"Join Something"
Dear Editor:
I have been in practice for 43 years. Over the years, there have been several attempts to make just one voice for chiropractic. "We need one strong voice for chiropractic," I've heard people say. "There is too much bickering and infighting against each other, so I won't join either group!"
When I was younger, I used to love to sing in the church choir. I didn't care to hear just a solo every Sunday; I used to love to hear a good blend of four-part harmony. I sing bass - one of the deepest basses. Yet I know that just singing bass does not yield the best music. It needs the other parts to complement and enrich the musical arrangement. I also know that the combined voices of all the members of the choir gave the best projection. To have 20 members in a choir, but only have two or three members sing, doesn't sound very good.
The same is true in chiropractic. Having three of four chiropractic organizations is not a weakness; it could be a great strength. The problem is that so few of our 70,000 chiropractors are members of any of our national organizations. We would have a strong voice worth listening to if all 70,000 would join one or the other of the organizations. That is why I would encourage everyone to join something.
Frederick Vlietstra, DC
Middletown, New York
In Defense of the Council on Chiropractic Practice
Dear Editor:
This letter is to correct some erroneous statements concerning the Council on Chiropractic Practice (CCP) made by Wayne N. Whalen, DC, is his article, "A Moment of Mercy and a Clinical Compass."1
The Council on Chiropractic Practice was established in 1995 as an apolitical, nonprofit organization and is not affiliated with the ACA, ICA, WCA, FSCO, COCSA, FCLB, or any state association. The process used to develop the CCP guidelines was open to any interested chiropractor. All DCs were welcome to participate in the peer review process.
Dr. Whalen's ad hominem remark characterizing the Council on Chiropractic Practice (CCP) guidelines as "touted by a small fringe group" is disingenuous. According to How Chiropractors Think and Practice: The Survey of North American Chiropractors, published in 2003 by the Institute for Social Research at Ohio Northern University, "For all practical purposes, there is no debate on the vertebral subluxation complex. Nearly 90% want to retain the VSC as a term. Similarly, almost 90% do not want the adjustment limited to musculoskeletal conditions. The profession - as a whole - presents a united front regarding the subluxation and the adjustment."2 Ninety percent of the profession can hardly be considered a "small fringe group."
If there is a fringe group within the profession, it composed of the 10 percent who renounce the subluxation and wish to limit chiropractic care to persons presenting with musculoskeletal symptoms.
The claim that the National Guidelines Clearinghouse (NGC) is "merely a collection of guidelines less than 5 years old" is deceptively incomplete. NGC was originally created by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). All of the criteria below must be met for a clinical practice guideline to be included in NGC.
The clinical practice guideline contains systematically developed statements that include recommendations, strategies or information that assist physicians and/or other health care practitioners and patients make decisions about appropriate health care for specific clinical circumstances. The clinical practice guideline was produced under the auspices of medical specialty associations; relevant professional societies, public or private organizations, government agencies at the federal, state or local level; or health care organizations or plans. A clinical practice guideline developed and issued by an individual not officially sponsored or supported by one of the above types of organizations does not meet the inclusion criteria for NGC.
Corroborating documentation can be produced and verified that a systematic literature search and review of existing scientific evidence published in peer reviewed journals was performed during the guideline development. A guideline is not excluded from NGC if corroborating documentation can be produced and verified detailing specific gaps in scientific evidence for some of the guideline's recommendations.
The full-text guideline is available upon request in print or electronic format (for free or for a fee), in the English language. The guideline is current and the most recent version produced. Documented evidence can be produced or verified that the guideline was developed, reviewed or revised within the past five years.3
Guidelines submitted to the NGC are evaluated by ECRI, a collaborating agency of the World Health Organization, before being included in the clearinghouse. In addition to the NGC, the CCP guidelines are included in Healthcare Standards: Official Directory, which is "the most respected index of healthcare standards. It is relied upon by clinicians, medical malpractice attorneys, paralegals, medical-legal nurse consultants, risk managers, insurers, health plan administrators, patient safety officers, librarians, and others charged with staying on top of the changing landscape of health care standards, clinical guidelines, and U.S. federal and state laws and regulations."4
The statement by Dr. Whalen that the NGC annotated bibliography "notes that the CCP guidelines are 'unsuitable for use in clinical practice" is also misleading. The paper by Cates, et al.,5 is but one of several articles included in the annotated bibliography. This paper merely expresses the opinions of the authors. It does not represent the position of the NGC. Persons who follow the link will be led to my critique6 of the Cates, et al., paper, conveniently ignored by Dr. Whalen. It should be noted that the NGC annotated bibliography also contains an article I co-authored that is critical of the Mercy guidelines7. As with the Cates, et al., paper, it does not represent an evaluation by the NGC, but merely a reference to a relevant publication.
Finally, Dr. Whalen makes the unsubstantiated claim that the CCP guidelines "are used by almost no one in the profession, and are completely ignored by those in authority outside the profession." The extent of their utilization will be the object of further research by CCP. However, we know that the CCP guidelines have been accepted in courts of law and have been used to successfully defend chiropractors in a variety of settings.
References
- Whalen WN. A moment of mercy and a clinical compass. Dynamic Chiropractic, Dec. 17, 2005. www.chiroweb.com/archives/23/26/01.html.
- McDonald W, Durkin K, Iseman S, et al. How Chiropractors Think and Practice. Institute for Social Research. Ohio Northern University; Ada, OH, 2003.
- www.ngc.gov/about/inclusion.aspx
- www.ecri.org/Products_and_Services/Products/Healthcare_Standards_Directory/Default.aspx
- Cates JR, Young DN, Guerriero DJ, et al. Evaluating the quality of clinical practice guidelines. J Manipulative Physiol Ther, March/April 2001;24(3):170-6.
- Kent C. Evaluating the quality of clinical practice guidelines (letter). J Manipulative Physiol Ther, Nov/Dec 2001;24(9):612-8.
- Kent C, Rondberg T, Dobson M. A survey response regarding the appropriateness of professional practice guidelines to subluxation-based chiropractic. J Vertebral Subluxat Res;1(2):13-8.
Christopher Kent, DC
President, Council on Chiropractic Practice
