April 2008

We have the power ... let's use it!

by Dr. Terry A. Rondberg

I received another Council on Chiropractic Guidelines and Practice Parameters (CCGPP) e-mail recently. It announced that the chapter on Soft Tissue had been released and was available at the CCGPP website for comment for the next 60 days. "Your help in dissiminating (sic) this information to the masses is greatly appreciated," the message read.

I'd estimate that about 90% of the "masses" who read the announcement ignored it and, in many ways, I can't blame them. In the past, we've rushed to the CCGPP site, spent a couple of hours reviewing the draft document, a few more trying to figure it out and even more writing our critiques and objections.

When the first couple of chapters were released, doctors flooded the CCGPP with their responses, most of which were negative. Organizations around the world registered harsh criticism and urged the group to trash them as harmful to the chiropractic profession and our patients.

The World Chiropractic Alliance, International Chiropractors Association and Federation of Straight Chiropractors and Organizations all spoke out against the methodology used by, and conclusions drawn by, the CCGPP team. Even the Congress of Chiropractic State Associations (COCSA), at whose request the CCGP was supposedly created, refused to endorse the draft of the low back pain document.

The CCGPP's response to the tremendous outpouring of protest was minimal. The draft chapters were approved with slight stylistic changes and no substantive improvements. The numerous complaints about the procedures used by the CCGPP were ignored.

In response, the profession, in its turn, began to ignore the CCGPP. The last news update on CCGPP I could find on the ICA's website was back in 2006 when it called for the withdrawal of the draft "Low Back" document. Same thing with the WCA website (although The Chiropractic Journal has continued to write articles on the issue). COCSA hasn't updated its online CCGPP news page since August of last year, which seems a clear indication that it, too, has given up trying to get the CCGPP to respond to the profession.

Most field doctors have also taken to ignoring the CCGPP and hoping somehow it will just "go away" or that the documents it develops and distributes to insurance companies and HMOs won't completely destroy their ability to practice chiropractic in accordance with their training and principles. In short, we simply washed our hands of the whole mess.

This, I imagine, is exactly what the CCGPP expected -- and wanted -- to happen. There are many ways to silence one's opponents. One of the easiest is to ignore us and make us think we are powerless. When we feel our voices aren't being heard, we cease to raise them.

But Brazilian educator and author Paulo Freire was right when he said that "Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral." By ignoring the CCGPP, we are actually aiding and abetting them.

The solution is not to give up the fight, but to use more effective tactics. Here are a few suggestions:

*** Continue to register your protests with CCGPP, and send copies of your critiques to The Chiropractic Journal. Yes, I know, the CCGPP's 60-day comment period is a farce. We can comment all we like and the CCGPP will continue to develop its opinion-based guidelines that are simply, as Christopher Kent, DC, noted in his column last month, a "claim cutters bible." Still, we need to have these criticisms on record, and be able to show that we did send them to the CCGPP. They might be ignored, but the Journal can print them and let it be known worldwide what the profession really thinks of these "best practice" documents.

*** Get your state organizations to officially reject the CCGPP. More than 20 state groups have already done this and we need to get similar statements from every chiropractic association. In court, we need to be able to show that the CCGPP documents being used against us have been widely rejected throughout the profession.

*** Stop the flow of money to the CCGPP. Hundreds of thousands of dollars have already been raised and spent on this fiasco and its 2008 budget is $300,000 -- money that could be going for public education, media relations, legislative lobbying and research. Go to the CCGPP website and review the list of donors (posted in the budget section). Is your state organization or school listed? Are any of the companies you do business with on the list? Are you a member of or do you donate or support any of the groups that are paying for CCGPP? If so, stop supporting them and let them know why. Keep in mind the words of American Revolutionary patriot John Dickinson: "No free people ever existed, or can ever exist, without keeping 'the purse strings' in their own hands." Let's take back the purse strings!

*** Support the only real alternative to CCGPP: the Council on Chiropractic Practice (CCP). The CCP guideline document was the only thing able to save doctors from the Mercy guidelines and, because it is the only set of truly evidence-based guidelines, it is the only one that has been able to win widespread acceptance and credibility. Chances are, if you have to fight for your chiropractic rights in court, before your board, with an insurance company, or in the "court" of public opinion, you'll be faced with countering some arbitrary consensus-based conclusion from the Mercy guidelines. In the future, it'll be the CCGPP. Either way, your only real recourse will be to turn to the CCP guidelines to find the scientific evidence needed to validate chiropractic. We might not be able to stop the CCGPP, but we can make sure we continue to have the CCP standing behind us. Visit www.ccp-guidelines.org  to make an online donation and download a copy of its guidelines.

If you have other suggestions, let me know so I can share them. The CCGPP may be willing to ignore you, but I won't. We can't stop them from putting out their document but we can minimize the impact they have over us and the way we practice. I know they want you to believe you are among the powerless, but the truth is, we -- the doctors who belong to the "masses" as they call us -- are the ones with the power. We just have to use it.