Referrals -- Apparently straight chiropractors may only refer to other straight chiropractors. Not only is there no provision for referral to other health care providers, referral to a nonstraight chiropractor is not even a consideration.The guidelines clearly state that they have been developed for use by a very specific segment of the chiropractic profession. What will be difficult for the general public and other health care professionals to determine is who is a Wyndham-straight chiropractor and who is a Mercy-straight chiropractor. Perhaps these guidelines can help facilitate a specialty designation that will help lessen the confusion.Practice Objectives -- A straight chiropractor under these guidelines is to treat vertebral subluxations only, regardless of specific symptoms or disease.
Education -- Only the Standards of Accreditation produced by SCASA's Accreditation Commission and the bulletins of the three SCASA colleges are recognized in "Professional Development," chapter twelve.
Diagnosis -- The guidelines do not recognize diagnosis per se. They do recognize "analyses" as the means of determining the presence of vertebral subluxations.
Terminology -- All terminology used in the guidelines are words specific to the chiropractic profession and not used by other health care professions.
If "imitation is the sincerest of flattery," as Charles Colton (1780-1832) wrote in Lacon, then the Mercy Commissioners should feel profoundly complimented by the Wyndham document duplication of the Mercy format, style, and verbiage. Less than four months after Ralph Boone, DC, PhD, attended the Mercy Conference as a Commissioner Member, he was attending the Wyndham Conference as its moderator, or as Wordsworth said, "As if his whole vocation were endless imitation."
Cover -- The Mercy document is white lettering on a maroon cover; the Wyndham document is maroon lettering on a white cover.Now that the Wyndham Guidelines are available, it will be interesting to see if any organizations besides the WCA, SCASA and the Federation of Straight Chiropractic Organizations (FSCO) choose to endorse or recognize them. It appears unlikely that government agencies and third-party payers will recognize these guidelines until they can determine which DCs prefer to practice under -- Wyndham or Mercy. Either way, there is now an opportunity to compare the two guidelines and consider their utility.Table of Contents -- Not only is each subject heading in approximately the same order, many of the chapter titles are the same. Indeed, out of 13 chapters in the Wyndham Guidelines (14 in Mercy), six of the chapter titles are identical, two have similar wording, and one Wyndham chapter uses a title very similar to the working title of the corresponding Mercy chapter used in the first Mercy draft.
Prefaces -- The Mercy Guidelines included the comments of Herve Guillain, MD, of the Agency for Health Care Policy and Research (AHCPR); The Wyndham Guidelines use a similar preface by Dr. Guillain. Instead of Paul Shekelle, MD, MPH, of the RAND Corporation (as used in Mercy), Wyndham has David Eddy, MD, PhD. Dr. Eddy admits in his preface that he lacks the knowledge to comment on the recommendations.
Steering Committee -- Just like Mercy, the Wyndham Conference had nine people, but the similarities stop there. The Wyndham nine are drawn from a very narrow pool: five who hold positions as SCASA college presidents or administrators, and four who hold positions with the WCA.
Committee Members -- The Mercy Conference had 35 Committee Members; The Wyndham Conference had 37. The Mercy Conference had observers, special consultants, and legal council -- so did the Wyndham Conference.
Chapter Formats -- Title pages of the chapters are identically formatted. In addition, each chapter is divided into sections that are either identically titled or very similar: the only difference being that the Mercy Guidelines also includes an epilogue and three appendices. Two of the Wyndham chapters have lists of subtopics that are close to identical to the corresponding Mercy chapters in wording and order of appearance.
Rating Systems -- The rating systems are also similar, but the Wyndham Guidelines fail to use any negative ratings. The "Evidence" classifications were also very similar; three each with different names.
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