Message to DC¼s in Israel  3/20/01


Chiropractic is a very important part of our lives. Not only is it a 
means for 

a very comfortable living, but more significantly it is a way to 
keep ourselves 

healthy.  The impact chiropractic has on the community is 
tremendous.  Thousands 

of people's lives are improved through chiropractic care, not to 
mention how 

many people have their life actually saved through regular spinal 
adjustments.

	Sadly, the profession of chiropractic is not as altruistic as it 
sounds above. 

 Chiropractic is run by politics.  Politics to most of us is an ugly 
word that 

we try to stay clear of. Not only is our profession constantly 
fighting with 

itself, but we also have to deal with the politics of the 
pharmaceutical industry, 

the medical establishment, government agencies and health 
insurers.  I do not 

have to tell you how a badly worded regulation can effect our 
practices. Just 

look at the whole personal injury and managed care mess in the U.S. 
This goes 

to show you how important it is to have rightly worded laws, 
statutes and regulations.

	With this in mind, I would like to address Dr. Scott Haldeman's 
derogatory remarks 

about the WCA and the CCP guidelines at his January 2001, ICS-
sponsored seminar 

in Israel.

	You may have thought that the WCA ‚ and IDOC in Israel, for 
that matter ‚ were 

only about straight chiropractic or represent some radical 
philosophy or dogma, 

but nothing could be farther from the truth.  It is about focusing on 
diagnosing, 

analyzing and correcting vertebral subluxations.  It doesn't matter 
if you do 

rehab, personal injury, nutritional or orthopedic supports, or use 
therapies. 

 As long as correcting subluxations is the most important thing you 
do and everything 

else is used to help the patient hold their adjustments, then 
according to the 

WCA and IDOC you are considered subluxation-centered.

	The WCA, the organization that was instrumental in developing 
and disseminating 

the CCP guidelines, is the only international chiropractic 
organization willing 

to stand alone in opposition with the organization Dr. Haldeman 
represents, the 

World Federation of Chiropractic (WFC).  Obviously, this causes 
resentment by 

the WFC towards the WCA, to say the least.  What's the „big deal¾ 
with the WFC?

	It is the position of the WCA that no set of guidelines should 
be interpreted 

as a "standard of care" or be used by state licensing boards, 
chiropractic organizations, 

insurance companies, courts of law, or any other entity in order to 
regulate 

or judge the practice decisions of any doctor of chiropractic.  
Instead, such 

guidelines are to be used only to assist doctors of chiropractic in 
providing 

the highest quality care to patients or to help non-chiropractors 
understand 

the scope and purpose of chiropractic.  In addi- tion, chiropractic 
guidelines 

should be the result of extensive input from the profession at large 
and address 

the primary purpose of chiropractic, the analysis and correction of 
subluxations. 

 Towards this goal, the CCP guidelines were developed.  For more 
information 

on CCP guidelines, please see Position Papers on the WCA Home 
Page at www.worldchiropracticalliance.org.

	By any of these standards, the Guidelines for Chiropractic 
Quality Assu- rance 

and Practice Parameters, commonly known as the Mercy document 
which the WFC vehemently 

supports and promotes, fails completely and is categorically 
rejected by the 

WCA.  It is the position of the WCA that any practicing doctor of 
chiropractic, 

government agency, health care organization, insurance company or 
other party 

should not use the Mercy Guidelines. In particular, the WCA 
condemns the use 

of the Mercy document by independent medical or chiropractic 
examiners as a means 

by which to judge the "medical necessity" of any care provided by a 
doctor of 

chiropractic.

	Among the specific reasons for the WCA's rejection of Mercy 
are: The Mercy document 

is, in essence, a set of medical guidelines which address non-
chiropractic issues 

related to the manual treatment of medically diagnosed conditions.  
The sole 

purpose of chiropractic is the analysis and correction of vertebral 
subluxations. 

Therefore, these medical guidelines have no bearing on the practice 
of chiropractic.

	The Mercy document restricts chiropractic primarily to the 
treatment of low-back 

pain in adults. The WCA strongly promotes the use of chiropractic 
as an integral 

part of a total health and wellness regimen, suitable for all people 
‚ from infancy 

to old age ‚ and regardless of the presence or absence of 
symptoms.

	The Mercy document is easily interpreted as setting limits on 
the number of 

visits a patient should reasonably have with a doctor of 
chiropractic.  It is 

the position of the WCA that each case, like each person, is unique 
and the determination 

of the duration of care should be a decision made by the doctor and 
patient.

	The Mercy conference was developed in a closed session by 35 
panel members without 

input from the profession at large. No explanation was given as to 
how these 

35 individuals were selected. A review of the people on the 
commission reveals 

an extremely heavy bias toward the more medicalized faction of 
the profession, 

despite the fact that it represents a minority of the pro- fession 
as a whole. 

 Only a few subluxation centered chiropractors were invited to 
participate and 

at least two afterward stated publicly that they felt they were 
included as "token" 

representatives but had no real affect on the proceedings. Also, the 
methodology 

of the Mercy conference was flawed.

	The Mercy document was rushed into the hands of the insurance 
industry before 

most doctors of chiropractic had been given a chance to review it.  
Almost immediately, 

several members of the commission began marketing seminars, 
books and other merchandise 

about the document, raising serious questions regarding conflict of 
interest. 

 The financial incentive of several members of the commission to 
profit from 

the acceptance of the guidelines throws significant suspicion on 
the motives 

behind their development and distribution.

	The Mercy document was published in 1993 as a working 
document to be updated 

and revised.  It has never been updated. In June 2000, the California 
Chiropractic 

Association, which had contributed to the conference and was one 
of the few organizations 

to give the guidelines a provisional endorsement, passed a 
resolution ending 

its support, saying the document "no longer represents the present 
state of scientific 

evidence."

	Further, major funding for the commission was derived by 
companies owned by 

commission members or having direct ties to those members, 
adding another layer 

of economic involvement to the picture.  Many of these companies 
were able to 

financially benefit from the findings of the conference and 
undoubtedly their 

financial aid had an influence on the outcome.

	The Mercy document has been rejected by almost every 
chiropractic organization 

on national, state and local levels, including the organizations that 
initially 

sponsored it. In addition, the Mercy document has been ruled 
inadmissible as 

evidence for testimony on a soft tissue injury (Reeves vs. Flaherty, 
et al. Expert 

testimony by Robert Martines, D.C., Santa Clara Superior Court, 
March 1999). 

 Finally, a survey conducted by The Chiropractic Journal revealed 
that chiropractors 

around the country have overwhelmingly rejected adoption of the 
Mercy Guidelines.

	For these reasons, and others not detailed here, the WCA 
rejects The Guidelines 

for Chiropractic Quality Assurance and Practice Parameters, a.k.a. 
Mercy document, 

and calls for its developers to publicly withdraw their support of 
this document 

as well.

Do you realize the impact this has on the Israeli scene?  If Israeli 
health authorities 

pass legislation on chiropractic as defined by the WFC ‚ which is 
how the authorities 

think today ‚ you will not be able to practice the way you do now! 
You will be 

restricted primarily to the treatment of low back pain in adults, 
limited to 

a set number of visits, whose necessity will be dictated by a 
medical doctor. 

It will be illegal to see chiropractic clients without an MD referral 
or on the 

basis of a total health and wellness regimen, suitable for all ages, 
and regardless 

of the presence or absence of symptoms.

	What can we do about this? We can support subluxation-
centered chiropractic 

by supporting the WCA and IDOC.  The WCA inter- nationally and 
IDOC in Israel 

are about protecting our rights as chiropractors and our patients' 
rights as 

clients of chiropractic. The WCA is made up of a large group of 
doctors from 

around the world who practice like you do, and the WCA is here to 
protect your 

rights and advance chiropractic to it's rightful place.  Your 
membership will 

help them support us.

	Not only has IDOC been founded as the Israel affiliate of the 
WCA, but also 

I personally am a proud WCA member for many years and would like 
to see as many 

chiropractors as possible join the WCA.  If you fill out an 
application in The 

Chiropractic Journal or online at the WCA website (see above), you 
may mention 

my name on the application as the doctor who referred you to join 
the WCA.  

	

Sincerely, 

Asher Nadler, DC