As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future. Throughout 2008, we will feature a review of the top headlines in chiropractic for a given year, along with an article on the future of chiropractic authored by an influential member of the profession.
January 2002: ACA Endorses Chiropractic Postage Stamp Project
The American Chiropractic Association (ACA) has officially endorsed the "Chiropractic Postage Stamp Project," sending a letter to the Citizens' Stamp Advisory Committee urging that a chiropractic postage stamp be approved.
"There have been U.S. postage stamps honoring medicine, pharmacy, dentistry, nursing and even public hospitals," noted ACA chairman James Edwards, DC, who heads the ACA efforts on this project. "It is way past time for chiropractic to be honored in the same manner, and the ACA looks forward to working with the World Chiropractic Alliance, the International Chiropractors Association and the Congress of Chiropractic State Associations on the project."
Each year the U.S. Postal Service receives approximately 40,000 proposals recommending subjects for stamps. The 15-member Citizens' Stamp Advisory Committee, which meets four times a year in Washington, D.C., evaluates the suggestions. To be successful, a stamp proposal needs to be backed by thousands of letters over an extended period of time. The committee makes its recommendations to the Postmaster General, who relies heavily on the committee's recommendations. It usually takes about three years for a stamp to be approved.
January 2002: Chiropractic VA Bill Sent to President for Signature
On December 20, 2001, the day before the 107th Congress adjourned for a month hiatus, the U.S. Senate passed with unanimous consent and without amendment H.R.3447, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. The bill provides a program to recruit and retain qualified nurses within the Department of Veterans Affairs, and to "enhance certain health care programs," i.e., chiropractic (Sec. 204: Program for Provision of Chiropractic Care and Services to Veterans). The bill was recently sent to the president and it's expected that he will sign it.
The chiropractic section of H.R.3447 is a compromise of the more sweeping bill the House passed. "The enactment of this historic legislation represents an enormous victory for America's veterans, who will now have access to the chiropractic care they have been denied for far too long," enthused ACA President Daryl Wills, DC.
"Historic" is accurate, as the first bill introduced to Congress to provide chiropractic services for veterans was, according to the International Chiropractors Association, drafted by ICA's founder and first president, B.J. Palmer in 1936. Congress has mandated chiropractic within the VA health care system over the opposition of the Department of Veterans Affairs, and by various provider groups, including the American Physical Therapy Association (APTA).
Joining the ACA in support of the legislation were the Association of Chiropractic Colleges, the International Chiropractors Association and the World Chiropractic Alliance. The associations expressed their appreciation to all state chiropractic associations, individual doctors and other chiropractic organizations that worked with them to help pass this landmark legislation, and to the players in Washington: Senate Majority Leader Tom Daschle (D-S.D.) was cited by the chiropractic organizations for personally fighting for the passage of this legislation. The bill was championed by House Veterans Committee Chairman Christopher Smith (R-N.J.) - the sponsor of the bill - along with Representatives Jerry Moran (R-Kan.); Lane Evans (D-Ill.); Bob Filner (D-Calif.); Senator Strom Thurmond (R-S.C.); and Senator Tim Hutchinson (R-Ark.). Governor Bob Wise of West Virginia was also instrumental in lobbying for support for the legislation.
February 2002: Chiropractic Celebrates - Bush Signs VA Bill
President Bush finally put pen to paper on the night of Jan. 23, to pass H.R.3447, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001, a bill that includes a mandate to establish a permanent chiropractic benefit within the Department of Veterans Affairs (DVA) health care system.
The American Chiropractic Association (ACA) hailed the passage of the bill (now designated as Public Law 107-135) as "an enormous triumph for the profession, but also proof of the powerful role chiropractic plays on Capitol Hill and in the nation's health care system."
The law authorizes hiring doctors of chiropractic in the DVA health system, sets a broad scope of chiropractic practice, and allows the chiropractic profession to oversee the development and implementation of the new benefit through an advisory committee composed, in part, of chiropractors.
Key provisions of the new law include:
- Immediate phase-in of the program.
- Designation of at least one DVA medical center in each geographic service area of the Veterans Health Administration to provide chiropractic services. The designated sites will be medical centers and clinics located in urban and rural areas.
- Scope of chiropractic services that "shall include a variety of chiropractic care and services for neuromusculoskeletal conditions including subluxation complex."
- Dissemination of educational materials on chiropractic to primary care teams "for the purpose of familiarizing such providers with the benefits of chiropractic care and services."
- Establishment of a chiropractic advisory committee that will advise the Secretary on protocols governing referral to doctors of chiropractic, direct access to chiropractic care, scope of chiropractic and other issues.
June 2002: 20% of New Drugs Will Be Labeled Dangerous or Withdrawn From Market, Study Reports
A study just released in the May 1, 2002 issue of JAMA revealed that the dangers of newly FDA-approved drugs are much higher than initially realized, prior to going to market. According to the authors: "Premarketing drug trials are often underpowered to detect ADRs (adverse drug reactions), and have limited follow-up. In some cases, drugs are approved despite identification of serious ADRs in premarketing trials."
The study involved the review of 548 new "chemical entities" that were approved by the FDA between 1975 and 1999. A surprising 8.2 percent (45 drugs) of these received one or more "black box warnings" in the Physicians' Desk Reference (PDR), with 2.9 percent (16 drugs) being withdrawn from the consumer market altogether for safety reasons.
Using Kaplan-Myers analyses, this means: "the estimated probability of (a new drug) acquiring a new black box warning or being withdrawn from the market over 25 years was 20 percent." This chilling fact is important for consumers to understand when accepting prescriptions for newly approved drugs. The authors noted: "Nearly 20 million patients in the United States took at least one of the five drugs withdrawn from the market between September 1997 and September 1998. Three of these five drugs were new, having been on the market for less than two years."
"Only half of newly discovered serious ADRs are detected and documented in the Physicians' Desk Reference within seven years after drug approval," the researchers found. Furthermore, only half of the withdrawals of unsafe drugs take place in the first two years. The authors specify that their definition of a serious ADR was "conservative, since it was limited to Physicians' Desk Reference black box warnings. We did not consider other labeling changes such as bolded warnings without boxes, 'Dear Health Care Professional' letters, or case reports in the medical literature."
Doctors read black-box warnings. Patients, however, rely on their doctors to assess and inform them of possible adverse reactions of certain prescription drugs. Some patients may even take the time to read some of the accompanying literature that comes with their prescriptions, assuming they can read the fine print. And then there are the pharmaceutical ads on TV that have the voice-over spitting out at machine-gun speed at the end of the commercial the potential reactions of taking certain drugs (which sound oddly like the commercial spoofs on "Saturday Night Live").
Taking the findings of this study to heart, perhaps patients should also be warned against taking any prescription for a drug released within the last seven years, particularly those released in the last two years. The study concludes with this warning: "Serious ADRs commonly emerge after Food and Drug Administration approval. The safety of new agents cannot be known with certainty until a drug has been on the market for many years."
November 2002: Congress Includes DCs in National Health Services Corps' Student Loan Repayment Program
The U.S. Congress passed the Health Care Safety Net Improvement Act (H.R.3450) on October 17, 2002 (passed by the Senate as S.1533). Sec. 301 of the bill deals with amendments to the National Health Service Corps (NHSC), a federally-funded program in existence since 1970, dedicated to serving the health needs of underserved areas of the U.S.
In 1972, Congress passed amendments to the Emergency Health Personnel Act that authorized scholarships for NHSC health professionals in return for service to underserved communities. In 1987, Congress authorized the NHSC Loan Repayment Program, which afforded primary health care professionals reimbursement for student loans in return for establishing and maintaining their practices in geographic areas, both rural and urban, designated by the government as medically underserved.
Sec. 338L of the bill establishes "a demonstration project to provide for the participation of individuals who are chiropractic doctors or pharmacists in the Loan Repayment Program." The inclusion of chiropractic in the program is a policy change that stems from nearly two years of lobbying efforts by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC).
President Bush is expected to sign the bill. Once signed into law, the legislation will allow doctors of chiropractic to take part in a three-year pilot program, or test period. At that point, the bill stipulates: "The Secretary shall prepare and submit a report describing ... how the participation of chiropractic doctors and pharmacists in the Loan Repayment Program might affect the designation of health professional shortage areas; and the feasibility of adding chiropractic doctors and pharmacists as permanent members of the National Health Service Corps."
The amendments to the Health Care Safety Net bill are part of a long-planned overhaul of federal legislation governing the Public Health Service Act, which includes the NHSC program. Having the chiropractic profession eligible to participate in the NHSC has long been a goal of the ACA and the ACC. Both organizations have worked hard toward that inclusion, but were opposed by other health care provider groups also seeking to be included in the program. ACA and ACC worked with key legislators, Senator Tom Harkin (D-Iowa), and Representatives Billy Tauzin (R-La.) and Michael Bilirakas (R-Fla.).
The NHSC reports that more than 22,000 NHSC clinicians have dedicated all or part of their careers to providing primary health care in underserved areas. The NHSC currently has 2,300 clinicians providing health care to approximately 3.6 million people.
November 2002: Largest Private U.S. Employer Axes Chiropractic
Wal-Mart won't cover chiropractic services after Dec. 31, 2002. The announcement came in the employee newsletter - a terse one-sentence entry below pharmacy co-pays, and ambulance and emergency room charges: "CHIROPRACTIC COVERAGE: Chiropractic services are no longer covered."
Without further explanation, Wal-Mart, the largest private employer in the world, which brags about its biggest single-day sales in history ($1.25 billion on the day after Thanksgiving 2001), had just "informed" its employees ("associates," the company calls them) that it would not help pay for their chiropractic care. Why? Betty Strout of Wal-Mart's benefits customer relations department responded: "Just as many other companies, Wal-Mart's group health benefit plan is experiencing unprecedented cost growth that is forcing us to make some tough choices. ... We regret that we had to make this decision, but the associates' medical plan is designed primarily to protect our associates from the significant financial costs that could result from catastrophic medical events."
The health benefit section on Wal-Mart's Web site notes that "60% of our associates tell us they joined Wal-Mart because of our benefits." The decision to eliminate chiropractic coverage, or indications that Wal-Mart was leaning that way, was leaked some time back. ACA President Daryl Wills, DC, said the association began contacting Wal-Mart a year ago. In a letter to Wal-Mart CEO H. Lee Scott, Dr. Wills called the decision "discriminatory," and one that "creates harm to employees and the public Wal-Mart insures." Dr. Wills asked Mr. Scott to explain Wal-Mart's rationale and urged Wal-Mart officials to participate in a meeting with ACA representatives. The ACA noted that it would educate DCs and their patients on "their rights to appeal denied claims under the new ERISA regulations."
Bill Wertz of Wal-Mart corporate communications told DC the benefits department was responsible for the decision and that it was considered a liability for associates to have to pay additional funds to maintain chiropractic care. Mr. Wertz added: "We have answered to the extent we can the questions you have raised about this decision. I'm sorry that we could not respond in as much detail as you would have liked. Feel free to call me, but I will not be able to go beyond the answers I have already given you."