUE CROSS BLUE SHIELD
I have had several calls about changes in the Blue Cross Blue Shield benefits since they have started changing their policies over to Anthem.  Some of the calls have been about more audits being done for use of the 98942.  Remember, the quantity and quality of the documentation should reflect the CMT services rendered and support the CPT codes reported. 

Other concerns have been over the place of service.  Some policies have a co-pay for procedures done in "office" and co-insurance for service done in a clinic, or out-patient setting.Co-pays are much more if done in an office, than co-insurance when done in a clinic.  I have also had calls where manipulation is not covered at all.  Please keep the MSCA informed about any changes that you run across, especially those that adversely affect our practices.

HMO CO-PAYS
There have been several lawsuits on behalf of chiropractic patientssome HMO plans with co-pays that were over 50 percent of the allowed amount on one service.  I have seen plans where the patient pays all the balance, as their co-pay is more than the amount allowed. Please notify us with any information on plans that may have an issue with the co-pay being over 50 percent for one service, and over 20 percent for multiple services.

UNITED HEALTHCARE
There have been many calls about the difficulties with denied claims, even with proper notification.  It appears that some of these difficulties are due to the doctors getting the claims in before the ACN notification gets processed.My staff was told they are 2 to 3 weeks behind due to the holidays. Make sure to get an up-to-date list, which should come out at the beginning of the year, of the plans that require notification as they change.  The tiering process is usually recalculated at this time of year.  I have not seen it change as of yet.  I have had a couple of calls from doctors who did not sign up for electronic statements and deposits but were put on electronic deposit remittances without their consent and checks are being deposited into their accounts.  Call if this has happened to you. 

CIGNA
Cigna HMO, in St. Louis, has American Specialties and Cigna in otherof the state have ACC.  ACC has an administrative fee, a global fee and $250 fee to sign up even though you may have been part of the CIGNA network prior to the change.  Does it get any better than that? Oh yes, the administrative fee is higher if you file claims on paper and you have to use their electronic filing company if you file electronically.

District Reports

District 2

This month District 2 representing chiropractic physicians in the nine Missouri counties of Benton, Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, and Ray reports on:   December seminar, February seminar, and Legislative Day.

We would like to thank the doctors that attended the December 2006, seminar.  It is your support that makes us a stronger organization.  The MSCA District 2 Christmas Banquet and Dance was held on Thursday, December 14, 2006, at the Holiday Inn Northeast (same location as the seminar).  The dinner was excellent.  Music was provided by Dr. Chuck Eddy and his band.  A hypnotist provided after dinner entertainment, which was enjoyed by all.  We hope more of our colleagues will plan to attend next year’s banquet.

Final preparation continues for the “2007 District 2 36-Hour Continuing Education Seminar” to be held on February 15, 16, 17, and 18.  Please update your calendar with these 2007 dates.  The location will be at the Holiday Inn Northeast (I-435 and Parvin Road Exit) in Kansas City.  Doctors will be able to acquire all 24 hours, if desired.  A mailing will be sent out soon to announce the specific dates and times for our classes and speakers.  If you need an enrollment form, or wish to be added to the mailing list, please contact Dr. Russell Mathias at 816-228-5113.

Legislative Day at Jefferson City is scheduled for Tuesday, March 6, 2007.  Dr. Linda Buckmiller is coordinating a bus that will transport doctors from the Kansas City vicinity to Jefferson City and will return in time for doctors to schedule late afternoon patients (approximately from 5:00 p.m. on).  Doctors in the District 2 region are encouraged to attend.  This is an opportunity where you can help legislators understand important legislative goals that protect your profession.  If you don’t do it, who will?  Legislators tell us the number of attendees makes a difference – so please spend one day to help us protect your profession.  If you wish to participate, please contact Dr. Russell Mathias at 816-228-5113 to reserve your seat on the bus.

The next District 2 Board meeting will be on Thursday, March 1, 2007.

District 4

District 4, in assocation with River City Imaging, isa 12-hour seminar in Cape Girardeau, Missouri, on April 28, 2007.

We, once again, are having a wonderful line up of speakers, which include Dr. Gentempo, Dr. Yochum, and Dr. Tribuno.12-hours of continuing education credits have been applied for.

Ask anyone that attended last year if they enjoyed it.Mark your calendar to attend, you will have
difficulty finding higher quality speakers in Missouri, especially for12-hour seminar.Hotel rooms have been reserved at the Drury Lodge in Cape Girardeau.Rates are $66 for singles, $76 for
doubles.Reservations can be made by calling 1-800-325-0720, under Missouri State Chiropractors Association.

If you have any questions,to register for the seminar, call Dr. Smothers at 573-996-2911.

We look forward to seeing you there!!!

Front Desk Organization & Patient Retention

by Susan Hoy

The front desk is an extremely busy place.  The key to de-stressing this position is systemization, organization, and simplification.  When you have a very busy practice, seconds count!  The emphasis should be on efficiency.  I have always believed the front desk CA should stand, not sit.  That way you’re always ready for action and action is what you will get.

FRONT DESK ORGANIZATIONAL TIPS
Have a notebook where phone messages are taken.  Every message should be logged in the notebook, before giving any messages to the team.  Place today's date at the top of the page and write the message down thoroughly.  The notebook should always be stored in the same place and saved in case any communication problems or discrepancies arise.  When disputes arise, you will have the notebook to look back on.  Once full, I write the dates the notebook contains on the cover and store the notebook away.  Additionally, have another notebook at your desk within easy reach.  Log today's date at the top of the page and whenever anyone asks you to do something you can=t complete immediately, write it down in your notebook.  This notebook is also great for writing down notes for yourself such as making copies of needed forms or supplies that need to be ordered, etc.  Always check off anything you've completed along with any note that may be appropriate.  Trust me, you may think you can remember, but as the day goes on you=ll be lucky to remember your own name.  Don't clutter your brain unnecessarily, write things down.

Have communication forms for communicating with team members.  This will save you a huge amount of time and frustration.  Instead of interrupting the team members during the course of the day, just write a note on the form and get it out of your head and onto paper.   Additionally, when a patient asks you for something specific, give them a communication form and ask them to write down their request.  This will eliminate any communications problems between patients and staff and it will save you time also.  All forms discussed can be found in the Chiropractic Team Training and Practice Management Manual.  Note cards should be kept within easy reach.  These note cards should be generic enough to be sent for any occasion and blank inside.  Any time there is a reason to send a card to a patient (engagement, new baby, wedding, sympathy, etc.), just pull out a card and write a simple sentence on it and send it out.  It should take less then a minute and cards always generate good feelings and good will!

All forms the front desk CA will need for daily patient care should be kept within easy reach.  Have storage bins for all forms needed. Your office supply store has bins for storing forms. These bins should contain items such as new patient telephone intake forms, records release forms, doctor=s excuse forms, communication forms, doctor referral forms, x-ray release forms, etc.  Each bin should be clearly marked for quick retrieval. Additionally, there should be storage bins for your front desk office forms that you need on a daily basis.  These should be kept apart from patient care forms.  These bins should contain forms such as Sign-in sheets, daily fee and revenue form, statistics forms, patient routing slips, new injury or patient update forms, new patient forms, work comp. forms, PI forms, etc.  Again, all bins should be labeled and an ample supply of these forms should be kept .  At the very bottom of the bin should be the original form to copy from.  Never make a copy of a copy!  It looks sloppy and unprofessional.  Put your original form in a sheet protector.

A phone list should be kept at the front desk for any numbers you will be giving out to patients or you need to call during the day, such as referring doctors, diagnostic referrals, hospital emergency numbers, x-ray facilities, etc.  In other words, any phone number that you must put your hands on when a patient is standing in front you should be easily accessible!

Here is a tip you will call and thank me for.  If you=re still working with a schedule “book,” certain periods of time should be very quick to locate.  For instance, when your doctor tells patients to come back in one week, two weeks, one month etc.  You should be able to immediately locate that date rather than trying to figure out what that date is and then trying to locate it in your book.  Have book marks labeled one week, two weeks, three weeks, four weeks, six weeks.  They can slide into your schedule book and “tab” the dates you are always looking for very quickly.  I have yet to find these in a supply catalog so I make my own.  Of course, they have to be moved up one page every day.

The preceding information has been excerpted from The Chiropractic Team Training and Practice Management Manual written by Susan Hoy and available at Back Talk Systems.  This manual contains over 200 pages of team training tips and practice management procedures and forms.  Why not join the hundreds of chiropractors who have already made the commitment to organize and systemize their office.  For more information contact Back Talk Systems at 800-937-3113 or log onto their website at www.backtalksystems.com.

PATIENT RETENTION BEGINS WITH A GOOD FOUNDATION

There is no magic bullet for retention.  Retention is a process that begins when you make your first contact with a potential new patient. Retaining a patient is a journey that never ends.

However, as with most things, good retention depends on how you set up a good foundation.  Your first two or three visits are crucial for creating that foundation.  New patient procedures must be practiced in order to create a good first impression.  Additionally, how you handle your Report of Findings will create the foundation of the patient’s care.  Getting a commitment from your patient is absolutely necessary for follow through.  Your staff can help you with retention but you must first get that commitment.  Once you get a commitment, part of the Report of Findings should be letting the patient know about your policies and what will be expected of them.  Of course, how you deliver these policies and your scripting is important.  You and your staff must be comfortable with scripting.  Whenever you present anything to your patient, it should always come from your desire to serve your patient but it should serve you as well!  Following are some suggestions of win/win scripting:

It is our goal to educate you on the benefits of chiropractic care.  Those benefits involve diet, nutrition, and exercise instruction along with spinal manipulation.  This office will never pressure you into care you do not want. We want to educate you so that you can make an informed judgment as to the level of care you desire from us.

The benefits of a series of adjustments are to teach your spine what its healthy position is, thereby strengthen the nerve flow in your body.  The adjustments must be tightly scheduled for best results, so we’ll start to develop an adjustment pattern.  We’ll stretch out the adjustments as improvement is noted.

Dr. ________ has suggested a series of appointments according to your condition. For optimum results, please follow this treatment plan as closely as possible.  If you find that you must cancel an appointment, we ask that you reschedule that appointment within the next day or so.

Because our office is busy, you are encouraged to make your appointments in advance.  That way you will get the times that will be most convenient for you and they will be easier to remember.  These appointments are not set in stone.  If you need to reschedule an appointment, Sandy at our front desk will be happy to work with you. 

We realize that your time is valuable and we will do our best to get you in to see the doctor as close to your appointment time as possible.  Service to our patients is our top priority.  We ask that you arrive promptly for your appointments so that we can serve all or our
patients as expediently as possible.

For your convenience we offer many payment options.  Most of our patients take advantage of our advance payment plans, which saves money and time.  I will be happy to explain them. Otherwise, payment for services is required at the time of visit unless otherwise arranged.  We don’t want finances to interfere with the care you need and we will be happy to work with you with regard to financial arrangements, if necessary.

Once your patients know your office policies and understand that they are established for their benefit, you have set up the foundation for retention.  Chiropractors who get a commitment from the patient and set up policies and responsibilities for care, will be creating a respectful relationship with the patient.  Additionally, the staff has a much better foundation to encourage
patient follow through.  Of course, there is much more to retention, but a solid beginning on those first few visits is a good start to your patient eventually choosing wellness care.

Susan Hoy has managed a busy chiropractic office since 1989.  Currently, Susan travels throughout the U.S. helping teams become more organized, systemized and energized.  Susan will be presenting team training events in the following areas:  Springfield MA, Chicago IL, Reading PA, Albany NY, Pittsburgh PA, Louisville KY, Des Moines IA, Virginia Beach VA.  For information contact Susan Hoy at 215-674-0130 or log on to her website at www.beefitup.net.

Newer, Stronger Health Warnings on Tylenol and Aspirin

by Dr. Mercola

According to the FDA, non-prescription pain relievers such as aspirin, ibuprofen and acetaminophen need stronger health warnings regarding risks of liver and stomach problems. 

This will affect brands such as Motrin, Advil, Aleve and Tylenol.

Some manufacturers already note the health risks on packages, but the FDA wants the warnings to be more prominent and more specific.

The FDA has suggested that products with acetaminophen should include warnings for liver toxicity, and over-the-counter NSAIDs should include warnings for stomach bleeding as a side effect in a variety of scenarios (patients over age 60 or those who have had ulcers).

About 100 people die in the U.S. each year after unintentionally overdosing on acetaminophen.

USA Today December 20, 2006
Yahoo News December 19, 2006

Dr. Mercola's Comment:

In a sequel of sorts to the fairly recent realization by conventional medicine that over-the-counter (OTC) painkillers can be very deadly to your health, the FDA has called for even stronger warnings.

Tylenol is actually the most common cause of liver failure not hepatitis C as many people might believe.

To some, like the consumer group Public Citizen, however, those heightened warnings were decades late in coming (the FDA had considered more stringent warnings for acetaminophen almost 30 years ago). And even now, you shouldn't expect any OTC drugs to carry newer labels for at least a year.

If you're concerned about the safety of an OTC drug you've been taking for a while or remain skeptical, I urge you to review the seven common misconceptions about the true safety of such medicines.

Over-the-counter drugs can have serious side effects and can even result in death if taken incorrectly. Some 56,000 people end up in the emergency room each year from misuse of acetaminophen alone. And as with prescription drugs, OTC drugs can interact with foods, other medications, and existing medical conditions and cause some major problems.

Consider safer, healthier options which have nothing to do with taking a drug. Don't risk your health on a drug sold behind the counter or in front of it.

If you currently take Tylenol or other types of acetaminophen regularly, it is important to understand that you can limit some of the damage by taking N-acetyl cysteine (NAC), which is the rate-limiting nutrient for the formation of the intracellular antioxidant glutathione.

Most experts believe Tylenol causes its damage by depleting glutathione. If you keep your glutathione levels up, the damage from the Tylenol may be largely preventable. Even conventional medicine recognizes this, as anyone who overdoses on Tylenol receives large doses of NAC in the emergency room.

Finally, please remember that acetaminophen only provides symptomatic relief and in no way, shape, or form treats the cause of the pain.

Tylenol has rarely, if ever, cured anything.

If you suffer from one of the conditions commonly treated with acetaminophen, such as headaches, joint pain and fevers, be aware that there are almost always reasons behind your symptoms.

The goal of your physician should be to help discover the causes behind the symptoms you suffer from. Then you can learn to rid yourself of these causes, once and for all, instead of using something that amounts to little more than a Band-Aid to simply cover things up.

On Vital Votes, an anonymous reader from Sanford, Maine tells the following horror story:

"Yeah, Tylenol is 'safe,' millions take it every day, and yet I won't let any of the stuff in my house.”

"Why?” You ask.

"I personally know three people who are dead from acute fulminant hepatitis from therapeutic doses of acetaminophen. All of them took it 'safely' on occasion for years and then - poof- they were dead within a couple of days.”

"Call it anecdotal prejudice...can't bring myself to trust the stuff." 

Painkillers Increase Risk of Miscarriage

Pregnant women who use non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin increase their risk of miscarriage by 80 percent. The risk was increased if the NSAID use took place around the time of conception or if the drugs were used for more than one week.

Researchers suggest that the drugs suppress the production of prostaglandins, which are fatty acids needed for successful implantation of an embryo into the womb. The drugs may therefore lead to abnormal implantation that increases the chance the embryo will miscarry.

British Medical Journal August 16, 2003

Dr. Mercola's Comment:

If you are a pregnant woman, or anyone for that matter, and you feel pain, that is a signal that something isn’t right in your body. Taking painkillers for the pain will mask the symptom but ignore the underlying cause of the pain.

Aside from the risk of miscarriage in pregnant women, NSAIDS may increase your blood pressure and your risk of heart and kidney failure.

Although this study didn't evaluate the influence of fish oil during pregnancy, it is one of the most important things a pregnant woman can take to have a healthy-term baby with high intelligence levels. The omega-3 radically reduces the risk of miscarriage as they form the basis for the prostaglandins that the NSAIDs interfere with.

Even Long-Term Use of OTC Painkillers Can be Deadly

The negative evidence continues to mount against taking painkiller drugs. In a study that raised questions about long-term use of over-the-counter (OTC) painkillers such as Advil, Motrin and Aleve, researchers came across an unexpected result: Although these drugs did cut the development of oral cancer by half, those positive results were superceded by an increased risk of dying from heart disease.

These findings only add fuel to the fire that heart risks extend beyond prescription medications like Bextra, Vioxx and Celebrex to the broader family of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) -- save acetaminophen or Tylenol, this includes brands of ibuprofen and nearly all other OTC pain pills.

Smokin' Discovery

The Food and Drug Administration has recently made the decision to warn against the long-term use of all painkiller drugs; this study involving smokers is the first evidence to support that warning. (Doctors wanted to find out whether NSAIDS could prevent oral cancer because previous work suggested they helped fend off other types of cancer.)

Surveying some 900 patients who were smokers and more prone to cancer and heart problems, researchers discovered that those who took OTC painkillers for a minimum of six months doubled their chances of dying from: stroke, heart attack, other heart-related problems.
The risk, however, was highest among ibuprofen users, who were nearly three times more likely to die of
cardiovascular disease than non-NSAID users.

Dr. Mercola's Comment:

There are a number of misconceptions floating around these days in regard to the use and safety of over-the-counter medications (OTCs). One of the more important ones is that OTCs are safer than their prescription-only counterparts.

OTCs are actually very capable of posing the same threat to your health that prescription medications do, and the results of this recent study certainly speaks
volumes in support of this notion.

With millions of people buying and using drugs like Advil, Motrin and Aleve everyday, who knows how many of the cardiovascular problems running rampant in our country could be prevented? What's even more concerning is that important results like these can still go "unnoticed" by the Food and Drug Administration (FDA).

With all the recent failures at the FDA, this study can also serve as a reminder that trusting their last word may be a risky proposition indeed.

It's important to remember that OTC medications are rarely needed to treat your aches and pains. Following the Total Health Program, and being especially sure to optimize your intake of omega-3 fats along with reducing omega-6 fats, can radically reduce your reliance on anti-inflammatory medications.

Also, while your body recovers its natural state of balance, where harmful inflammation is minimized, you can also get some symptomatic relief from a number of different natural remedies that not only treat inflammation, but protect your heart at the same time.

Painkillers Inhibit Bone Healing
 
Nonsteroidal anti-inflammatory painkillers known as NSAIDs continue to be prescribed for patients as part of their recovery for healing fractures even though using these medications have been found to diminish bone healing, formation and remodeling.

NSAIDs block cyclooxygenase (COX) enzymes that create prostaglandins, chemicals in the body that cause inflammation that can lead to problems with indigestion and cause ulcers. Several of the prostaglandins, created by COX-1 enzymes, are also important in forming new bones that promote healing.

As a result, researchers believe NSAIDs exert significant effects on the slowing of bone formation after injuries, the healing of fractures and the growth of bone around prostheses. In some cases, however, some NSAIDs have a positive effect on soft-tissue healing by stimulating collagen that can increase the strength in the early phases of skin and ligament healing, but results have been inconclusive.

Researchers recommended in cases of healing fractures and spinal fusions, NSAIDs should be avoided at all costs.

Journal of the American Academy of Orthopaedic Surgeons May-June 2004;12(3):139-43

Dr. Mercola's Comment:

Using drugs as temporary bandages to cure symptoms rather than the root cause of your problems does far more harm than good. That same logic applies here too.

If you want to heal properly from a bone injury or surgery, here’s more evidence you should avoid medications such as Celebrex and Vioxx. There are 10 billion other reasons not to take pain relievers, as in all the dollars pharmaceutical companies steal from your pockets annually!

Truth is, by merely changing the ratio of omega-3 to omega-6 fats--essential to human health--you already have a natural alternative to taking drugs at your fingertips.

Giving you the tools to take personal control of your own health is the best and most important reason I started this Web site. I encourage you to take the next step in your journey to better total health by subscribing to my twice-weekly newsletter sent free to Mercola.com subscribers.

MSCA Auxiliary Report

Greetings from MSCA Auxiliary

The theme for this year's convention is "Pirates."officers are busy working on our. Kathleen has secured Kathy Mills-Chang to be our speaker for CA Day.If you have any suggestions for topics you would like to hear, please advise by April 20. We look forward to your input. You can e-mail Kathleen at the state office.Thanks and have a great day.

ACA Report

by Jack Kessinger, DC DABCI Missouri Delegate

The ACA National Chiropractic Legislative Conference (NCLC) is scheduled for March 23-24, 2007.  Much as the Missouri State Chiropractors Association’s (MSCA) Legislative Day (being held Tuesday, March 6 this year) is important for educating our local lawmakers about chiropractic, the annual NCLC is an equally essential on the national level.  In other words, the more doctors, and student doctors, seen by and/or visiting their politicians, the greater impact our message will have, and the closer they will listen.  Can you just imagine the positive impact for our profession this could make if all 1,800 chiropractic doctors licensed in Missouri would simply take one day to attend the Tuesday, March 6 Legislative Day at the Capital in Jefferson City?

The ACA’s thirty-third NCLC annual conference will feature in-depth discussion and up-to-the-minute analysis on legislative issues affecting doctors of chiropractic and their patients at the national level.  Some of today’s top policy makers, and chiropractic supporters, will attend the NCLC, providing inside information on how our profession can improve its niche in the health care community.  Some of the attendees will include Senators Chuck Grassely, former Senator Tom Daschle (who was instrumental in passing the “Dietary Supplement Health and Education act 1994), former HHS Secretary Tommy Thompson.  Senator Barack Obama, Senator Tom Harkin, and House Ways and Means Chair Charles Rangle are also expected to attend.  Following the presentation of the ACA Legislative Committee, the doctors and students will “Visit the Hill” to meet their legislators.  Fortunately, the presence of many students, representing most chiropractic colleges, help make NCLC the success it has enjoyed over the years, and help make the ACA one of the most powerful special interest associations in Washington.

Congress Passes Legislation Reversing Select Medicare Payment Cuts

Congress, in one of the final acts of the session, passed legislation that halts a five percent cut in Medicare physician fees.  The reduction was scheduled to go into effect on January 1, 2007, in addition to the eight percent cut doctors of chiropractic that will occur in February, 2007.

Supplement Legislation Will Not Restrict Patient Access to Supplements: 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed by President Clinton.  Congress’s intent in enacting the DSHEA was to meet concerns of consumers and manufactures to help ensure that safe and appropriately labeled products remain available to those who want them.  DSHEA grants the FDA authority to establish Good Manufacturing Practices (GMP) regulations governing the preparation, packing, and holding dietary supplements under conditions that ensure their safety.  For the past couple of years, there has been concern that Congress may consider new legislation that would trump DSHEA and put consumer access to dietary supplements at risk.  Earlier last year, Senator Orin Hatch (R-Utah) and Representative Chris Cannon (R-Utah) introduced the Dietary Supplement and Nonprescription Drug Consumer Protection Act (S.346/ H.R. 6168).  The legislation passed without objection.  Senator Hatch has assured the ACA staff that this legislation will not restrict public access to supplements.  In a nutshell, this bill requires makers of dietary supplements to report any serious reactions to the FDA.  As of December 9, the bill was headed to the White house for the President to sign.

Probiotics

by DK Weamer

To many Americans, “beneficial bacteria” is a contradiction in terms with all bacteria to be likely inferred unsafe.  In Japan or Europe it’s another story, they have been experiencing the benefits of probiotic supplementation for years – centuries in some instances.  But the US is catching up.

Recent data indicates around two million adults in the United States are currently taking a probiotic supplement, and demand is on the rise.  Probiotics are showing up on the shelves of mainstream grocery stores in brands of yogurt, and other dairy products, and are even found in supplement form along side more well know digestive aids.  But what exactly are probiotics, and what is the benefit of probiotic supplementation?

Probiotics are a valuable part of any good health regime. A healthy digestive tract should contain hundreds of different species of beneficial probiotic organisms. In fact, it is estimated that there are more beneficial microbes associated with human health than there are cells in the human body.¹

These beneficial colonies of microorganisms contribute to human health in a number of ways. They aid in the breakdown of difficult to digest foods such as lactose,² fiber and proteins.2, 3  In addition to assisting in the synthesis of vitamins and improving the absorption of essential nutrients; they stimulate immune function, help to break down possible carcinogenic and mutagenic compounds, and prevent pathogenic bacterial overgrowth and the toxins they produce.

Drugs, antibiotics, poor eating habits and illness can upset the balance, destroying many of these “beneficial bacteria,” allowing pathogenic microbes to flourish, which in turn leads to disorders such as constipation, diarrhea, yeast overgrowth, food intolerances, and many other health complications.  Taking a probiotic supplement can help restore and maintain balance by providing billions of viable organisms and re-establishing balance.

While admittedly, the journey of a probiotic is a treacherous one, through stomach acid and bile salts, a 2001 study published in the American Journal of Clinical Nutrition states: Nevertheless, many probiotic strains can withstand the rigors of passage through the upper gastrointestinal tract and enter the colon in a viable state in sufficient amounts to affect its microecology and its metabolism.4  To further ensure the success of a probiotic supplement, it can be taken on an empty stomach when the pH of the stomach is less acidic – preferably one hour before and two hours after eating.

The following are five strains of organisms found in high quality probiotic supplements:

Lactobacillus acidophilus
Acidophilus balances colon pH, and helps create a positive environment in favor of beneficial microflora. It also inhibits the growth of invasive pathogenic
bacteria including H. pylori, and promotes potent anti-carcinogenic and anti-tumor effects.5

Lactobacillus rhamnosus
Rhamnosus is suggested to be one of the most important probiotic species, providing significant benefit for both infants and the elderly.  It is primarily found in the small intestine and vaginal tract.  It colonizes, acidifies and protects the environment of the small intestine, and is useful in inhibiting bacteria involved in vaginal and urinary tract infections.6, 10   In the large intestine, this microorganism stimulates colonization of bifidobacteria.  Lactobacillus rhamnosus adheres to the intestinal mucosa and protects against harmful bacteria including E. Coli, Helicobacter pylori and Salmonella.6  In addition, it may down-regulate hypersensitivity reactions and intestinal inflammation in patients with atopic eczema and food allergies, and is associated with the prevention and alleviation of disorders such as lactose intolerance, diarrhea, inflammatory bowel disease, chronic pariodontial disease and arthritis.7, 8, 12, 13   Rhamnosus demonstrates immune enhancement especially for the elderly and may inhibit the formation of colon and liver cancer. 9, 14

Lactobacillus plantarum
Lactobacillus plantarum is used to improve the microbial safety of foods, and has the ability to secrete the antibiotic lactolin and synthesize L-lysine, an anti-viral.15, 17  Effective against both extra- and intra-cellular pathogens, it is capable of metabolizing semi-resistant membranes and fibers including yeasts, bacteria, wheat, oats and rye, and as a result reduces associated discomfort and malabsorption.   Plantarum also demonstrates a powerful inhibitory effect against Candida and has been found to reduce bacterial movement from the gut to internal organs - making it an effective weapon against disorders resulting from candidiasis and leaky gut syndrome.18  Plantarum also aids in the break down of bile acids and the lowering of cholesterol.16

Lactobacillus salivarius
Salivarius has been shown to be effective in a majority of chronic bowel conditions and in preventing flatulence. It strengthens the immune system.16  It inhibits and detoxifies intestinal putrefaction, and produces high levels of lactic acid - inhibiting pathogenic organisms including H. pylori and Salmonella.19

Bifidobacterium longum
Widely studied for its ability to stimulate the immune system, Bifidobacterium longum also reduces frequency of gastro-intestinal disorders such as nausea, diarrhea, etc., during antibiotic use. It helps to eliminate nitrates found in foods, protects against DNA damage and carcinogenesis - including mammary, liver, and especially colon tumors.20  It has also proven beneficial for individuals exposed to radiation and inhibits E.coli, Shigella and Salmonella.21, 22, 23 

Probiotic use is indicated to compliment the treatment of a plethora of conditions:  Chronic constipation and diarrhea, intestinal parasites, family history or predisposition for cancer- especially breast, liver or colo-rectal cancer, imbalances of intestinal pH and/or bacterial overgrowth, viral, vaginal or urinary tract infections, food allergies, lactose intolerance, skin disorders, chronic bowel issues, gastro-intestinal disorders, ulcers, arthritis, weakened immune response, illness requiring drug or antibiotic therapy, elevated cholesterol, or aging.

One would be hard pressed to find a supplement with more benefits, and backed by more research, than probiotics.  Health care professionals, and health conscious consumers, will be wise to keep informed of developments in this area of supplementation rapidly becoming more mainstream.

ABOUT THE AUTHOR

DK Weamer is the Director of Technical Services for Enzymes, Inc.  Ms. Weamer received a Master of Arts in Behavioral Psychology from the University of Kansas where she became interested I the impact of diet and nutrition on behavioral and leaning problems.  This inspired her to obtain a Master of Science degree in Clinical Nutrition from the University of Bridgeport.  For more information please call Enzymes, Inc. at 800.637.7893 and visit www.enzymesinc.com.

REFERENCES

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