June 2007

CCGPP process continues despite clear opposition

A letter e‑mailed by the Council on Chiropractic Guidelines & Practice Parameters (CCGPP) boasts that, despite widespread opposition from the profession, the group is continuing its development and distribution of what it calls its "best practices" initiative. "While things have been quiet, the process has continued forward," stated Mark D. Dehen, vice‑chairman of the CCGPP.

According to the communication, the CCGPP is making minor editing on the first chapter to "improve its clarity and readability," but will not be "amending the existing research or conclusions." In response to demands that the document contain information about subluxation correction ‑‑ a topic that was virtually ignored in the original draft ‑‑ the CCGPP established a "task force" chaired by Drs. Carl Cleveland and Meridel Gatterman, who was involved in the development of the chapters relating to Contraindications published in both the Mercy Guidelines and Canadian Chiropractic Practice Guidelines.

The CCGPP letter also boasted that the group is "in discussion with the FCER on ways of partnering to promulgate the dissemination and implementation of evidence based care for the chiropractic profession."

"It's clear from this statement that the CCGPP intends on foisting this document on us, regardless of what the profession says," stated Terry A. Rondberg, DC. "Obviously, the call for feedback from the profession and from various chiropractic organizations was a complete charade. They ask for comments and suggestions and then ignore them. Now, they tell us that their Mercy II guideline document is a done deal and there's nothing we can do to stop them."

Some 30 chiropractic organizations have rejected the CCGPP draft and/or already voted to ask the CCGPP to withdraw or rewrite its flawed "Best Practices Lower Back Draft Document." The World Chiropractic Alliance, the International Chiropractors Association, and the Federation of Straight Chiropractors and Organizations have issued official statements rejecting the CCGPP 'best practices' guidelines.

Even the Congress of Chiropractic State Associations (COCSA), which originally created the CCGPP, failed to endorse the draft of the first chapter, released last year. Instead, COCSA members unanimously approved a list of recommendations to CCGPP, including the suggestion that the document incorporate changes suggested by COCSA member organizations.

Dr. Dehen's letter is vague and confusing when it comes to discussing what changes the CCGPP will actually incorporate. He notes that "Dr. Bill Meeker and Dr. Dana Lawrence, team leads for the low back evidence synthesis chapter, are completing the review and synthesis of the commentary received. Once that commentary has been collated, it will be reviewed by the team for consideration as part of the expert opinion process. That commentary and the team response will then be included in the final version of the low back evidence synthesis."

A careful reading indicates that the CCGPP does not promise to actually incorporate any of the suggested changes, but merely "review" them and then include the team response in the final version.

The letter also implies that CCGPP members recognize the mounting opposition and have already begun planning ways to "sell" the document to the profession. A seminar is being planned "with the goal of enhancing the appreciation of the field practitioner for the utilization of evidence in promoting and defending the care they provide for their patients."

Dr. Rondberg stated that although it may be impossible at this point to prevent the CCGPP from publishing its document and distributing it to the insurance industry, field practitioners can fight back by supporting the Council on Chiropractic Practice Guideline, which is currently undergoing necessary revisions. The revisions are needed to update the findings and positions as well as to ensure continued inclusion in the National Guideline Clearinghouse.

When it was first developed, the CCP guideline document was reviewed by an independent research agency (ECRI) which is a Collaborating Center of the World Health Organization. Based on this review, it was accepted for inclusion in the National Guideline Clearinghouse (NGC), a public resource for evidence‑based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]).

The CCP and its official published documents were also accepted for inclusion in the Healthcare Standards Database and the printed version of the Healthcare Standards: Official Directory. Healthcare Standards (HCS) is a comprehensive list of published standards, guidelines recommendations, position papers, policy statements, technology assessments, and other authoritative documents. ECRI is the World Health Organization's official healthcare standards and guidelines archive. HCS is used daily in legal and clinical settings by a wide variety of medical and legal professionals such as: risk managers, litigators, paralegals, legal nurse consultants, medical and legal librarians, patient safety officers, biomedical engineers, insurance carriers and more.

The CCP document is the ONLY major chiropractic guideline that supports subluxation‑based chiropractic. The guideline is a compilation of the best available evidence concerning the detection, management, and correction of vertebral subluxation. It serves as a tool to empower DCs with the information needed to develop more effective clinical strategies, and objectively assess functional and clinical outcomes.

The CCP document also provides chiropractors with the intellectual ammunition needed to defend their practice style when challenged by regulators, policy makers, and in court proceedings.

"Chiropractors have a clear choice," Rondberg noted. "They can do nothing, and allow the CCGPP to have the an even more disastrous affect on their practices than the Mercy Guidelines had, or they can make sure we have an alternative, truly chiropractic set of guidelines to help maintain our profession's high practice standards while safeguarding its unique character."

The CCGPP's 2006 budget is $444,000 ‑‑ bringing the total already spent for their activities to well over a million dollars. According to the CCGPP's website, "We continue to solicit funding from the profession, from suppliers to the profession, from federal and private grant sources. CCGPP has applied for federal funding because many patients served by chiropractic doctors are in federal programs which need a more relevant chiropractic focus." It notes that "Meetings, accounting expenses, clerical expenses, research honorariums, travel for teams to meet and for CCGPP council members to attend meetings and speak before stakeholder groups as well as stakeholder communications are the other principal budgetary items."

In contrast, the CCP relies almost totally on volunteer effort from chiropractors around the world and has no large corporate sponsors or government grants. Still, the CCP needs approximately $50,000 to complete its revisions. Donations may be made online by visiting the CCP website at www.ccp‑guidelines.org, which also contains more information about the CCP, its guidelines, and the CCGPP document. Copies of the current CCP Guidelines may be downloaded free of charge at the website.