I need to add a note of explanation to the front-page graph about nonmusculoskeletal complaints displayed in the most recent issue of Dynamic Chiropractic ("Beyond Musculoskeletal," DC, July 30, 2001, front page; on line at www.chiroweb.com/graphs).
The legend was very misleading to readers, stating that 10.3 percent of chiropractic patients present with nonmusculoskeletal complaints.
As the principal investigator of the study cited, I can tell you that this figure applies only to the sample of DCs in our study. It was so high because we specifically recruited chiropractors that saw higher-than-average numbers of patients with nonmusculoskeletal complaints, as part of the study design for the project described in the paper you cited. The general prevalence of nonmuscu-loskeletal chief complaints in chiropractic practice is much lower - less than three percent, and probably closer to one percent.
Cheryl Hawk, DC, PhD
Director, Palmer Practice-Based Research Program
Not "dismissed" - "simply not re-elected"
I am compelled to respond to Dr. Mark Van Hemert's letter, published in the June 4, 2001 issue of Dynamic Chiropractic, concerning the Council on Chiropractic Practice (CCP).
Dr. Van Hemert alleges that he was "dismissed" from the CCP Board. Our by-laws provide for a formal process, including a hearing, to remove a sitting member from the board. To date, this process has never been implemented. In actuality, Dr. Van Hemert was simply not re-elected when his term expired.
Our panel carefully considered Dr. Van Hemert's input. Since our objective was to produce evidence-based guidelines, we could not rely upon wishful thinking or speculation. Neither Dr. Van Hemert nor any other panelist was able to produce evidence supporting the validity of any method to prospectively determine the frequency and duration of care necessary to correct or stabilize vertebral subluxations.
We did, however, find reliable and valid technologies to measure anatomical and functional manifestations of vertebral subluxation. It is this evidence, which forms the basis for our recommendation that frequency and duration of care should be determined on an individual basis, using appropriate assessments.
Dr. Van Hemert's suggestion that the panelists, technique developers, consultants, and peer reviewers were "used" by Dr. Rondberg is not consistent with the facts. Furthermore, it is insulting to those individuals who gave their time and talent, with no remuneration. Dr. Rondberg was one of over 200 individuals involved in the guideline development process. He had one vote on our panel, like each of the other 15 members. There was never any mention of his malpractice insurance company.
The mission of the CCP was, and remains, "to develop evidence-based guidelines, conduct research and perform other functions that will enhance the practice of chiropractic for the benefit of the consumer." It was never our objective to pander to any special interests, be they third-party payers or malpractice insurance companies. I believe we succeeded in our stated mission.
Clinical Practice Guideline No. 1, Vertebral Subluxation in Chiropractic Practice was the first chiropractic guideline to qualify for inclusion in the National Guideline Clearinghouse. The Guideline enjoys widespread acceptance by chiropractors whose practices emphasize the detection and correction of vertebral subluxations, and has been accepted in courts of law.
I am sorry that Dr. Van Hemert didn't get a "Thank you" for his efforts; neither did any of the other panelists. However, as president of CCP, I am happy to correct that oversight by extending my personal thanks to all those who participated in the development and promulgation of Clinical Practice Guideline No. 1, Vertebral Subluxation in Chiropractic Practice.
President, Council on Chiropractic Practice Ramsey.