Association of Health Care Journalists' reporting fellowship application deadline is Nov. 9

The Association of Health Care Journalists is offering fellowships for reporting on health care performance to journalists who wish to pursue a significant year-long reporting project related to the U.S. health care system. It can be local or national in scope -- or a little of both, according to materials included with the announcement, which suggests a topic could be "an aspect of the Patient Protection and Affordable Care Act playing out in your community or subject specialty, or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets."

Newsrooms for which the fellows work need to commit to publish or air their work. Freelancers will also need to have that commitment from a news source. Guidance is provided by AHCJ fellowship leaders through seminars on health care systems, conference calls and email consultations. The fellowship covers the cost of attending the seminars and conferences, and a project allowance is available. Application deadline: Nov. 9, 2012. (Read more)

Here are some examples of the work done by those awarded fellowships in 2012:

• The New Goliaths: The 2010 health law was designed to lower costs. Yet hospitals merging seems  to have upped the price of care.
  
• Nothing to Smile About: The number of dentists is shrinking. 
  
• In Praise of Price-Fixing:  Maryland may have found an answers to health care inflation. 
  

The Association of Health Care Journalists is offering fellowships for reporting on health care performance to journalists who wish to pursue a significant year-long reporting project related to the U.S. health care system. It can be local or national in scope -- or a little of both, according to materials included with the announcement, which suggests a topic could be "an aspect of the Patient Protection and Affordable Care Act playing out in your community or subject specialty, or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets."

Newsrooms for which the fellows work need to commit to publish or air their work. Freelancers will also need to have that commitment from a news source. Guidance is provided by AHCJ fellowship leaders through seminars on health care systems, conference calls and email consultations. The fellowship covers the cost of attending the seminars and conferences, and a project allowance is available. Application deadline: Nov. 9, 2012. (Read more)

Here are some examples of the work done by those awarded fellowships in 2012:

• The New Goliaths: The 2010 health law was designed to lower costs. Yet hospitals merging seems  to have upped the price of care.
  
• Nothing to Smile About: The number of dentists is shrinking. 
  
• In Praise of Price-Fixing:  Maryland may have found an answers to health care inflation. 
  

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CaldWELL County group campaigns for smoking ban

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.

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Understanding FIP virulence

Chang HW, Egberink HF, Halpin R, Spiro DJ and Rottier PJ. Spike protein fusion peptide and feline coronavirus virulence. Emerg Infect Dis. 2012; 18: 1089-95. [free, full text article]
 
Coronaviruses are enveloped RNA viruses known for their potential to change their cellular tropism. Tropism refers to the specificity of a virus for a particular host tissue, determined in part by the interaction of viral surface structures with receptors present on the surface of unique host cell (e.g., endothelial cells, macrophages). Whether tropism switching leads to cross-species transmission as happened with severe acute respiratory syndrome (SARS-CoV) jumping from bats to humans or, as in the case of feline coronaviruses, switching leads from a relatively low virulence enteric virus (FECV) to a systemic pathogenetic form (FIPV), it is clear that this family of viruses is an important public health concern and feline pathogen. In the case of FECV, identifying the genetic mutation(s) leading to this tropism switching still remains a quandary for researchers, veterinarians, and cat owners alike.

The researchers in this study compared full genome sequenced data from 11 viruses in each pathotype and identified the most distinctive site(s) by further refining sequence variation between the two pathotypes around those site(s). Two putative sites that both code for regions in the fusion peptide domain of the spike protein were found to distinguish FECV from FIPV, accounting for > 95% of cases. The S protein functions in cell entry via receptor attachment (involving the N terminus) and membrane fusion (membrane-proximal domain). These researchers further speculate that these two mutations in addition to other mutations likely within the accessory 3c gene account for switching to the virulent FIPV form. [GO]

See also: Pedersen NC, Liu H, Scarlett J, et al. Feline infectious peritonitis: Role of the feline coronavirus 3c gene in intestinal tropism and pathogenicity based upon isolates from resident and adopted shelter cats. Virus Research. 2012; 165: 17-28.

More on cat health:
Winn Feline Foundation Library
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Chang HW, Egberink HF, Halpin R, Spiro DJ and Rottier PJ. Spike protein fusion peptide and feline coronavirus virulence. Emerg Infect Dis. 2012; 18: 1089-95. [free, full text article]
 
Coronaviruses are enveloped RNA viruses known for their potential to change their cellular tropism. Tropism refers to the specificity of a virus for a particular host tissue, determined in part by the interaction of viral surface structures with receptors present on the surface of unique host cell (e.g., endothelial cells, macrophages). Whether tropism switching leads to cross-species transmission as happened with severe acute respiratory syndrome (SARS-CoV) jumping from bats to humans or, as in the case of feline coronaviruses, switching leads from a relatively low virulence enteric virus (FECV) to a systemic pathogenetic form (FIPV), it is clear that this family of viruses is an important public health concern and feline pathogen. In the case of FECV, identifying the genetic mutation(s) leading to this tropism switching still remains a quandary for researchers, veterinarians, and cat owners alike.

The researchers in this study compared full genome sequenced data from 11 viruses in each pathotype and identified the most distinctive site(s) by further refining sequence variation between the two pathotypes around those site(s). Two putative sites that both code for regions in the fusion peptide domain of the spike protein were found to distinguish FECV from FIPV, accounting for > 95% of cases. The S protein functions in cell entry via receptor attachment (involving the N terminus) and membrane fusion (membrane-proximal domain). These researchers further speculate that these two mutations in addition to other mutations likely within the accessory 3c gene account for switching to the virulent FIPV form. [GO]

See also: Pedersen NC, Liu H, Scarlett J, et al. Feline infectious peritonitis: Role of the feline coronavirus 3c gene in intestinal tropism and pathogenicity based upon isolates from resident and adopted shelter cats. Virus Research. 2012; 165: 17-28.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

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Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

Read More

Medicaid managed-care firm files suit, alleging the state's rush job resulted in unreliable financial information for bidders

Medicaid managed-care company Kentucky Spirit alleges in a lawsuit filed Monday that Gov. Steve Beshear so hurriedly privatized the service last year that he gave incorrect cost information to the bidders. The company said it relied on the bad information and thus has lost $120 million since its work began a year ago.

John Cheves of the Lexington Herald-Leader reports that Kentucky Spirit had hoped that it could let its contract terminate a year earlier than scheduled without paying the damages that Health and Family Services Secretary Audrey Haynes has now said the state will pursue. Cheves writes that Kentucky Spirit says they relied on a "data book" -- what managed-care companies used to estimate costs in their bids -- prepared by the accounting firm PricewaterhouseCoopers. (Read more)

Medicaid managed-care company Kentucky Spirit alleges in a lawsuit filed Monday that Gov. Steve Beshear so hurriedly privatized the service last year that he gave incorrect cost information to the bidders. The company said it relied on the bad information and thus has lost $120 million since its work began a year ago.

John Cheves of the Lexington Herald-Leader reports that Kentucky Spirit had hoped that it could let its contract terminate a year earlier than scheduled without paying the damages that Health and Family Services Secretary Audrey Haynes has now said the state will pursue. Cheves writes that Kentucky Spirit says they relied on a "data book" -- what managed-care companies used to estimate costs in their bids -- prepared by the accounting firm PricewaterhouseCoopers. (Read more)

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Chiropractic vs. Medical Management of Scoliosis: Let's Look at the Numbers

By Mark Studin, DC, FASBE(C), DAAPM, DAAMLP

For more than 100 years, chiropractors have been treating adolescents with idiopathic scoliosis. Both myself and my colleagues, current and former, have realized and reported within the profession remarkable and often dramatic positive results.

But only recently has the viability of chiropractic treatment for scoliosis been documented through research and reported in the indexed medical literature.

According to the Mayo Clinic, "Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe cases of scoliosis."¹

Three-dimensional lateral curvatures of the spine affect 2-3 percent of the adolescent population.²Utilizing 2000 U.S. Census Bureau statistics, the number of adolescents in the United States is 41,747,962. If 2.5 percent of all adolescents have scoliosis based on the 2-3 percent estimate, this equates to 1,043,699 (1.04 million) children facing issues as a result of scoliosis.³ Yet keep in mind that "only 10% of adolescents diagnosed with scoliosis have curve progression requiring medical intervention."⁴

Lou, et al., state: "Brace (orthotic) treatment is recommended for growing children with curves of 25-45 [degrees] Cobb angle. Surgery is the final treatment option for curves greater than 45° and its goals are to obtain safe correction, to produce a solid spinal fusion of the curve region, and to bring the spine and body into a more balanced position."²However, they conclude, "Although brace treatment for scoliosis has been used for more than fifty years, its effectiveness is still debatable. ... Most studies used the amount of curve progression (as measured by the Cobb angle) to determine the effectiveness of brace treatment. Some defined success as 5° or less curve progression."²

Bracing in adolescent males had unsuccessful results in 76 percent of the cases, with 46 percent requiring surgery for idiopathic scoliosis.² The overall surgical rate for failed bracing was 23 percent when used as a treatment for idiopathic scoliosis.⁶ "A retrospective review of 16,536 individual costs and charges, including overall reimbursements, for 125 consecutive patients who were managed surgically for the treatment of adolescent idiopathic scoliosis by three different surgeons between 2006 and 2007.... The mean age of the patients was 15.2 years." Costs ranged from $29,995 to $33,652, averaging $31,832.50 per case.⁷

The total number of hospital discharges in 2009 for idiopathic scoliosis for children under 18 years of age was 6,709. However, the estimated number of children undergoing spinal fusion was 38,000, with 85 percent being a result of idiopathic scoliosis. That means the total number of children being operated on is 32,300, with a national price tag of more than $1 billion ($1,028,189,750).

Scoliosis bracing is estimated to be used for 30,000 children. If we take the same statistic of 85 percent for idiopathic scoliosis, the approximate number of children braced for idiopathic scoliosis is 25,500. According to MG Labs, a prosthetic and orthotic lab in New York, the national average cost of a thoracolumbosacral orthosis is $2,100. That places the national cost for bracing at over $53 million ($53,550,000).

The estimated number of physician visits for scoliosis is 600,000.⁹ Again, if we take the 85 percent statistic for idiopathic scoliosis, the number of physician visits is 510,000. Omitting X-rays, MRIs and other required services for scoliosis, the average cost for a doctor's visit is conservatively $100, averaging both primary and specialist care. This would be for a range of E&M codes for initial visits including 99203-99204 and 99205. The national price tag is thus $51 million. (Note: For this review, we aren't considering the negative sequellae of radiation exposure for tracking the scoliosis as the adolescent matures.)

While allopathic medicine is still entrenched in the debatable practice of bracing and eventual surgery with the inevitable progression of scoliosis, there are proven solutions. A 2011 study concluded that as a result of chiropractic spinal adjusting and chiropractic spinal manipulation, a thoracolumbar curvature (scoliosis) averaged a 17.2° reduction that was maintained for 24 months, the length of the study. Across all spinal groups, an average 10° reduction persisted for 24 months, again the length of the study. It was also concluded that pain scales reduced by 60 percent at 24 months and function improved by 70 percent, while respiratory capacity increased by 7 percent.¹⁰

The real issue is that if adolescents have their curvatures reduced by between 10° and 17.2°, then a significant amount of bracing and surgery will no longer be an option because it will not be indicated. As bracing has been deemed questionable in the literature and now the literature reflects chiropractic as a highly effective modality, the standard of care across professions should be chiropractic care for scoliosis as the first-line treatment option and should be standardized in every discipline.

Considering the overall national cost of idiopathic scoliosis of $1,132,739,750 ($1.13 billion), excluding imaging studies and the research results on chiropractic care, the conclusion is that as a society our money can be better spent while simultaneously helping our children. The question remains, "Will politics and prejudice or facts rule the day?"

References

1. Scoliosis: Definition. The Mayo Clinic, 2009.
2. Lou E, Hill D, Hedden D, Mahood J, Moreau M, Raso J. An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis. Medical Engineering and Physics, 2010;33(3):290-294.
3. ACT for Youth Center of Excellence. U.S. Teen Demographics, 2011.
4. Lenssinck M, Frijlink AC, Berger MY, Bierma-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Physical Therapy,2005;85(12):1329-1339.
5. Karol LA. Effectiveness of bracing in male patients with idiopathic scoliosis. Spine, 2001;26(18):2001-2005.
6. Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine, 2007;32(19S):S91-S100.
7. Kamerlink JR, Quirno M, Auerbach JC, Milby AH, Windsor L, Dean L, Lonner BS. Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. The Journal of Bone and Joint Surgery, 2010;92 (5:1097-1104.
8. U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality. 2009 Hospital Stays for Children Only - Principal Only.
9. National Scoliosis Foundation. Information and Support.
10. Morningstar M. Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis. Journal of Chiropractic Medicine, 2011;10(3):179-184.

---

Dr. Mark Studin is a 1981 graduate of New York Chiropractic College. He is the co-founder and former executive director of the New York Chiropractic Council. Currently, he is president of CMCS Management. Contact Dr. Studin with questions and comments regarding this article at drmarks380@aol.com .

About Dr Kevin Lau

Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.

By Mark Studin, DC, FASBE(C), DAAPM, DAAMLP

For more than 100 years, chiropractors have been treating adolescents with idiopathic scoliosis. Both myself and my colleagues, current and former, have realized and reported within the profession remarkable and often dramatic positive results.

But only recently has the viability of chiropractic treatment for scoliosis been documented through research and reported in the indexed medical literature.

According to the Mayo Clinic, "Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to straighten severe cases of scoliosis."¹

Three-dimensional lateral curvatures of the spine affect 2-3 percent of the adolescent population.²Utilizing 2000 U.S. Census Bureau statistics, the number of adolescents in the United States is 41,747,962. If 2.5 percent of all adolescents have scoliosis based on the 2-3 percent estimate, this equates to 1,043,699 (1.04 million) children facing issues as a result of scoliosis.³ Yet keep in mind that "only 10% of adolescents diagnosed with scoliosis have curve progression requiring medical intervention."⁴

Lou, et al., state: "Brace (orthotic) treatment is recommended for growing children with curves of 25-45 [degrees] Cobb angle. Surgery is the final treatment option for curves greater than 45° and its goals are to obtain safe correction, to produce a solid spinal fusion of the curve region, and to bring the spine and body into a more balanced position."²However, they conclude, "Although brace treatment for scoliosis has been used for more than fifty years, its effectiveness is still debatable. ... Most studies used the amount of curve progression (as measured by the Cobb angle) to determine the effectiveness of brace treatment. Some defined success as 5° or less curve progression."²

Bracing in adolescent males had unsuccessful results in 76 percent of the cases, with 46 percent requiring surgery for idiopathic scoliosis.² The overall surgical rate for failed bracing was 23 percent when used as a treatment for idiopathic scoliosis.⁶ "A retrospective review of 16,536 individual costs and charges, including overall reimbursements, for 125 consecutive patients who were managed surgically for the treatment of adolescent idiopathic scoliosis by three different surgeons between 2006 and 2007.... The mean age of the patients was 15.2 years." Costs ranged from $29,995 to $33,652, averaging $31,832.50 per case.⁷

The total number of hospital discharges in 2009 for idiopathic scoliosis for children under 18 years of age was 6,709. However, the estimated number of children undergoing spinal fusion was 38,000, with 85 percent being a result of idiopathic scoliosis. That means the total number of children being operated on is 32,300, with a national price tag of more than $1 billion ($1,028,189,750).

Scoliosis bracing is estimated to be used for 30,000 children. If we take the same statistic of 85 percent for idiopathic scoliosis, the approximate number of children braced for idiopathic scoliosis is 25,500. According to MG Labs, a prosthetic and orthotic lab in New York, the national average cost of a thoracolumbosacral orthosis is $2,100. That places the national cost for bracing at over $53 million ($53,550,000).

The estimated number of physician visits for scoliosis is 600,000.⁹ Again, if we take the 85 percent statistic for idiopathic scoliosis, the number of physician visits is 510,000. Omitting X-rays, MRIs and other required services for scoliosis, the average cost for a doctor's visit is conservatively $100, averaging both primary and specialist care. This would be for a range of E&M codes for initial visits including 99203-99204 and 99205. The national price tag is thus $51 million. (Note: For this review, we aren't considering the negative sequellae of radiation exposure for tracking the scoliosis as the adolescent matures.)

While allopathic medicine is still entrenched in the debatable practice of bracing and eventual surgery with the inevitable progression of scoliosis, there are proven solutions. A 2011 study concluded that as a result of chiropractic spinal adjusting and chiropractic spinal manipulation, a thoracolumbar curvature (scoliosis) averaged a 17.2° reduction that was maintained for 24 months, the length of the study. Across all spinal groups, an average 10° reduction persisted for 24 months, again the length of the study. It was also concluded that pain scales reduced by 60 percent at 24 months and function improved by 70 percent, while respiratory capacity increased by 7 percent.¹⁰

The real issue is that if adolescents have their curvatures reduced by between 10° and 17.2°, then a significant amount of bracing and surgery will no longer be an option because it will not be indicated. As bracing has been deemed questionable in the literature and now the literature reflects chiropractic as a highly effective modality, the standard of care across professions should be chiropractic care for scoliosis as the first-line treatment option and should be standardized in every discipline.

Considering the overall national cost of idiopathic scoliosis of $1,132,739,750 ($1.13 billion), excluding imaging studies and the research results on chiropractic care, the conclusion is that as a society our money can be better spent while simultaneously helping our children. The question remains, "Will politics and prejudice or facts rule the day?"

References

1. Scoliosis: Definition. The Mayo Clinic, 2009.
2. Lou E, Hill D, Hedden D, Mahood J, Moreau M, Raso J. An objective measurement of brace usage for the treatment of adolescent idiopathic scoliosis. Medical Engineering and Physics, 2010;33(3):290-294.
3. ACT for Youth Center of Excellence. U.S. Teen Demographics, 2011.
4. Lenssinck M, Frijlink AC, Berger MY, Bierma-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Physical Therapy,2005;85(12):1329-1339.
5. Karol LA. Effectiveness of bracing in male patients with idiopathic scoliosis. Spine, 2001;26(18):2001-2005.
6. Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine, 2007;32(19S):S91-S100.
7. Kamerlink JR, Quirno M, Auerbach JC, Milby AH, Windsor L, Dean L, Lonner BS. Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases. The Journal of Bone and Joint Surgery, 2010;92 (5:1097-1104.
8. U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality. 2009 Hospital Stays for Children Only - Principal Only.
9. National Scoliosis Foundation. Information and Support.
10. Morningstar M. Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis. Journal of Chiropractic Medicine, 2011;10(3):179-184.

---

Dr. Mark Studin is a 1981 graduate of New York Chiropractic College. He is the co-founder and former executive director of the New York Chiropractic Council. Currently, he is president of CMCS Management. Contact Dr. Studin with questions and comments regarding this article at drmarks380@aol.com .

About Dr Kevin Lau

Dr Kevin Lau DC is the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to: http://www.hiyh.info.

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Wellness programs looking good as business investments

Businesses should like these numbers a lot: Invest $1, get $3 back. That's the latest math on the return on employee wellness programs and experts are saying that may just be the start for the financial returns they can expect from targeted prevention efforts. Mark Green of The Lane Report writes that no less of an expert than Dr. William Frist of Nashville -- doctor, policy specialist, former U.S. Senate majority leader and venture capitalist -- has said: “No question in my mind, if we are to invest a dollar to have the greatest value in terms of outcome and results, we should put that dollar in prevention and wellness."

Frist, reports Green, "is a strong advocate of wellness -- as a business practice to adopt and a business sector to be in. Individual doctors, hospitals and the entire healthcare industry need to get involved, he said." Frist broke down for Green what factors most determine how long someone lives: “The numbers break down 30 percent genetic, 5 percent environmental, 15 percent socioeconomic, which is surprising to a lot of people, and then 40 percent behavioral: wellness, prevention. And then what is left (10 percent) is who your doctor is, what hospital you go to, what your emergency room is.” Those numbers  are important to Frist because to impact longevity healthcare spending over time, he said, resources should be on the 40-percent sector: behavior, wellness and prevention. Think smoking programs, weight loss, exercise, nutrition, seatbelt use. (Read more)

Businesses should like these numbers a lot: Invest $1, get $3 back. That's the latest math on the return on employee wellness programs and experts are saying that may just be the start for the financial returns they can expect from targeted prevention efforts. Mark Green of The Lane Report writes that no less of an expert than Dr. William Frist of Nashville -- doctor, policy specialist, former U.S. Senate majority leader and venture capitalist -- has said: “No question in my mind, if we are to invest a dollar to have the greatest value in terms of outcome and results, we should put that dollar in prevention and wellness."

Frist, reports Green, "is a strong advocate of wellness -- as a business practice to adopt and a business sector to be in. Individual doctors, hospitals and the entire healthcare industry need to get involved, he said." Frist broke down for Green what factors most determine how long someone lives: “The numbers break down 30 percent genetic, 5 percent environmental, 15 percent socioeconomic, which is surprising to a lot of people, and then 40 percent behavioral: wellness, prevention. And then what is left (10 percent) is who your doctor is, what hospital you go to, what your emergency room is.” Those numbers  are important to Frist because to impact longevity healthcare spending over time, he said, resources should be on the 40-percent sector: behavior, wellness and prevention. Think smoking programs, weight loss, exercise, nutrition, seatbelt use. (Read more)

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