Chiropractic history was made in Phoenix last month with the formation of the Council on Chiropractic Practice (CCP). The meeting was attended by an interdisciplinary assembly of distinguished chiropractors, medical physicians, basic scientists, attorneys, and consumer representatives.

The Council on Chiropractic Practice (CCP) is an apolitical, non-profit organization, and is not affiliated with the ACA, ICA, WCA, FSCO, COCSA, FCLB, or any state association. The CCP is a grass roots movement to produce practice guidelines which serve the needs of the consumer, and are consistent with "real world" chiropractic practice.

The mission of the CCP is "to develop evidence based guidelines, conduct research and perform other functions that will enhance the practice of chiropractic for the benefit of the consumer."

Previous guidelines efforts, such as Mercy, have been dominated by members of the academic and research community. Input from the field was minimal. Many instances have been reported where patients have been denied reimbursement for necessary chiropractic and associated diagnostic testing based upon the Mercy guidelines. This has had devastating effects on the incomes of many D.C.s, damaged doctor-patient relationships, and adversely affected the D.C.s perceived value of chiropractic services.

The CCP will develop practice guidelines with the active participation of field doctors, consultants, seminar leaders, and technique experts. In addition, the Council will utilize the services of interdisciplinary experts in AHCPR guidelines development, research design, literature, law, clinical assessment, and clinical chiropractic.

In harmony with these general principles, the CCP has created a multidisciplinary panel, supported by staff, and led by a project coordinator and methodologist, who will serve as a consultant. The first endeavor of the panel is to analyze available scientific evidence revolving around a model which depicts the safest and most efficacious delivery of chiropractic care to the consumer.

A contingent of panelists, chosen for their respective skills, will direct the critical review of numerous studies and other evidence. In areas where more study is needed, recommendations will be made to bridge the gap and the best level of care will be proposed based on the professional expertise of the participants.

Since the guidelines process is one of continuing evolution, new evidence will be considered at periodic meetings to update the model of care defined by the guidelines.

During the initial meeting, the panel focused on defining the scope of the guidelines, establishing necessary committees to facilitate the process, and discussing the topics for literature review.

The panel will gather in a second meeting to interview technique masters to ascertain the degree to which their procedures can be expressed in an evidence-based format. Individuals representing over thirty-five techniques have been invited to participate.

Representatives of techniques not represented in the initial invitation are welcome, and the CCP actively solicit their participation. The technique masters have been invited to present evidence substantiating their protocols and assessment methods.

Since the primary goal of the panel is to stimulate and encourage field practitioners to adapt their practices to enhance patient outcomes, it is necessary to involve as many practitioners as possible in the development of workable guidelines.

To achieve this objective, an "open forum" will be held for practitioners to offer their opinions and insight in regard to the progress of the panel and the product that will be emerging. Opinions will be solicited by the panel, and all information that improves the process will be considered for incorporation. Field practitioners who are unable to attend the "open forum" session are encouraged to make written submissions.

The panel will convene for a fourth time to assess comments received through the "open forum" process and determine how the evolving guidelines should be modified. If necessary, further review of evidence will be undertaken, and new evidence duly considered. After the development of the working draft of the document, it will be submitted to peer reviewers for commentary and additional editing.

The last stage before final review of the document is pilot review by practitioners for clinical utility and "user friendliness." The final draft will be published and distributed.

The guidelines will be developed to protect the ability of any patient to obtain subluxation based chiropractic, including children and asymptomatic patients. Evidence based guidelines will be developed to protect the ability of D.C.s to use analytical and diagnostic procedures necessary to characterize the vertebral subluxation and its effects. Parameters for corrective procedures will be based upon objective evidence of subluxation correction, not merely temporary symptomatic relief.

Those in political chiropractic who created and marketed the Mercy guidelines may promulgate new guidelines which may have a negative impact on the practice of chiropractic. As a consequence, the CCP will produce apolitical, evidence based guidelines developed with input from a wide spectrum of chiropractic constituencies will best serve the patient and the profession.

"The biases and opinions of a self selected mutual admiration society should not prevail over the evidence, including clinical results, of the past 100 years," said Christopher Kent, D.C., newly elected CCP president. "We welcome written or oral evidence from any interested chiropractor. This includes case reports and observational studies as well as controlled studies. Our objective is to empower field doctors with information that will enhance their effectiveness. We are not here to tell anyone how to practice, or subjugate their clinical judgement."