Last month, presenting two history-making symposiums in Phoenix, Ariz., the newly founded Council on Chiropractic Practice (CCP) took its first, promising steps on the journey toward creating true chiropractic guidelines.

The first event brought together 28 of the profession's most prominent technique experts to explore issues they consider vital to the progress of the profession. It was the first time in chiropractic's 100 years that such a group had gathered for the harmonious sharing of ideas and information.

The second meeting, held one week later, gave the CCP board an opportunity to hear from the profession's leading practice management consultants on practical issues affecting field doctors in real-life situations.

Diverse techniques explored

During the CCP Technique Symposium, a wealth of technical data was presented on each technique, with the actual developers often in attendance to personally explain their methods.

In addition to the technical information, CCP organizers emphasized to attendees the importance of remaining open-minded and tolerant of all techniques.

After warning of attempts by several state boards to outlaw certain techniques based on what he called "capricious and arbitrary" reasons, CCP board member Patrick Gentempo, D.C. stated, "Even if we disagree with a particular technique...even if we feel some other technique is better...we must fight to the death to protect the right of doctors to choose what technique they will use. It's about freedom, not fascism."

Dr. Ted Morter, head of Best Morter Health Systems, acknowledged that, "This is a big job we have ahead of us." To accomplish their goals, he advised the group to remember "Chiropractic was not created for chiropractors. It was created for the public as a complete and distinct alternative health care, not adjunct number two."

To remain strong, chiropractic needs to "focus on natural health care, on wellness -- not disease and eliminating it, but health," Morter stressed. "That's our forte. Finding and removing the cause of interference. We have to maintain the concept, the principle, the philosophy of innate intelligence."

Pointing out that he often works with other health care professionals, Morter stated, "Medical doctors and physical therapists are no threat to us except politically. We have no competition in health and wellness and healing...no competition in removing interference. But we have a problem which is bigger than the one facing any single technique. It's the survival of chiropractic as a distinct and separate health care provider. Let's not lose sight of that."

Differences set aside for meeting

Before the symposium, some observers worried that personal, professional or business rivalry would make it difficult to have meaningful dialogue between "competing" technique experts. However, those fears proved to be unfounded as the meeting progressed.

"For many years, we focused on methods rather than objectives," noted Dr. Christopher Kent. "We focused on our differences rather than our commonalities. What I've observed...is that everyone in this room has a commitment to the analysis and correction of the vertebral subluxation -- a commitment that transcends methods and gets into objectives and most importantly, to preserving our clinical freedom."

While focusing primarily on the key issue of techniques, attending doctors discussed at length the CCP in general and contributed significant input into its goals and process.

Dr. Gentempo echoed the sentiment of several colleagues in attendance when he admitted that, "Philosophically, I am completely opposed to the guidelines process as a way of government. Government by consensus, by definition, is fascism, it's mob rule. Whoever has the biggest mob, rules. I am against the concept of any group controlling the profession through guidelines. However, I realize that maybe guidelines can be put together in a way that provides for freedom yet can still satisfy the AHCPR in a way that Mercy could never satisfy the field and the insurance carriers and the AHCPR and everyone else."

The inability of the Mercy Conference to provide acceptable guidelines for the process was seen as a particularly strong impetus for the CCP efforts. "The key point is whether field doctors are happy with the Mercy Guidelines," said Dr. Donald Epstein. "Can doctors be happy practicing within its limitations? If not, this may be their only opportunity to make a positive change, to have their voices heard."

Dr. Fred Barge noted that evidence-based guidelines specifically geared to chiropractic are vital if the profession is to "remain separate and distinct."

Asked what he thought would happen if Mercy remained the only existing set of chiropractic guidelines, Dr. Don Olson was ominous. "The large number of new and relatively new and unestablished practitioners will, out of fear and ignorance, be more likely to compromise their chiropractic principles," he stated. "They and the world would suffer."

Establishing clear agenda

However, the failure of Mercy was seen as an obstacle as well.

"After being burned by the Mercy document, many field doctors are wary of the agenda of any group that seeks to have such a an effect on the profession as a whole," cautioned Dr. Richard Belli. "If this group has an agenda for all, and not just for one, the support will come."

CCP leaders took extraordinary steps to make sure the group's "agenda" could be embraced by the profession as a whole. It has carefully avoided formal affiliation with any national or state chiropractic organizations and emphasized throughout the meeting that its purpose was to obtain information on -- not to endorse or "sell" -- any particularly technique.

One of the most common criticisms about the Mercy Conference was its failure to obtain input from technique experts or others involved in the actual care of patients in clinical settings. The preponderance of academicians, research scientists and political leaders at the Mercy Conference made it difficult, some critics say, to create guidelines which had relevance to real practitioners.