An Honor and a Privilege

The recent Mercy Center Conference was a testament to the strength the chiropractic profession. On January 25th, 1992, 35 DCs chosen from the many diverse groups within the profession gathered (with some trepidation) to set standards and guidelines for chiropractic. By the end of the conference on January 30th, these chiropractors had hammered out a compromise. The participants had proudly produced a document which had been through four separate draft revisions and countless conference committee amendments. It's anticipated that this document will be available in April.

Dynamic Chiropractic asked the Mercy Center Conference participants to write a short description of their reactions to the conference. The following are their responses:

Alan H. Adams, D.C. -- The Quality Assurance Conference at Mercy Center was a monumental success. The dedication and hard work of the Steering Committee, captains, members, and support staff brought a seemingly impossible task to completion.

The formal consensus process provided for fair representation of diverse points of view, appropriate evaluation of clinical and scientific evidence, and the opportunity to reach agreement on the recommendations put forth by the members.

The recommendations in the conference proceedings should provide a solid foundation for the development, dissemination and implementation of practice guidelines in the chiropractic profession.

Meredith Bakke, D.C. -- "The consensus process works!" That was the "consensus" of the 35 participants; we were exhausted, relieved, and excited as we gathered for a last time: pictures to celebrate! A year of research and review complimented by 35 "lifetimes" of education, clinical practice and reverence for the art and science of chiropractic culminated in a document that will controversial but hopefully well-received.

It was another great beginning for chiropractic and a real honor to be there. The final verdict will rest with those who adopt and use what was created at the Mercy Center. Either it will go down as one of the great moments in chiropractic history or, as a friend of mine put it, "the lock-in on Super Bowl weekend."

Ralph Boone, D.C., Ph.D. -- I was impressed by the dedication of the participants, the commitment of the steering committee, and the financial support of the business element of the profession. I consider it a privilege to have been invited to participate. I am ambivalent, however, in my impression of the product. While I support the outcome as a consensus to those present, I do not believe the document was a representation of the profession as a whole. While the _process_ was fair in that it provided a mechanism for minority opinions to surface, the selection of participants was such that the majority present held essentially the same perspectives on the recommendations presented. A golden opportunity to produce a document reflecting the diversity of opinions within chiropractic was missed. As a result, I envision the necessity for a future conference, similarly designed, but weighted with those holding other perspectives of the profession to produce a document reflective of views not considered at the Mercy Center Conference.

Linda J. Bowers, D.C. -- I was honored to be a part of this historic conference. The collegial atmosphere of hard work accomplished will serve to improve the level of quality care for our patients. I believe the profession will be pleased with the recommendations contained in the document.

David Chapman-Smith, L.L.B.(hons.): This conference revealed a chiropractic profession in good shape to meet the challenges and exciting opportunities of the 1990s. The diversity of opinion and strong viewpoints are still there -- which is healthy and right. However, faced with an historic opportunity to move the profession forward, everyone was informed, attentive, willing to work around the clock and able to negotiate wisely and modify positions to advance the best interests of the profession as a whole.

If the spirit of the Mercy Center Conference takes root and grows, absolutely nothing is going to stop the chiropractic profession blossoming as never before during the next 10 years.

Gerard Clum, D.C. -- The proceedings of the Mercy Center Conference should be of great import to the chiropractic profession. They are not the "final words." They are not a definitive point for the profession: they are however a significant first step toward self-definition and self-determination.

The recommendations are not what any one person would write, but they do represent a basis from which research, development, and future efforts of this nature will spring, a basis from which to reconcile the views of disparate opinions.

Tammy De Koekkoek Rubinstein, D.C. -- Seated alphabetically between Gerry Clum and Arlan Fuhr, I looked across the room which included J. Triano and Reed Phillips. I listened to discussion become animated and even passionate, and watched, amazed, to see opinions transform into compromise. In those five days, camaraderie and a willingness to learn complemented the process of arriving at concensus, a process through which we were cheerfully guided by Scott Haldeman. The result was, I believe, a document of honest intent and an earnest beginning to what we hope will be an on-going process of accountability by this profession.

Robert Francis, D.C. -- The Mercy Center Conference was indeed a unique opportunity to participate in an historic event for the chiropractic profession. Intraprofessional consensus is difficult to achieve in any profession. The steering committee and the commission are to be commended for courageous dedication and significant personal sacrifices required to carry out the charge to develop a document that represents the entire profession. I was most impressed with the unity that was achieved in spite of the variety of opinions expressed.

The entire process ran smoothly and was organized in the most professional manner. I consider it to have been an honor to be asked to participate in this significant endeavor.

Arlan Fuhr, D.C. -- "Common sense prevails at the Mercy Center Conference" is my reaction to the January 1992 meeting. The results were serious discussion, exchange of views, and believe it or not, compromise that all should be able to live with. This national level meeting provided sufficient expertise to deal fairly with issues such as treatment type, frequency and patient management. An additional benefit of the conference was the determination of chiropractic's research needs. Hard work lies ahead for all in implementing these recommendations.

R. James Gregg, D.C. -- There can be no doubt that the conference that took place in January was historic, perhaps even unique in the history of the chiropractic profession. There is also little doubt in my mind that the process was of value. I think it is premature however to offer any conclusions on the document that was produced. Any group that presumes to represent the chiropractic profession, without open-ended input or truly comprehensive representation, must be careful with any standards they develop. Until the document produced at the Mercy Center Conference is validated or ratified by the profession at large, I don't think it should be presented as anything more than the opinions of those individuals present and participating in the development process. Furthermore, we must wait to see the impact this document has in the hands of those outside the chiropractic profession, in particular, the insurance industry and government. Only after the operational consequences of this document are fully understood, will we know whether we have done something good or created a monster that could destroy us.

It is important that the organizers of the conference be prepared to take such steps as are necessary to modify or delete any portion of the current document that is found to be detrimental to the best interests of the profession, or to expand in areas that were not thoroughly dealt with. The potential consequences of a job half done should be recognized and all participants should be willing to reconvene, with an expanded pool of participants, if necessary, to make any changes that are necessary to shore-up weaknesses that may become apparent as the document is subjected to the critical scrutiny of the people upon whom it will have the greatest impact: the doctor of chiropractic in daily practice.

Daniel T. Hansen, D.C. -- On Saturday, January 25th, I left my family with only suitcase and a large briefcase on my way to a convent. I felt that I was prepared with respect to the chapters that I was assigned, I was very familiar with the "consensus" process, but yet I was unsure about what to expect. Did we really expect to achieve agreement on the vastness of chiropractic practice based on good science, or were we going to witness yet another classic chiropractic confrontation? Well, after four grueling days of committee work and endless plenary panel sessions that saw almost every chapter get critically scrutinized, my body said that it was "okay" to be tired. It took three days to "recover" from the mental and physical exhaustion and reacquaint myself with my family and my practice. But now, one week later I am very _proud_ of _my_ profession for what it accomplished. The _process_ of consensus used at the Mercy Center proved itself to be valid and the outcome far exceeded my expectations. The resulting collection of recommendations will serve as a strong foundation in the recognition of our profession as a legitimate member of the health care delivery system. Most significant to me though, was witnessing the dynamics between individual panelists to work out their differences and "collapse disagreements" into reasonable consensus statements. It may appear to the world that the "magic" occurred with those 66 individuals that were holed up in that convent, but the truth is, credit goes to the many groups and individuals that supported and endorsed this conference from its inception. And probably more important to those of us that captained each topic, credit and kudos go to the literally hundreds of people that were asked to serve as consultants on the various chapters over the past year. Take a bow folks!

Donald J. Henderson, D.C., FCCS(C) -- Given the volume of work that had to be accomplished over four days covering 15 areas of practice, I was doubtful that recommendations could be properly concluded without ambiguity and some heated controversy -- and there were some contentious issues debated particularly during the small group sessions! Attentive input by team members and advisors over the past year leading to four draft revisions of the chapters as well as intensive discussion during the committee and plenary sessions helped collapse all differences of opinion, almost without exception, to a point of full consensus. Understanding the "rules" of the consensus process was essential in arriving at fair and honest conclusions that hopefully will be reflective of the "average, reasonable" chiropractor's viewpoint.

John Hsieh, M.S., RPT, D.C. -- I was very impressed with the whole process of the Mercy Center Conference. Everything was well-organized and every participant worked very hard to achieve the goal of the conference. If there is a drawback, I think it could be that we voted too many recommendations for too long of a day. I think most committee members felt that five days of conference were still too short. One interesting observation is that I saw the straight and mixed groups were actually able to have consensus on the majority of the recommendations. Being a researcher and practitioner, I think the guidelines from the Mercy Center Conference represented the best mixture among the academic, clinical, and political exercises from the profession. A future conference will be needed to upgrade the recommendations of the practice procedures when such information becomes available.

Thomas E. Hyde, D.C. -- It was an honor and a privilege to participate in the Mercy Center Conference. This conference brought together some of the best minds in the profession. It also included a diversity of philosophies with each major group represented. I was amazed that with few exceptions, this very different and diverse group could unanimously agree on the vitally important issues addressed by this historic conference. It is my belief that the document produced will provide great latitudes for all chiropractors regardless of philosophical view. While the final results may not be embraced by every practicing chiropractor, the process by which this document was created, was extremely well-planned and executed. Hats off to the steering committee, Dr. Scott Haldeman, Mr. David Chapman-Smith, Mr. Don Petersen and staff, captains, observers, sponsors and all participants for a job well done.

Donald P. Kern, D.C. -- I must confess, I agreed to participate in this historic event with a fair degree of apprehension. I did not believe that consensus could be achieved on such a wide range of topics. It was inevitable that some minority opinions would surface and they did; however, agreement was attained on many issues and I believe that the profession will ultimately benefit from this happening. A climate of fairness and respect for the views of others prevailed. It was not always an easy task to vote on issues with one's mind and intellect rather than with one's heart. As the conference proceeded, this intellectual reasoning process, based upon existing evidence and expert opinion, occurred. The conference chairman, staff, steering committee, team captains and participants devoted much time to their respective roles and the total team effort paid off. The recommendations that will evolve from this conference, the first of its kind, will certainly focus our research attention for the future. It would be my hope that the challenges for the profession and for chiropractic education will become evident to those who read and comprehend the printed recommendations that will result from the Mercy Center Conference.

Norman Kettner, D.C., DABCR -- The process of consensus at the Mercy Conference employed a broad based of training, experience and geographic variation. I feel this provided for a true peer review mechanism. It also enabled all of us to learn from one another.

The final document is a reflection of the current practices and standards within our profession: It is a good starting point. I look forward to further assist in any way possible.

Charles Lantz, D.C., Ph.D. -- Although most people feel that the purpose of the conference was to produce a standards of care or practice guidelines document, the real accomplishment was not the product but the process. Whatever document is produced will change in time, and the details of the process will change in time, but the process of assessment and reassessment of the status of the profession has begun and will be with us as long as the profession exists. The process was one of consideration and compromise. Everyone came to the conference with their fears and apprehensions, but as the conference progressed a transformation took place. Fears and apprehensions were replaced by understanding; anger, and suspicion were replaced by sincere discussion. The end result is that we all learned from the experience. I believe that every single person in the conference had to compromise some aspects of their personal beliefs, and despite that, I do not believe that a single person felt that they had lost any aspect of their principles or beliefs. It is my hope that this conference will be the catalyst for change within the profession, that we can all learn that there is compromise without capitulation and that there can be differences of opinion without differences in purpose. The Mercy Center Conference was an instrument of change in the lives of the participants and, I hope, for the profession.

Eugene Lewis, D.C. -- I was initially apprehensive that politics and emotion might compromise the quality of this long-needed document. However, it became readily apparent that my concerns were unfounded as a well-thought-out, concise report was constructed, utilizing the input of all those present. This was accomplished regardless of the diversity of groups represented by members of the commission, who acted in the spirit of mutual recognition that we all were chiropractors and must pull together in the face of ever-increasing inspection by government, industry and other professions. I left the gates of Mercy Center feeling a true awareness of history having been made.

John L. Martin, D.C .-- The consensus that was reached by all factions of the chiropractic community from the liberal, scientific to the conservative, philosophical to the middle of the road everyday chiropractor was scientific, legal, and fair to all branches of our profession. I was pleased to see the different divisions of the profession sitting down in the same room and working together for the common good of the profession. Consensus was reached with agreement, good will, a desire to "make it work," attitude and no animosity. This document will move our profession forward in all areas and needs to be accepted wholeheartedly by the entire chiropractic profession. Rational, reasonable clinicians will see the value of what has been done at this momentous meeting and accept the outcome.

Marion McGregor, M.Sc., D.C. -- My initial reaction to the Mercy Center Conference was, I am sure, shared by most participants: exhaustion. I will remember it as an intellectually intense time. I will also remember the pride I felt in my profession and my colleagues as the 35-member commission tried with sincerity and dedication to formulate appropriate and inclusive recommendations that spanned many differing perspectives. I was particularly struck with the flexibility exhibited by all in attempting to assimilate the scientific evidence available with the practices and procedures in the profession today. I was amazed at the willingness of everyone to leave their egos out of the conference as well as the ability of the commission members and support staff, to maintain a reasonable (and occasionally outrageous) humor amidst the seriousness of the proceedings. The Mercy Center Conference afforded the opportunity for the rationale behind opposing points of view to be aired. Once aired, reasonable decisions could be made. The process worked due to the dedication of those organizing and facilitating the meeting and the ability of the members to be reasonable and rational. How the efforts of this commission will be used is now up to the profession at large.

Rick McMichael, D.C. -- The Conference participants and support staff worked together to complete a global guidelines document with a high degree of consensus. The quantity of work handled in four days was incredible. Hopefully the profession will agree that the quality of work completed was excellent as well. The Mercy Conference was an important step in the ongoing process of defining guidelines and standards for the chiropractic profession. We must now direct our attention to response this document receives from chiropractic clinicians and to the impact it has on clinical practice.

William C. Meeker, D.C., MPH -- I believe the Mercy Center Conference was a seminal experience in chiropractic. Never before, in my experience, have so many chiropractors agreed (or agreed to disagree) on such a wide range of important clinical issues. The fairness of the process was clear to all and most of the time, a clear consensus was reached. The structure of the process ensured that all important points of view were heard and I do not believe that anyone can fairly impugn the evenhandedness of the results. The results and recommendations will not make everyone happy, but I sincerely believe that the great majority of chiropractors can live with them. Among other things, the document certainly defines an ambitious research agenda for the profession. My one minor fear is that only the summary recommendations will get publicity. Chiropractors must obtain and read the entire document including the extensive reviews of the literature in order to understand the results of this historic event in the proper context. Special thanks should go to Scott Haldeman for his untiring leadership and to Don Petersen and his staff for their outstanding technical support.

Dale Mierau, BSPE, D.C., M.Sc.(Orth), FCCSC -- It was my pleasure to be involved in the Chiropractic Consensus Conference for Guidelines and Quality Care Assurance held at the Mercy Center in January, 1992.

Chiropractic has joined the other health care professions in developing standards of care. As a participant, I was able to develop, discuss, and vote on the recommendations proposed in the final document. It is clear that there is a wide range of opinion among delegates about most topics concerning chiropractic today. The consensus process allows for discussion and varying opinion to enter into the recommendations along with present scientific evidence.

I am grateful for the opportunity to participate in these proceedings.

Silvano A. Mior, D.C., FCCS(c) -- There are few events/opportunities that can impact upon one's professional career as the recently held Mercy Conference. The initial concerns expressed by members of the committee, chiropractors and their respective associations, created an air of pessimism regarding the conference's goals. These concerns were quickly abrogated as the consensus process began to unfold. Committee members cognizant of professional and scientific responsibilities, interacted in a manner exemplifying the importance of the situation. Individual concerns were expressed and debated in an open, fair, and collegial manner. The recommendations were made and voted upon with due consideration to the practicing chiropractor and the paucity of supportive literature. The legitimacy and success of the conference is evident in the fact that 35 chiropractors from diverse backgrounds and interests were able to reach unanimous consensus on the vast majority of the recommendations. In my opinion, the effort and time expended by the committee members, observers, consultants, and organizers have produced a document beyond my expectations. Criticisms and comments will inevitably follow, but such would not be possible without first having taken this historic step.

Robert D. Mootz, D.C. -- For the first time in my 15 years with this profession, I saw displayed a real maturity comparable to other clinical and scientific disciplines. A group of chiropractors representing every geographical, philosophic, and scope of practice perspective engaged in meaningful, critical discussion of the real issues: what is best for our patients. The standardized consensus process allowed input from all points of view and as a result a stronger document came out. Although the end product will have room for improvement, the product this conference produced is a useful, meaningful, representative, and accurate portrayal of chiropractic clinical practices. It highlights our strengths, identifies the areas we need to prioritize for our further evolution as a profession, and establishes a precedent for the right way this profession should tackle issues regarding its identity. I was most amazed at the real consensus that was evident. Of the more than 300 recommendations put forth, all but a few had full consensus of the participants. Of those few items that sustained a majority-minority opinion, the difference between them was consistently small. This whole process gives me a lot of encouragement for the future of our profession.

Kelli Pearson, D.C. -- Prior to the Mercy Center consensus conference, I had never experienced such a sense of professional gratification. Despite the long and mentally challenging hours required to produce this awesome document, all I can remember are the satisfaction and pride generated by the process. My respect for our profession has been magnified exponentially because of the experience. I believe this document allows us to look to the future with bright anticipation of further successes.

Michael D. Pedigo, D.C. -- I was honored to be invited to participate in the Mercy Center Conference. I was excited to see such broad base professional support for this project. The diverse group of sponsoring organizations and the professional cross section of participants in the conference truly gave this conference and the soon-to-be-published book input from the profession as a whole. Some have expressed amazement that it was possible to bring such a broad cross section of the profession together to write a book on "Standards of Practice" and complete the task with only three minority reports out of over 300 recommendations! I am excited about our accomplishment, but I have maintained for years that this profession is not as far apart on important issues a it is often portrayed. I still believe that this profession could function more effectively under the umbrella of one national association. The conference adds support to that opinion.

I believe that the conference and the book that will be published will be a "landmark" in chiropractic history.

Donald M. Petersen Jr., HCD (hc) -- Never before have the major chiropractic organizations in North America come together for such an important event. To have the Congress of Chiropractic State Associations (COCSA), representing forty-three state associations, commission this conference was the broadest support base possible. Then to have the American Chiropractic Association (ACA), Canadian Chiropractic Association, International Chiropractors Association (ICA), Federation of Chiropractic Licensing Boards (representing every state licensing board in the United States), the Foundation for Chiropractic Education and Research (FCER) and the Association of Chiropractic Colleges as co-sponsors made this conference a true representation of the entire profession from a sponsorship point of view.

This when coupled with the full-spectrum representation of the conference participants made the Mercy Center Conference a consensus event that gave due weight to all segments of the chiropractic profession. This process itself will cause the practice guidelines established by this conference to receive high acclaim and respect throughout the profession and the health care world. Others may attempt to create their own guidelines after their own agenda, but this work involving so many will outshine and outclass all other efforts.

Reed Phillips, D.C., Ph.D. -- The Mercy Center Conference was a moment in chiropractic history. We as a profession should be proud of the process that occurred. We reached a consensus. I think we were all surprised that our differences were not insurmountable. We need to begin the plans for another conference.

William C. Remling, D.C. -- Personally, I felt the conference was dominated by the researchers and academicians and not a true consensus of the field practitioners. Too much to do and too little time to do it. My appreciation and respect to Don Petersen and the secretarial staff that gave so much to make the conference possible. They truly made it happen. Dr. Scott Haldeman orchestrated the event masterfully keeping everyone on course, on purpose, and on schedule.

Dennis R. Skogsbergh, D.C. -- What a challenge ... to assemble such a widely diverse group within chiropractic, and ask for consensus! Consensus, no less, on such an electrified and controversial issue as standards of chiropractic care. Expectations, while hopefully high, had to be tempered with the possibility of disappointment. The phenomenon of committee and plenary session action was demanding, both physically and emotionally. In many ways it was an ordeal beyond description, yet at the same time it became a training lesson that resulted in significant growth. In performance, the consensus process performed remarkably as the recommendations were presented, modified, and voted. Even lone objectors were given the floor to proffer advice or register concern. In the end it was sweet success. Despite the biases, the differences in emotions and knowledge, the disagreement and even quarrel, the process gave birth to accord, harmony, and a general spirit of great accomplishment. Clearly this represents a landmark event that will posture and poise our profession for advancement in the years to come.

Marilyn P. Smith, D.C. -- The Mercy Conference was a dynamic success. It was something our profession has needed for a long time. I feel it was a landmark achievement and one that will ultimately lend more credibility to the chiropractic profession.

For me, it was a phenomenal experience. The process was educational and the outcome certainly gratifying. I felt we all were able to put aside our individual philosophies and attend to the business at hand for the betterment of the entire profession.

Monica Smith, D.C. -- The numerous participants in the conference represented the many facets within chiropractic, including academicians and practitioners, specialists and generalists, etc. The iterative process encouraged modification of the guidelines to include the perceptions of all participants, and accommodated the need to recognized varying levels of consensus on some issues. Practice guidelines are by no means static, and further guidelines development should continue to reflect the evolution and growth of our knowledge base. Future efforts at knowledge accumulation and dissemination will likely include more population-based research (epidemiologic studies) demonstrating the overall effectiveness of chiropractic care, as well as further clinical/experimental research demonstrating the efficacy of manipulation and other chiropractic modes of care. The criteria for assessing relevant research must accommodate various research approaches, recognizing that sophisticated statistical methods of mathematical modeling can be used to rectify many of the shortcomings in weaker (e.g., non randomized) research designs.

Louis Sportelli, D.C. -- Going into the conference, I had great fears about what would happen, how each group would posture themselves, or what kind of "cookbook chiropractic" would be proffered as a result of this conference. To my surprise, nothing has been more encouraging to me or has exceeded my expectations more than the Mercy Center Practice Guidelines Conference. Not only was it productive in content, but it brought together literally every faction and facet of this profession ... from conservative to the liberal, from broad to narrow, from academia to clinical practice, from research to politics. The cross section of the group represented every single chiropractic dimension.

The chiropractic participants can certainly be commended for having the vision to see the benefit of this conference and tenacity to stick it out and remain positive about what this profession must do to insure our survival and growth.

I was proud to be a participant at the conference and my hopes for the future of this profession have never been more fortified. This will be one of the most important documents ever produced by the chiropractic profession in this century. It has established chiropractic as a profession.

John Triano, M.A., D.C. -- the Mercy Center Conference: there was question that it would actually occur. There were fears and perceived threat by the process expressed by a few colleagues and some professional organizations. On Saturday, the participants assembled with apprehension and determination. By Wednesday, all the tension levels had evaporated and each participant recognized that all of the others were colleagues having similar overall aspirations for the benefit of chiropractic health care delivery. The system worked and worked well. No one left without having made significant impact on the consensus for their perspective. No one left without having their own views and positions effected. New doors were opened between members who represented politically diverse points of view. The result bodes well as a basis for continued growth and development of our profession. It is now up to the profession at large to determine if they understand and agree with the process.

Howard Vernon, D.C., FCCD(c) -- It was an honour to be asked to participate in this landmark effort in the chiropractic profession. I was particularly impressed with the fact that, given the great diversity of thought and practice approaches amongst the chiropractors on the panel, there was a singular commitment to the hard work, innovation and compromise that was necessary to produce consensus. The fact that the vast majority of recommendations were accepted near-unanimously is testimony to the inherent fairness and rightness of the process and the people involved.

The conference has established a benchmark for chiropractic at which we can never aim below. We can now only strive to attain this standard or to exceed it. Thank you for allowing me to participate.

James F. Winterstein, D.C. -- Twenty years ago, I was privileged to be a participant in what has come to be known as the "Houston Conference." That event was a major step forward in bringing different factions within the profession to the same table for a common purpose. The significance of that event pales in comparison to the Mercy Center Conference both in magnitude and in outcome.

Thanks to the foresight of Dr. Scott Haldeman, Mr. Don Petersen and the members of the Steering Committee, this conference was eminently fair. At every turn, Dr. Haldeman went out of his way to provide ample opportunity for expression of divergent views and opinions. Truly, this was a _consensus_ development.

The proceedings were very intense, but those of us who participated left with a very strong sense of accomplishment and shared understanding. Yes, there continue to be differences of opinion, but this is good. Clearly, the document which comes out of this effort must be a flexible one, and future proceedings must refine and, in some instances, redefine this document. However, I believe that the development of a recommended practice guidelines document is the most vital accomplishment that this profession will experience for some time to come. I am proud to have participated!

Scott Haldeman, M.D., D.C., Ph.D. -- The Commission for the Establishment of Guidelines for Chiropractic Quality Assurance and Standards of Practice has completed its task and is now disbanded. The only remaining function is the publication of the Consensus Report, and this responsiblity has been turned over to a committee of the Association of Chiropractic Colleges.

The commission represents the support and work of numerous individuals and chiropractic organizations. Its success cannot be attributed to any single person or association. No group or point of view can be considered to have dominated the process. The 35 participants were all graduate chiropractors and 24 (70 percent) were in private practice. Participants were from 14 states or provinces, associated with 10 chiropractic colleges and held offices in multiple state and national associations. They represent the greatest cross section of the profession that could be included in a panel of 35.

A commission of this type takes tremendous effort and commitment. It requires the support of the profession and the dedication of the organizational and participating committees. It could not have occurred without the vision of COCSA, the trust of the sponsoring organizations and companies, the unflagging dedication and energy of the members of the commission and the skill and limitless work capacity of Don Petersen and the support staff who worked with him.

The Mercy Conference was the culmination of two years of work. The camaraderie and friendship of chiropractors with different points of view should serve as an example of what can be done in this profession. I am privileged to have had the opportunity to participate in this process and I am proud of being a chiropractor. As chairman of the Commission, I offer the consensus document on Guidelines for Chiropractic Quality Assurance and Standards of Practice to the chiropractic profession for its consideration and endorsement.