Dr. Kent responds to allegations in resolution

Christopher Kent, D.C., FCCI, president of the Council on Chiropractic Practice (CCP) was quick to respond to allegations made by the anti-subluxation faction in Canada.

1. Allegation: The CCP Guidelines were developed for a portion of the chiropractic profession in the United States and do not represent the Canadian chiropractic profession.

Response: The CCP Guidelines were designed to be international in scope, and involved peer reviewers in 12 countries, including Canada.

2. Allegation: The CCP Guidelines does (sic) not rate the categories of evidence and has ascribed the category of opinion equivalent to that of higher experimental studies such as controlled trials.

Response: The CCP guideline states the nature of the evidence found which supports the recommendations. As noted by Sackett (Spine 1998;23(10):1085), evidence-based clinical practice is "the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients...(it) is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our questions."

This sentiment is expressed in ACC (Association of Chiropractic Colleges) Position Paper #1, which states, "A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence." This statement was agreed to by all North American Chiropractic College Presidents, including Dr. Moss of Canadian Memorial Chiropractic College.

The CCP Panel sought broad input, including hand and computer database searches, reviews of presentations at symposia, privately published notes, and oral presentations at an invited symposium attended by technique developers.

It is the task of the practitioner to assess the applicability of that evidence to the individual patient.

3. Allegation: The CCP guidelines have not adequately and accurately presented the research that is claimed to support these guidelines.

Response: The CCP panel had the intellectual honesty to include citations which disagreed with their recommendations, as well as references which supported them. The preponderance of evidence cited supports the recommendations.

4. Allegation: The CCP guidelines quote symposia abstracts as research studies that support their guidelines.

Response: Research abstracts are quoted for what they are. A review of symposia was included in an effort to find the best available evidence. Arbitrarily excluding presentations at symposia would exclude valuable evidence.

5. Allegation: The CCP guidelines quote studies to represent evidence regarding one viewpoint, when in fact careful reading of the same study reveals the opposite viewpoint.

Response: See answer 3.

6. Allegation: The CCP guidelines do not adequately address the concept of clinical validity in describing its guidelines.