The long-awaited practice guidelines document developed by the Council on Chiropractic Practice (CCP) has been released after nearly three years of intensive study and work.

The CCP, which was founded in 1995 for the express purpose of developing an evidenced-based document to help guide chiropractors in their practices, is comprised of a multidisciplinary panel, supported by staff, and led by a project director.

According to CCP president Christopher Kent, D.C., "The purpose of these guidelines is to provide the doctor of chiropractic with a 'user friendly' compendium of recommendations based upon the best available evidence. It is designed to facilitate, not replace, clinical judgement."

Because it recognizes the importance of both the vertebral subluxation and scientific evidence, the CCP guidelines are thought to be more applicable to the chiropractic profession than the Mercy Guidelines, which were widely rejected by chiropractors and their organizations.

In his research column for this issue of The Chiropractic Journal, Kent notes that surveys have shown there is strong support for "subluxation-based family wellness care," and great opposition to the Mercy Guidelines.

Advance copies of the "CCP Clinical Practice Guideline Number 1, Vertebral Subluxation in Chiropractic Practice" have won overwhelming support from practicing doctors, who commend both the document's content and the process which created the guidelines.

"For the first time, subluxation-oriented field doctors will have a document which will help guide them in real-life situations," said XXXXX. "They'll be better doctors because of it."

Others saw in the document a way to combat the negative effects of the Mercy Guidelines, which until now were often used by the insurance industry to curtail payments.

"No longer can adjusters or lawyers offer the Mercy document as 'proof' that chiropractic care shouldn't be provided to children, or that vertebral subluxations simply do not exist," stated Timothy Fueling, marketing director of Chiropractic Benefit Services.

Fueling estimates that the majority of chiropractors have been injured by the Mercy document.

"Mercy has been a tool for the insurance companies, and for attorneys who take chiropractors to court. Until now, we didn't have a strong weapon to use in our defense. Now, we do."

Other doctors applauded the open process used by the CCP to develop the guidelines. The Mercy Guidelines were strongly criticized as being "elitist" and out of touch with real chiropractic practice. The Mercy document was constructed by a handpicked group of 34 individuals who met behind closed doors and released it to insurance companies and government agencies before most chiropractors had a chance to even see it. It did not go through a peer-review process or seek any input from technique developers or the profession at large.

In contrast, the CCP held an "open forum" to encourage the participation of all interested doctors. It even solicited written comments from those doctors who could not attend in person.

Further, it held a separate forum attended by many of the top technique developers or their representatives, in order to gain their insights and information.

Ultimately, doctors from more than 12 countries supplied input into the process before the first draft was even written. Finally, the draft document was distributed to 195 peer reviewers, who worked diligently to refine it so it met the needs of chiropractors everywhere.

The result is the first and only evidenced-based guidelines which have the potential to unite the profession.

Even strong supporters of the Mercy document have been observed wavering now that the CCP document has been released.

In the August 24, 1998 issue of Dynamic Chiropractic, which helped fund the Mercy efforts, Donald Petersen, Jr., editor and publisher, noted, "Guidelines with the credibility of the AHCPR reports would necessitate multidisciplinary panels and involve researchers from several countries..."

Petersen himself sat on the Mercy Guidelines panel. Although he does not specifically mention the CCP guidelines in his column, he refers to the multidisciplinary panels and international composition which set CCP apart from Mercy.

He went on to say, "If we ever hope to be more than just low-back specialists, we have no choice. To turn back now is to seal the outcome. The entire human body cries out for the renewal of life and vitality that chiropractic adjustment brings. The public knows the value of chiropractic for low-back problems. It's now our job to move beyond that to the rest of the spine and, ultimately, to the whole person."

Although such rhetoric is uncommon for Dynamic Chiropractic, it might signal a change in direction for some supporters of Mercy, who in the past have focused almost solely on acute low back pain in adults and have shied away from using the word "adjustment."