IMA - Newsletter Issue 38 Page 2

In 1999, the U.S. Congress established NCCAM as one of the institutes and centers at the National Institutes of Health (“NIH”). At that time, NCCAM created its first 5-year strategic plan, outlining its vision and goals.

As NCCAM celebrates its fifth anniversary during 2004, they have started a strategic planning process for 2005-2009 and invite their stakeholders--members of the public, health care professionals, researchers, and others who have an interest in research in complementary and alternative medicine (“CAM”) to participate in this process. They welcome ideas for NCCAM's future investments in research, integration, training, and outreach and plan to release a final strategic plan in January 2005.

To receive e-mail updates on NCCAM's strategic planning process as well as other NCCAM news and announcements, please subscribe to NCCAM Update. Messages are sent approximately once each month and include timely information about important NCCAM activities and announcements.

Currently, the Congressional Justification 2005 is available on the NCCAM Web site at nccam.nih.gov/about/congressional. This document, prepared each year for the consideration of the U.S. Congress, outlines NCCAM’s plans and priorities for fiscal year 2005 (which begins October 1, 2004) and includes details of the proposed budget, a legislative history, and other items.

Vermont to be 9th Medical Marijuana State

In a statement issued in May, Vermont Governor James Douglas (R) said he would allow Vermont's medical marijuana bill, S. 76, to become law without his signature. Vermont now becomes the ninth state to allow qualified patients to grow, possess, and use marijuana for medical purposes without fear of arrest under state law, and the second state to do so via the state legislature rather than a ballot initiative. The medical marijuana bill's enactment culminates a three-year effort.

(This news story courtesy of the Collaborative for Healthcare Renewal Foundation Newsletter. To subscribe to the newsletter visit their website at www.thecollaboration.org )

Naturopathic physicians will soon be licensed as primary care providers in the nation's capital. Anthony Williams, mayor of Washington, D.C., has given final approval to a bill to license NDs, which was unanimously approved by the city council in April. The U.S. Congress must still review the new law, but licenses could be issued as soon as September 2004. This means that 13 states, the District of Columbia, the U.S. Virgin Islands, and Puerto Rico now have laws enabling NDs with four years of training at a naturopathic medical college to serve as providers of primary care.

This story adapted from a May 12, 2004 press release published on The American Chiropractic Association’s website www.amerchiro.org

The American Chiropractic Association (“ACA”) headquartered in Virginia, and other chiropractic plaintiffs in the federal antitrust lawsuit against Trigon Blue Cross Blue Shield will appeal a May 6 decision by the U. S. Court of Appeals for the Fourth Circuit to dismiss the case.

Initially, the ACA will petition for a rehearing and appeal to the full panel of judges in the Fourth Circuit. The ACA cites in its lawsuit that a conspiracy existed between Trigon and the medical specialty societies in Virginia to ensure that patients with musculoskeletal conditions were diverted to medical doctors instead of doctors of chiropractic. A key piece of evidence in ACA's case was the existence of a committee established by Trigon to review low-back guidelines published in 1994 by the federal government's Agency for Health Care Policy and Research (“AHCPR”) - guidelines favorable to chiropractic - and to recommend appropriate protocols for referring patients to chiropractic doctors.

The ACA reports that the committee was appointed from a pool of representatives recommended by medical specialty associations from throughout the state of Virginia. No doctors of chiropractic were appointed to the committee and no chiropractic associations in Virginia were given the opportunity to submit names of nominees to the committee. As a result, the committee published guidelines that did not mention the positive effects of spinal manipulation that had been a highlight of the AHCPR report. The committee instead diminished spinal manipulation's value, and in doing so, essentially invalidated a legitimate federal study, according to the ACA.

"To put it simply, Trigon and the medical societies re-juggled the priority of treatments in the AHCPR guidelines in favor of medical care - not competitive chiropractic care - making it highly unlikely that a medical doctor would refer to a chiropractor," explained ACA President Donald J. Krippendorf, DC.

The Court of Appeals found that the committee was an agent of Trigon - not a separate entity - and therefore no conspiracy existed. Instead, the court likened Trigon's actions to a hospital's credentialing "peer review" process - in which a group of medical physicians determines the qualifications of other medical doctors who are candidates for employment. "That is peer reviewing peer, and only medical doctors can do it," explained Dr. Krippendorf. "That is totally different from fraudulently issuing distorted guidelines with inappropriate care suggestions without any underlying research, and falsely claiming that they are the federal guidelines.

"We believe that it is inappropriate to compare a hospital's credentialing review process to the types of coverage, payment and referral policy making decisions that Trigon and the selected medical societies engaged in," Dr. Krippendorf continued. "A hospital is not an insurance company. “

Despite the setback, the chiropractic profession has already made significant progress in the insurance arena thanks to the Trigon litigation. Millions more Americans now have greater access to chiropractic care and hundreds of millions of additional dollars are being reimbursed for chiropractic care as a result of ACA's legal action. The National Blue Cross Blue Shield Association and the ACA have begun working cooperatively to improve chiropractic recognition and coverage in BCBS plans nationwide.

One tangible benefit that is a direct result of ACA's legal action is a new chiropractic benefit - worth an estimated $120 to $140 million per year - in the Federal Employee Health Benefits plan administered by Blue Cross Blue Shield.

Another favorable outcome of the Trigon case is the launching of the Blue CCHiP program (“Blues/Chiropractic Clinical Healthplan Program”), a liaison program that has allowed doctors of chiropractic to become integrated into local Blue Cross Blue Shield medical policymaking committees across the country.

Although some favorable outcomes have already materialized for the chiropractic profession, the ACA feels that this has not diminished its responsibilities to pursue the alleged antitrust violations and the civil racketeering counts in this case.

http://www.amerchiro.org/media/releases/051204.shtml

According to a new nationwide government survey,¹ 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM). CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. When prayer, specifically for health reasons, is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62 percent.

"These new findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, M.D., Director, National Center for Complementary and Alternative Medicine (“NCCAM”). "The data not only assists us in understanding who is using CAM, what is being used, and why, but also in studying relationships between CAM use and other health characteristics, such chronic health conditions, insurance coverage, and health behaviors."

The survey, administered to over 31,000 representative U.S. adults, was conducted as part of the Centers for Disease Control and Prevention's (“CDC”) 2002 National Health Interview Survey (“NHIS”). Developed by NCCAM and the CDC's National Center for Health Statistics (“NCHS”), the survey included questions on 27 types of CAM therapies commonly used in the United States. These included 10 types of provider-based therapies, such as acupuncture and chiropractic, and 17 other therapies that do not require a provider, such as natural products (herbs or botanical products), special diets, and megavitamin therapy.

Although there have been many surveys of CAM use to date, the various surveys included fewer choices of CAM therapies. In addition, they often surveyed smaller population samples primarily relying on telephone or mail surveys versus in-person interviews used for this survey. Thus, the results from the CAM portion of the NHIS provide the most comprehensive and reliable data to date describing CAM use by the U.S. adult population.

Overall, the survey revealed that CAM use was greater among a variety of population groups, including women; people with higher education; those who had been hospitalized within the past year; and former smokers, compared to current smokers or those who had never smoked. In addition, this was the first survey to yield substantial information on CAM use by minorities. For example, it found that African American adults were more likely than white or Asian adults to use CAM when megavitamin therapy and prayer were included in the definition of CAM.

"We're continuously expanding the health information we collect in this country, including information on the actions people take in dealing with their own health situations," said NCHS Director Edward J. Sondik, Ph.D. "Over the years we've concentrated on traditional medical treatment, but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands."

CAM approaches were most often used to treat back pain or problems, colds, neck pain or problems, joint pain or stiffness, and anxiety or depression. However, only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner. According to the survey, the 10 most commonly used CAM therapies and the approximate percent of U.S. adults using each therapy were:

Prayer for own health, 43 percent
Prayer by others for the respondent's health, 24 percent
Natural products (such as herbs, other botanicals, and enzymes), 19 percent
Deep breathing exercises, 12 percent
Participation in prayer group for own health, 10 percent
Meditation, 8 percent
Chiropractic care, 8 percent
Yoga, 5 percent
Massage, 5 percent
Diet-based therapies (such as Atkins, Pritikin, Ornish, and Zone diets), 4 percent.

In addition to gathering data on the use of CAM practices, the survey also sought information about why people use CAM. Key findings indicate that:

55 percent of adults said they were most likely to use CAM because they believed that it would help them when combined with conventional medical treatments;
50 percent thought CAM would be interesting to try;
26 percent used CAM because a conventional medical professional suggested they try it; and
13 percent used CAM because they felt that conventional medicine was too expensive.

Interestingly, the survey also found that about 28 percent of adults used CAM because they believed conventional medical treatments would not help them with their health problem; this is in contrast to previous findings that CAM users are not, in general, dissatisfied with conventional medicine.

The results of the survey reveal new patterns of CAM use among various population groups and provide a rich source of data for future research. Furthermore, the survey results provide a baseline for future surveys, as it establishes a consistent definition of CAM that can be used to track trends and prevalence of CAM use.

¹ Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

National Center for Complementary and Alternative Medicine (“NCCAM”) Welcomes Input to its 2005 Strategic Planning Process

For more information, visit http://nccam.nih.gov

Vermont to be 9th Medical Marijuana State