White House Passes Health Care Safety Net Act
In November 2002, President George W. Bush signed into law legislation that allows chiropractors to participate in a federally funded student loan reimbursement program.    

Passed by the House of Representatives on October 16, 2002, the Health Care Safety Net Improvement Act (S 1553/HR 3450) aids uninsured and underserved people across the country. It also allows doctors of chiropractic to participate in the National Health Service Corps’ (NHSC) reimbursement program for a 3-year pilot trial. The NHSC grants certain health care professionals who deliver primary care services in medically underserved geographic areas, reimbursement for student loans.

The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) has pushed the legislation for 2 years. Sen Tom Harkin (D, Iowa) and representatives Billy Tauzin (R, La) and Michael Bilirakas (R, Fla) are among those that backed the bill. The ACA is hailing the inclusion of the chiropractic provision in the bill as a significant victory for chiropractic students and the profession as a whole.

“This sends a strong signal that chiropractic care should be considered an essential element in the delivery of health care in this nation,” ACA Chairman James Dewards, DC, said.

After the pilot program, Congress will review the results of the test and consider making the chiropractic profession a permanent fixture in the program. CP

Auto Safety Group, Spine Institute Meet in San Diego
On August 9–11, 2002, the Center for Research into Automotive Safety and Health (CRASH), in conjunction with Spine Research Institute of San Diego (SRISD), conducted its fourth annual full-scale, human volunteer crash test workshop and training program at the institute’s crash test facility. The event was attended by nearly 100 of the top experts in whiplash traumatology from across the United States.

“Doctors of chiropractic have a stake in whiplash traumatology. Being active in both crash testing research and specialized training places the profession, strategically, in the vanguard,” said Arthur C. Croft, DC, founder and president of CRASH and director of SRISD.

The thrust of the program was to continue the previous year’s validation process of the auto crash reconstruction and occupant kinematic assessment method (the momentum, energy, and restitution method). The method requires measurement of bumper isolator stroking after impact as an estimate of absorbed energy. This energy is then converted mathematically into speed change and, ultimately, into an occupant head linear acceleration value.

Another purpose of this year’s crash series was to compare the occupant kinematics and forces between human volunteers and a RID 2 Anthropomorphic Test Dummy. The RID 2 was provided by First Technology Safety Systems of Plymouth, Mich.

CRASH is a nonprofit organization dedicated to learning more about injury mechanisms related to motor vehicle crashes through scientific research. The organization focuses on public health and public interest.

“In order for this profession to support its long-time claims in terms of knowledge and treatment efficacy as it regards to whiplash, it has to step up to the plate with a commitment for scientific research in both areas,” Croft said. “CRASH deals initially with the first. The organization will also deal in the future with the second issue.” CP

New CP Columnist, EAB Member Chiropractic Products welcomes Jeffrey D. Olsen, DC, as the magazine’s new Practice Sense columnist and Editorial Advisory Board (EAB) member. Graduating magna cum laude from Brigham Young University, Provo, Utah, in August 1993 with a degree in French, Olsen went on to earn his doctor of chiropractic degree from Palmer College of Chiropractic, Davenport, Iowa, in 1996. Currently, he is a partner at Olsen Clinic of Chiropractic, PLC, in Roanoke, Va, and a technical adviser for the customer service department at Foot Levelers Inc, Roanoke, Va. He is certified by the National Board of Chiropractic Examiners and is also physiotherapy certified. As a board member, Olsen will contribute articles, technical expertise and advice, and editorial direction to the magazine. In his columnist position, he hopes to impart knowledge gained from attending 18 continuing education seminars in the United States and Canada in 2002. “While the glamour of air travel has diminished, the exciting changes and events occurring throughout the profession are invigorating. I will draw on these experiences and from leaders throughout the chiropractic profession to offer suggestions for the most important work you can do on your practice when you’re not working in it,” Olsen said. “Like most practice consultants, I hope to make you more successful by simply reminding you to do what you probably already know! I assure you that together we will think new thoughts, implement successful business procedures, and enjoy practicing more.” CP

Hormone Therapy May Inflate Heart Attack, Cancer Risk
Two recent studies found that women face potential health hazards from taking hormone replacement therapy (HRT) for postmenopausal symptoms.

The first study, sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, found that postmenopausal women with heart disease who took hormone therapy and high-dose antioxidant vitamins—either alone or in combination with hormones—did not have fewer heart attacks, deaths, or progression of coronary disease. In fact, both treatments showed a potential for harm. Although the actual number of deaths in the Women’s Angiographic Vitamin and Estrogen (WAVE) study was small, participants taking both active hormones and vitamins had the highest death rate, while participants on placebo versions of both treatments had the lowest death rate.

Furthermore, participants taking hormones and vitamins had either more or equal progression of their coronary disease compared to participants taking placebo versions of these treatments.

WAVE researchers studied 423 postmenopausal women at seven clinical centers in the United States and Canada and used angiography to assess the effects of hormone replacement therapy. The vitamin doses in the WAVE study were much higher than what is used in standard multivitamin preparations.

“Although some other studies with lower doses of vitamins have suggested that antioxidant vitamin supplements might not be helpful, the trend toward more deaths found in WAVE was unexpected,” said David Waters, MD, WAVE principal investigator, chief of cardiology at San Francisco General Hospital, and professor of medicine at the University of California, San Francisco. “The good news is that there are proven therapies to treat and prevent coronary heart disease.”

In the active hormone group, 26 patients died, had a nonfatal heart attack, or suffered a stroke compared to 15 in the hormone placebo group. In the active vitamin group, 16 patients died from all causes compared to six in the vitamin placebo group. In the active vitamin group, 20 patients experienced either death or a nonfatal heart attack compared to 10 in the placebo group. There were few cases of breast cancer or other cancers—-and no differences in the occurrence of cancer between the groups.

The results of the trial were published in the November 20 issue of the Journal of the American Medical Association and presented November 20 at the American Heart Association’s annual meeting in Chicago.

The second study, published in the December 15 print issue of CANCER, found evidence that progestin included in HRT is linked to breast cancer. Led by Janet Daling, PhD, of the Fred Hutch-inson Cancer Research Center in Seattle, the researchers for the Women’s Contraceptive and Reproductive Experi-ences Study assessed the relationship between types of postmenopausal hormone therapy and histological types of breast cancer. They concluded that postmeno-pausal women taking a combined formula of hormone replacement therapy, called combined estrogen and progestin hormone replacement therapy (CHRT) are at an increased risk for lobular breast cancer. Data was collected on 4,575 postmenopausal women aged 35 to 64 years diagnosed with the first incidence of breast cancer and 4,682 postmenopausal women with no history of breast cancer.

In women who used CHRT for 5 years or more, those who used the continuous formula that includes progestin daily dosing for more than 25 days per month were at greater risk than those who used the sequential formula with fewer than 25 days per month of progestin daily dosing. There was no association of any type of breast cancer with women who use or used estrogen-only hormone replacement therapy. The estrogen-only therapy was not associated with an increased risk of breast cancer of any type, regardless of the duration of use.

“Our study, in agreement with three others, indicates the adverse effect of HRT may be confined to risk of lobular or mixed lobular breast cancer, histologies that are less common, more likely to be ER positive, and to have more favorable prognosis than ductal carcinoma,” the authors concluded. The authors recommend further investigation in older women who have used CHRT over the long term “since the use of continuous progestin therapy is relatively recent.” CP