Members of the International Chiropractors Association (ICA) are overwhelmingly opposed to any ICA support of or involvement in the guidelines process being conducted by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP).

In response to a questionnaire mailed to all ICA members on April 4, 1996, 95% of respondents said the ICA should NOT offer any financial support to the CCGPP group before they have seen the guidelines it will propose. Only three percent said they would approve of the ICA providing such support. The remaining two percent either did not respond to the question, or indicated they did not know.

The cause for this cautious approach is clear from the responses to another question. Of those who answered the questionnaire, 70% said the Mercy guidelines have had an adverse effect on their practices. For 63% of them, the guidelines have been used to cut or deny insurance claims.

The ICA had initially supported and participated in the development of the Mercy guidelines, hoping that its input would balance the more medically-oriented stance of most ACA representatives. However, for the most part, their opinions and suggestions were ignored and the ICA rejected the resulting guidelines, which were distributed to insurance companies before the profession had an opportunity to review them.

Having been burned once, ICA members apparently are not willing to allow the same thing to happen again. That's why 90% of them stated, on the survey, that they feel "the prudent course is to wait to see what the CCGPP guidelines say, and whether they are consistent with ICA principles, before contributing to them."

While their disdain for the CCGPP -- dubbed by most chiropractors as "Mercy II" -- was strong, their support for the Council on Chiropractic Practice (CCP) was even stronger.

The development of subluxation-based practice guidelines by the CCP had the support of 96% of respondents, and fully 99% said they supported the mission of the CCP which 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." Support for the CCP concept of "lifetime, subluxation-based family wellness care," received almost unanimous support, with 98% of the respondents saying they advocate that philosophy.

The questionnaire was distributed by the CCP in order to obtain feedback on the opinion of ICA members about the two guidelines efforts going on concurrently.

"The members of the ICA have always been the most steadfast defenders of chiropractic as a drug-free, subluxation-based health care profession," stated CCP President Christopher Kent, D.C. "Their opinions are extremely important to us and will help us chart the CCP's future course."

Along with their surveys, many doctors included copies of letters they were sending to ICA officials about the issue.

C.A. Riekeman, D.C. of Albuquerque, N.M., wrote to ICA President Robert Braile, noting that she has been an ICA member since he graduated from PCC in 1974 and that her father was an ICA member until he retired in 1986. During all that time, Dr. Riekeman explained, neither ever wrote to the ICA since, "I have been pleased with ICA's position on issues and its accomplishments."

Riekeman added, "At this time, I feel strongly enough about a particular issue to break my 21 years of silence and will take the time to express my opinion concerning the CCGPP and their attempt to create 'Mercy II.' Give me a break! Mercy I was bad enough. I can just imagine what Mercy II will do to my practice and my profession.

"Thankfully," she continued, "in most cases I have managed to maneuver around the Mercy guidelines because most of the organizations to which I belong do not endorse the guidelines and often the adjustor I am dealing with will back down when I declare I am not subject to the guidelines since they are not endorsed by the organizations to which I belong, and since they are not universally accepted within the profession as a whole.

"I have spent many hours dealing with this and I will never know what it has cost me monetarily," she stated. "And what about the patients? They are the big losers in the whole mess. They are the ones denied the care they need (or the reimbursement for that care). Multiply my experience by all the chiropractors out there trying to provide their patients with proper care and the effects of Mercy are disastrous."

Riekeman concluded with an appeal echoed by many others who wrote to the ICA.

"Let the CCGPP show their hand before they are given any further support," she suggested. "I am respectfully asking you as ICA president to refuse to give CCGPP any support, especially financial, until the new guidelines are completed and carefully reviewed. I DO NOT want any of my money supporting the CCGPP until I am convinced they are not engineering further chaos or a new and improved form of disaster."

Christopher P. Allen, D.C., ICA district representative for Oregon, offered a similar argument.

"Looking back at Mercy I," he wrote, "we can see that while on paper the intent may have been good, the end result has been highly negative. Different states and state organizations have refuted Mercy while on the other hand Mercy has been used to cut payments made for reasonable and necessary care. I've had this experience in my own practice, specifically with PI claims being cut and the Mercy document being footnoted as the reason for non-payment."

Dr. Allen added, "I feel that any guidelines accepted should be based on a true chiropractic model of subluxation-based care. This is certainly not the case with Mercy ..."

Brian W. Zaleski, D.C., of Vacaville, Calif., who proudly noted that "I am deeply committed to the ICA and subluxation-based chiropractic," wrote: "If Mercy II goes through in its present form -- three subluxation-based representatives and five non-chiropractors (perhaps Joe Keating will finally find a job that he can keep for a while) --- it will be, to use Dr. Kent's analogy, like having three minorities at a Klan meeting and saying that minorities were well represented."

Dr. Zaleski underscored the intensity of his feelings by stating, "If the ICA lends ANY financial assistance to this travesty prior to the approval of the membership (or at least the Board), I will immediately resign from the organization and will urge everyone else I come in contact with to do the same."

Jack M. Masche, D.C., of Greenfield, Wis., was direct and to the point when he said, "As a member of the ICA I urge you to stand strong against the CCGPP with the upcoming and infamous 'Mercy II Guidelines,' soon to assault our profession. Please do not support this in any way shape or form. As a subluxation-based chiropractor, I find the CCGPP both repugnant and obvious in their bid to take over chiropractic. You displayed great courage and foresight in rejecting Mercy I. Please hang tough and do it again for all that we hold dear in chiropractic."

The survey's statistical analysis was provided to the leaders of the ICA. Although they are not bound by the results of the survey, most members feel confident that they will abide by the wishes of the membership and withhold support from the CCGPP until the profession can evaluate its guidelines.

The responses were tabulated and analyzed by research associate Marnie Dobson (present address: Anatomy & Neurobiology, College of Medicine, University of California-Irvine). Dobson noted that the number of returns received within one month of the mailing date was sufficient to constitute a valid "representative sample."

She commented that a "high level of internal consistency was shown between questions, suggesting respondents were discerning when answering the survey."

Dobson noted that there were "no statistical differences in responses according to geographic location" when calculating the percentage of response from each of four geographic regions within the U.S.