When the "Guidelines for Chiropractic Quality Assurance and Practice Parameters" -- better known as the Mercy Guidelines -- were released in 1992, they were widely condemned as anti-chiropractic. Nearly all major national and state chiropractic organizations except the ACA, rejected the document.

At the time, the World Chiropractic Alliance (WCA) warned that, "If applied to all doctors -- without distinction -- its medical approach to diagnosing and treating diseases and injuries would mandate the incorporation of medical practices into the chiropractic office."

An initial review by the National Association of Chiropractic Attorneys called one section "a blueprint for claimant's attorney in chiropractic malpractice actions."

In May 1992, the board of directors of the International Chiropractors Association (ICA) voted to reject the document. They said they had "serious concerns relative to clinical goals and practice concepts of ICA members as well as other members of the profession."

Sid Williams, D.C. noted, "This document attempts to modify the practice of chiropractic, transforming it from a subluxation-oriented health care system into a musculoskeletal treatment program. ... The document attempts to force chiropractic into the medical model, using such terminology as 'treatment dosage,' reducing the chiropractic adjustment to just another modality."

The board of the Florida Chiropractic Society voted not to "accept, endorse, approve or otherwise sanction" Mercy for similar reasons.

In an article for the New York Chiropractic Council (NYCC), William Remling, D.C., FICA, NYCC chairman, and Mercy Center Conference participant reported, "It became obvious very quickly that the academicians and researchers were dominating this process ... I do not feel it did justice in representing traditional chiropractic practice."

The Colorado Chiropractic Association voted not to endorse Mercy, saying "The danger of any document like the Mercy Conference Standard is that it will be used against us... Let us consider all things and go slowly on this."

In the ensuing years, other groups and individuals have joined the chorus of condemnation against the ill-conceived set of guidelines.

Despite this overwhelming rejection, supporters of the controversial document continued to distribute, promote and hold seminars on the Mercy Guidelines, ignoring the sentiment of the majority of the profession.

In recent years, much of the outspoken criticism of the document has died down. This isn't because of any growing acceptance of Mercy, but of the perception that it had, finally, been defeated and had "gone away."

A new development, however, indicates that perception is erroneous. Mercy supporters have never accepted the verdict of the profession and are still attempting to force its medical standards of care on the chiropractic profession.

The latest evidence of this "never say die" attitude is the attempt by Mercy supporters to have the guidelines included in the National Guideline Clearinghouse (NGC).

The NGC is a comprehensive electronic database administered by the Agency for Policy and Health Care Research (AHCPR) which allows access to accepted guidelines from various health care disciplines.

The "Vertebral Subluxation in Chiropractic Practice Guideline," developed by the Council on Chiropractic Practice (CCP), were included in the NGC in February 1999.

Although the government announced formation of the NGC in April 1998, no attempt was made by Mercy organizers to apply for inclusion until shortly after the CCP guidelines were accepted.

A letter, from ECRI, an international nonprofit health services research agency, to William Meeker, D.C., director of research at Palmer College, stated that the NGC web site had received "many requests" for the Mercy document. The letter was dated May 5, 1999, and there have been unconfirmed reports that Mercy supporters orchestrated an "e-mail campaign" after the CCP document was included.

Dr. Meeker worked ECRI to prepare the web version of the document but there has been no evidence that the online document notifies readers that the chiropractic profession has almost universally rejected the Mercy Guidelines.

When informed of the controversial nature of the document, federal officials were quick to distance themselves from them, pointing to the NGC disclaimer that any document which meets the minimum requirements can be included in the database but that inclusion "does not mean that either AHCPR, its partners, or the contractor that administers the NGC operations 'approve' the posted guidelines."

There is some dispute, however, over whether the Mercy document meets even the minimum requirements.

According to the criteria set up by the Department of Health and Human Services, the guidelines must have been "developed, reviewed or revised within the last 5 years."

The Mercy Guidelines were developed in 1992 -- seven years ago -- and although the developers claimed the document was a "work in progress" and would be reviewed and revised periodically, no revised or updated version has ever been released.