The Piggy Banks Are Screaming

First of all, let's understand what this column is NOT about.

When the Mercy Center Guidelines were first available in their draft form, for the exclusive use by the major sponsors in their consideration of how they would react to the document, each chiropractic organization had to make a choice. Some organizations, such as the Federation of Chiropractic Licensing Boards (FCLB) and the American Chiropractic Association (ACA), decided that while they did not agree with every one of the 304 recommendations in the guidelines, they could endorse the guidelines in total prior to publication.

In contrast, the International Chiropractors Association decided that they could not at this time endorse the Mercy Guidelines. Curiously, one of the primary reasons for the ICA not endorsing the Guidelines eventually became one of the reasons the ACA could. The difference was one week.

In an effort to insure the best guidelines possible for the chiropractic profession, legal council of the Mercy Center Conference, David Chapman-Smith Esq., and a special "Practice Parameters Committee" formed by members of the National Association of Chiropractic Attorneys (NACA), have been working long and hard. Just prior to the ICA convention, the NACA reported their concerns over parts of the Mercy Guidelines. Unfortunately, because of the timing, the ICA never had the advantage of seeing Mr. Chapman-Smith's response to the NACA's recommendations.

The ACA, on the other hand, was able to not only see that most of the recommendations were followed, but enjoyed the pleasure of having David Chapman-Smith on hand to answer questions (he was a speaker at their convention). What a difference a week's worth of information can make.

For the record, I believe the actions of both the ICA and the ACA were appropriate, given the information they had available to them at the time and their respective positions. The involvement of both national associations as well as the chiropractic attorneys in improving the framework, disclaimers, and general verbiage surrounding the recommendations should be commended. (Please bear in mind that the recommendations themselves have not been altered.)

Again, this is NOT what this article is addressing.

Nor is this an attempt to respond to the petty politics of those attempting to maneuver themselves into self-important positions to enhance their own dubious notions of fame and glory. Unfortunately, this is not new to our profession, nor is it unexpected. Everyone sees these individuals for the political animals that they are.

The only theme of this column is to bring to light the screaming of those companies and individuals who have financial interests which the Mercy Center Conference refused to serve. They've begun their ranting, and you need to understand why.

No technique, no procedure, no piece of equipment received the kind of rating in the Mercy Guidelines that its proponents would have liked. This is because of two simple facts:

The measuring stick for all procedures, equipment, etc. is RESEARCH. The Agency for Health Care Policy and Research (AHCPR) has made it plain that regardless of what health care profession you are in, who you are or what procedure (equipment) you use, if its efficacy is not established by valid research, you won't get reimbursed.

Most of the procedures, techniques, and equipment we use aren't well researched, if at all.

These two facts make the task of those who make their living selling seminars, equipment, etc. very simple: do the research and live with the results. Fortunately, most of the companies involved with the sale of clinically related knowledge or equipment understand the challenge and are gearing up for it. Motion palpation, a diagnostic procedure, has been facing this challenge for some years.

But there are a few (and there will probably be a few more) that have chosen to attack the guidelines, the conference, the process, the participants, the sponsors, anything and anybody in an attempt to draw the attention away from the lack of viable research on their product. They refuse to allow their technique or product to be judged by the same measuring stick that everyone else is judged by (research). Why?

One possible answer is that valid research has been already attempted behind closed doors. And upon discovering that honest research not only doesn't support their sales claims but may in fact refute them, they are left with nothing to do but scream as their house of cards begins to fall. What else can they do?

Yes, of course they will produce their own "research" that isn't published in any reputable, indexed research journals. Yes, they will tell you that "chiropractic is under attack" as the third party payers have begun to deny claims for reimbursement (unfortunately, they won't give you any money to fight the denial, that's your problem). You know the routine.

It's really quite simple: Those who can, do. Those who can't, complain.

So when you hear the screaming, recognize the financial interests associated with the screams and ask the question: "Where's the research?"

DMP Jr., B.S., H.C.D.(hc)