Articles by JCS
Chiropractors Image Makeover
The chiropractic profession’s image took a hard blow recently during the FSU debacle, only compounding our already fractured image after the Life Diploma Mill scandal that left us with a huge black eye. Now we have two black eyes after reading the press accounts of the FSU debate where “pseudoscience” was thrown around liberally without any response. Indeed, we’re on the ropes without any sign of a good defense.
It seems whenever an angry MD spouts off and cast aspersions our way, we have no champion to fight in our defense. Indeed, while vendor-driven Life (which is still a dumb, cultish name for a college) remains an embarrassment to chiropractic education, the failure at FSU was a crushing defeat to any hope of escalating our science to the graduate level in a public university. And hearing our “straight” brethren in the Florida Chiropractic Society testify against the FSU program was a dagger in our hearts.
Although the recent WFC and FCP surveys on our public image are two steps in the right direction, neither will overcome the impact of these recent public setbacks. Added to this mix are the Trigon and HHS lawsuit defeats, the Bush Administration’s refusal to pursue the Patients Bill of Rights and Health Care Reform, and the triumph of ASHP in its lawsuit filed by the California Chiro Assn, and we don’t have a lot to cheer about recently. Indeed, if it weren’t for the good work of the ACA in its legislative victories, this profession would be in dire straits despite the traitorous Chiro Coalition that fights the ACA on every effort.
Waiting for the lawsuit to be appealed or hoping to rally a dysfunctional, splintered profession around the FCP PR program does not give us field docs much hope that we can turn the tide soon with these problems. As HMO’s squeeze care to expand their profits at the blessing of the Bush Administration and as our downtrodden public image worsens, what can we do to stem this tide? Although it seems we can’t get the monkey off our backs, I do have one solution that may work and not cost a dime, if we have any luck and innovative leadership.
Recently an Associated Press writer, Rachel Zoll, religious editor, has written two interesting articles about evangelical sects undergoing reconciliation within their factions and public image makeovers. Ironically, it seems these religious groups are doing exactly what the chiropractic ought to do; indeed, it should have been done decades ago, but for all intent and purposes, that was impossible as long as obstructionists were in power.
FYI: the following headline appeared last Saturday in my local newspaper:
Evangelicals seek to clarify their beliefs to a wary public
HAMILTON, Mass. Feb. 12, 2005 - Recognizing that many Americans worry about their influence following President Bush's re-election, evangelicals are saying that they have been misunderstood and - in some ways - remain underdogs in a nation they consider hostile to public talk about faith.
The image of evangelicals is a key element in an ongoing series of conferences in Washington and other cities explaining the movement; the first meeting was held last week at Gordon-Conwell Theological Seminary outside Boston.
Couldn’t the same exact comment be made about chiropractic—being “misunderstood” and “remain underdogs in a nation they consider hostile to public talk about” healthcare?
Here’s another article Ms. Zoll wrote about a similar problem we share with our faith-based Baptists:
NASHVILLE -- Four black Baptist groups whose churches were a training ground for prominent civil rights leaders, but split in part over how that fight should be waged, said yesterday that they were embarking on a new era of cooperation meant to put the concerns of their community atop the national agenda.
Wouldn’t it be grand if someday soon in the Associated Press we might read a similar headline: “Long-divided chiropractors try to unite around common agenda”? How about the following article?
Chiropractors seek to clarify their beliefs to a wary public
Recognizing that many Americans remain confused, if not skeptical, following the recent failure at FSU to implement a chiropractic program and the loss of accreditation at Life University, once the largest chiropractic college in the world, chiropractors are saying that they have been misunderstood and - in some ways - remain underdogs in a nation they consider hostile to this non-drug, non-surgical treatment for neuro-musculoskeletal disorders that plague this country.
“We’re the third largest primary health care profession that is now 110 years old, but our healing art is still unknown to millions of American who sorely need us,” said the ACA’s spokesman, Dr. Dudley DooRight.
Like Rodney Dangerfield, chiropractors now feel they don’t get the respect they deserve despite new research studies that support their treatments.
“There have been nearly 60+ research clinical trials recently that confirm spinal manipulative therapy ranks at the top of proven treatments for the epidemic of low back and neck pain, but many in the public remains unaware of our potential to help fight this epidemic that is the leading cause of disability and costs nearly $100 billion annually.”
Part of the problem Dr. Dooright said was due in part to public skepticism due to unfounded hyperbole boasted by outdated chiropractors. “This is not your grandfather’s chiropractic any more,” said Dr. DooRight.
“Sadly, some of our forefathers made claims that research couldn’t support and to this day many Americans still recall these exaggerations. Let me state clearly: modern chiropractors, for instance, do not treat diabetes, cancer, or heart disease, a common misunderstanding that lingers on that besmirches the image of today’s chiropractors who follow evidence-based guidelines.”
“The new ACA is here now to clear the air for these past indulgences and to say simply that doctors of chiropractic are proven to be among the best non-drug, non-surgical practitioners to this epidemic of neck and back disorders.”
And it couldn’t have come at a better time since the same research studies have shown that the standard medical approach to back pain—pain pills, muscle relaxors, steroid injections, and spinal surgery—have not proven effective in the majority of cases, all have serious side effects as we’ve read lately about Vioxx and Celebrex, and are very costly according to the latest clinical trials.
“Millions of patients have discovered that chiropractic care is safe, effective, longer-lasting and inexpensive compared to medical treatments. We’ve often told our critics: let the chips fall where they may and don’t be surprised who’s holding the best hand as the latest research has shown.”
But he also warns the public to select their chiropractic doctor carefully since not all chiropractors are the same. “Just like MDs and attorneys specialize, so do chiropractors—some specialize in low back pain, some in neck problems, some do sports injuries and so on. And just like there are good and bad MDs and attorneys, make sure whatever your problem is that you select a member of the American Chiropractic Association, the leading national organization with the highest ethical standards of care.”
The ACA’s spokesman’s advice is simple: “If you’re one of the millions of Americans suffering from neck or back pain, give chiropractic spinal care another look and you just might find the solution you’ve been looking for, and without the high costs or risks of drugs or surgery.”
Wouldn’t a set of newspaper articles like this be invaluable to set the record straight in order to begin a new image by admitting directly our past egregious errors? Announce a tabula rasa just like the evangelics have done, stake our claim to the epidemic of NMS disorders, and blow the lid off the ineffective, costly, and risky medical procedures all in one fell swoop.
Imagine if an ACA leader like Chairman Big Mac McClelland, an articulate spokesman very aware of the research from his involvement with FCER, current Prez Don Krip or past Chairman Big Jim Edwards were to go on all the TV news programs with this message! What an impact and it would cost nothing! It’s time we claimed our stake in this back pain business—indeed, it’s time to go on the offensive with the facts!
Of course, some obstructionists like the Chiro Coalition of Evil Vendors would never support the idea of raising ethical standards or restricting our scope to NMS disorders. In effect, they continue to ignore the solid research and are hell-bent on staying on the chirovangelism course that chiropractic is a cure-all, warnings be damned! But such a position would further isolate these rascals to the margins of respectability where they still exist, so the only solution is full steam ahead without these anchors to progress!
The Painful Reality Strikes
But can we handle the truth about ourselves since obviously some are still in denial? These two surveys announced by the WFC and the Foundation for Chiropractic Progress (FCP) confirmed the huge schism between our identity and image. The consultants were Manifest Communications (Toronto) and they delivered their report entitled ‘Consultation on Identity - Quantitative Research Findings’ and a copy of the survey and the report is available at www.wfc.org
To reiterate, on page 30 of this report was undoubtedly the most shocking evidence of the huge gap between our self identity and perceived public image:
“Perceptions of How DCs versus the General Public Perceive
the Chiropractic Profession”
“Should be perceived by DCs” versus “Is currently perceived by the public”
Wellness Care 83% 6%
Primary health care 67% 2%
Mgt of VSC 56% 9%
Mgt of spinal problems 60% 60%
Mgt of back/neck pain 47% 81%
Non-drug, surgical care 82% 45%
As you can read, the image of DCs as Wellness Care practitioners, PCPs, or the high priests of the omnipotent VSC has not resonated among the vast majority of potential patients. Ironically, unless DCs have additional training in wellness care, nutrition or diagnostics, most chiropracTORs are among the least qualified to practice as such, certainly those from Life, Sherman, and other “straight” chiro colleges who are committed to only “detect and correct VSC.” I’ve never understood how straight chiropracTORs can advertise themselves as wellness docs when they have no academic training in that area, but that’s just me I guess. Indeed, real wellness care is more than lip service and cheap talk as I've often heard from these chirovangelists selling “wellness.”
"This is challenging stuff," said Mark Sarner, president of Manifest, "given how chiropractors would like to be seen and utilized. So what we have, between what people do and what they think, are the parameters of the challenge. We have defined the problem." And the problem is us, I might add!
Indeed, without any standard identity or profession wide guidelines, all DCs will suffer the Forrest Gump syndrome—like a box of chocolates, you just never know what you’ll get. My esteemed colleague from the Volunteer state, Dr. Mike Massey, addressed this point in the ACA chat room recently bemoaning the angst of mainstream members:
“While I do not consider the WCA (or the WCA/ICA/FSCO triumvirate) to be "flourishing" now, the point is still what we've been batting around here: they may be small in number, but their capacity is high to sway public (and inter-professional) opinion to the lowest common denominator. I, like so many of my colleagues, am tired of being painted with a broad brush. So many times, the public perception of chiropractic is not set by those of us who seek to do our best and to further our profession via typical means, but by those who make a sideshow mockery of a healthcare delivery system in the name of "philosophy".” Ignoring them has obviously not made them go away...and likely won't. But,
my colleagues, what is the answer? How do we differentiate ourselves from the rest? How do we let the public know that we're not all "like that"?
The truth is, we simply don't have a uniform ethical standard, much less a
legal standard by which to measure and reprimand those who step outside the mainstream. So, as a result, we're all "chiropractors"...like a box of
chocolates, we all have the capacity to be nuts...but you don't usually know
what you're going to get, unless you have experienced enough to know what to look for.
Michael Massey, DC, CCSP, Athens, TN
So, while these PR pros are analyzing our predicament, the mainstream keeps marching onward to different steps, oddly, to the same drummer. Whatever advertising scheme they suggest, I still contend we, the mainstream in the ACA and the conservative docs who don’t belong to any national organization collectively need to offer a tabula rasa just as Rachel Zoll wrote about for our evangelical brethren. The American public is a very forgiving lot, especially when well-meaning folks have the courage to admit the errors of their ways. Do we?
As example of denial by some chiropracTORs, during the FCP announcement, Terry Wrongberg, the yellow journalist and dictator of the phony WCA, had the gall to approach an ACA leader with his chirovangelist suggestion for PR. Instead of following the FCP’s suggestion to stick to “neck and back pain” as our PR focus inasmuch as that’s what the public perceives us doing best, Wrongberg (whose vendor-driven phony group has been publicly renounced by the ACA last year) suggested an alternative theme: “Chiropractic—because the body heals itself.”
Okay, stop laughing.
While he may have thought it was so clever, the rest of the rational DCs would cringe at his suggestion and it’s obvious he just doesn’t get it—the public doesn’t buy into the VSC cures all gobbledygook as Dr. Joe Keating has so aptly shown.
But this illustrates to all that these Chiro Coalition obstructionists will never follow the lead of experts to bail water no matter how quickly our ship is sinking. So, the only course is to go it alone without the input of these rascals. Let them go down alone as they continue to mislead the public as Wrongberg and his phony research ruse have done or as CJ Mertz continues to do with his infomercial that states chiropractic care cures pimples. Indeed, with skewed leadership like these two vendors, straight chiropractic has little to offer to this profession, ya folla?
It’s not as if the recent findings by the FCP are new to this profession, at least to those who've read the many PR reports done through the decades. A poll done long ago in 1984 by Welling & Company spearheaded by the renown Dr. Robert Brooks from Tulsa along with the Oklahoma Chiropractic Research Foundation in cooperation with the Chiropractic Association of Oklahoma surveyed the “Attitudes toward chiropractic health care in Oklahoma” by 400 households.
The results were interesting to say the least, provoking in what they revealed, and insightful as to what we should be considering in any future PR campaign. Indeed, the public is singing the same old song of skepticism we’ve heard for years, but if we listen to the people in this poll, perhaps we’ll convince ourselves what the best track actually is.
The Summary Analysis included:
“As might be expected in a survey of this type, there is both good news and bad news for the survey sponsors. As is no surprise, chiropractors tend to be at the lower end of the image scale among many of the professions…but not that far behind osteopathic doctors and attorneys…to many respondents, chiropractors are seen as being fine for many people in the community, but ‘I wouldn’t want my daughter to marry one.’
“Most of the real favorable feeling toward chiropractors is, of course, among those who have experienced chiropractic medicine in the past. Those who have never been to a chiropractor, nor has anyone in their immediate family, tend to hold very negative reactions and opinions toward chiropractors on many of the factors.
“Half of those interviewed admit their knowledge of chiropractic medicine is slight or non-existent and therefore, the opinions they hold, in most cases, are built either on misconceptions or erroneous word-of-mouth. Only 10% feel they have great knowledge of chiropractic, and this is generally based on first-hand experience.
“The most common sources of any knowledge or opinions held about chiropractic tends to be, first of all, friends or relatives (38% cite this as their primary source of knowledge), followed closely by first-hand experience (34% cite this as their primary source of knowledge). A distant third in providing information around which persons form opinions about chiropractic are article or books written on the subject which 11% say forms the basis of their opinions.
“The weakest ratings held regarding chiropractors are seen not only among those which have no experience with chiropractors, but in certain demographic groups. For instance, lower ratings are received from those over 65 years of age than their younger counterparts. As a matter of fact, the younger the respondent, the more favorable he is likely to feel about chiropractors and chiropractic medicine. Those in the highest income group (over $40,000 per year) also tend to hold a lower opinion of chiropractors than do those in the middle-income groups in particular. Along the same lines, men seem to hold a lower opinion of chiropractic than do women…
“The fact that nine out of ten admit they do not have great knowledge of chiropractic medicine is somewhat confirmed by the fact that 40% indicate they have no idea as to how much education is required to become certified as a doctor of chiropractic. 38% indicate that at least four years is required, while 22% assume that less than four years is required.
“Some of the axioms around which chiropractic is structured are firmly believed in, and these are the ones which should be promoted more stringently since they will reach a higher degree of sympathetic belief. A particularly high number (over eight out of ten) agree that:
1. Once nerves are involved, almost anything can go wrong
2. Bones in the spine can pinch or get out of alignment and affect functions
Additionally, a very high number (71% to 75%) also agree that:
1. The spine can easily get out of alignment and affect functions
2. Nerves more than anything regulate function
3. There is an unseen life force which cannot function unless all is in harmony
“The fact that chiropractors are an acceptable part of the health care scene is the number one attitude which is agreed with in a list of eleven offered to respondents. Number two is the fact that most people do not have a good opinion of chiropractic. 71% feel chiropractors probably suffer under a stigma which may not be deserved. However, it should be pointed out here that a certain degree of transference may be inherent in this answer. That is, there may be those who are saying ‘My friends are prejudiced against chiropractors, but I’m not,’ when in fact, that’s not necessarily true.
“The third most agreed with factor is the opinion that chiropractors are highly underestimated regarding their benefit to the community and their patients. 60% hold or agree with this opinion to one extent or another.
“The fourth most agreed with factor overall tends to be the fact that chiropractors will try to perform more of their services than needed. Rounding out the top five is the attitude which is agreed with by nearly six out of ten, to some degree, that most doctors of all types end up treating you far more than is necessary.
“Therefore, of the top five factors or statements of attitude which were offered respondents, three of the top five tend not to be favorable toward chiropractors. These top five tend to stand out somewhat above the others on the list. Overall, of the eleven factors, only four tend to be agreed with by a majority of the respondents. However, some were presented in a negative posture and therefore, disagreement with them may in fact be favorable to chiropractors.
FAVORABLE TO CHIROPRACTORS % WHO AGREE
DCs are an acceptable part of health care 86%
DCs’ benefit is highly underestimated 60%
MDs and DOs do a lot which could be done better by DCs 33%
DCs often cause more harm than good 25%
DCs are okay for some but not for me 34%
Anything a DC does, a MD can do better 22%
Visiting a DC is not socially acceptable 15%
UNFAVORABLE % WHO AGREE
Most people do not have a good opinion of DCs 71%
DCs will try to perform more than is needed 45%
Most DCs try to treat problems they aren’t qualified for 39%
“Overall then, how is the chiropractor seen by the public? 72% feel the chiropractor is rightfully a spinal or structural specialist. Therefore, indication with this particular label will be one which is believable and is consistent also with earlier findings which show that a significant number agree that certain problems can be caused by improper alignment or spinal, structural and nerve problems.
“Only 52%, on the other hand, feel that a chiropractor is the best place to go initially for a sore back or stiff neck. Apparently, many see a chiropractor as a secondary source after visiting their MD or DO if they see chiropractic as a source at all. Unfortunately, chiropractors are not seen as the first place to go with pain in general. Only 19% indicate they would think of visiting a chiropractor first regarding any pain or suspected illness.
“Along these same lines, then, to what extent are misconceptions held about chiropractors? Between 26% and 40% of the respondents tend to hold certain misconceptions about chiropractic medicine and these are the ones which probably should be addressed first in educational material.
1. DCs are expensive to visit (40%)
2. Once you start visiting a DC, you have to continue (39%)
3. DCs tend to fall short in the area of diagnosis (37%)
4. Visiting a DC is not covered by most medical insurance (30%)
5. Visiting a DC can be painful (26%)
“Nearly half indicate they would be more likely to visit a DC if the first visit were free. This appears to be an area of potential for developing new contacts for chiropractors. However, it should be pointed out here that if the public perceives that the first visit is simply a way to hook patients into some sort of a continuing program, then the first free examination will lose credibility. Therefore, before strongly pushing the free visit, it is recommended that the Chiropractic Association of Oklahoma or individual doctors first educate the public in the area of the continual visit or habitual visit syndrome, as well as the area of diagnostic capability of chiropractors. Once the public tends to have confidence in these two areas, then the effectiveness and impact of a free examination or initial free visit will be much more favorable.
“The impact of this 45% is particularly strong in view of the fact that only 59% of those interviewed have never been to a chiropractor. Therefore, assuming that most of those who said they would like their first visit to be free is represented by those who have never been, then over three-fourths of those who have never been to a chiropractor indicate they would be fairly strongly influenced by a possibility of a free visit or examination.
“Overall, 42% have virtually no experience with chiropractic in that neither they, themselves, nor anyone in their family has been to a chiropractor. Of all those who have been chiropractic patients, 41% indicate they make or made regular visits to their chiropractor, while 59% indicate they go to the chiropractor only when they have pain which they feel the chiropractor can address. The most prominent reason for the most current visit to their chiropractor dealt primarily with back pain, as might be expected. Nearly six out of ten who have been to a chiropractor recently indicated that back pain was the main reason, while neck pain or stiff neck was distant second at 16%. 5% indicated they went because of a headache, while 18% had various other pains which led them to seek relief from a chiropractor.
“As indicated earlier, the most significant factor dealing with selection of a chiropractor stems from recommendations by friends or relatives. 43% say the reason they first selected a chiropractor to visit rather than some other potential source was because a friend, acquaintance or relative had strongly recommended a chiropractor. A distant second in this reasoning is ‘general knowledge’ which was mentioned by 17%. 14% said their doctor recommended a chiropractor and therefore they visited one, while 10% simply said they had exhausted all other methods and turned to chiropractic as a last resort. Only small numbers indicated they visited a chiropractor in the first place because of personal acquaintance with a DC or because of advertising.
“On the other hand, when asked why they selected a particular chiropractor over others, again, the recommendation of a friend, acquaintance or relative was the strongest factor by far, with 58% pointing to that reason. 9% said they were personally acquainted with a chiropractor which they first visited, while 9% said the location of the chiropractor’s office contributed to their selection. 4% said advertising influenced them in their selection.”
Mystery Science Profession or Not?
Although some may discount this 1984 poll as outdated, I daresay it may not be invalid since painfully little in public relations has occurred in the meantime to change the public’s perception. Despite the research that shows chiropractic’s effectiveness with low back pain (AHCPR, Manga, Meade, UK BEAM) and headache (Duke, Nilsson, Nelson), our profession has done very little to promote these endorsements—missed opportunities of huge proportions.
Although years ago the ACA under the supervision of the advertising firm of Ira Davis created many forms of PR and advertising for its members, this effort waned and has been supplanted by individual advertising, much of which focused on the free spinal exam bait-and-switch procedures that this poll warned against doing. The lack of a nationwide TV PR program has certainly kept our status alive as the Mystery Science profession. Hopefully once the Legal Action effort is done, we can turn our attention and monies toward a massive PR campaign.
Of greatest interest to me was the fact that only 4% of respondents said advertising influences their selection of a DC, while 58% were referred. As Dr. Nimmo once said, “The preferred patient is the referred patient,” and this poll verifies that point. The fact that 59% of current patients sought chiropractic care only after a relapse occurs indicated the conflict between continued maintenance care that may resemble over-utilization to them versus preventative care that the other 41% of current patients actually utilized.
Another interesting point was regarding diagnosis and scope issues—37% felt DCs did a bad job at diagnosis and 39% felt some DCs treated outside their scope. Of course, when one DC does a bad job in this regard, all are tainted. For example, on CJ Mertz’ videotape, he listed numerous conditions supposedly helped by chiropractic care, including pimples, that are simply unfounded. Mertz’ logic, as with many chirovangelists, are based on a few ol’ time chirovangelist clichés that “the power that made the body, heals the body,” and “the body needs no help, just no interference.”
This faith-based belief system, while remotely plausible, is simply unproven and a rather simplistic extrapolation of the one cause-one correction-one cure notion. This is the basis of our Innate-based brethren, but it has become the fly in the ointment of respectability by the public.
Without any proof that, in fact, a subluxation impairs homeostasis or reduces innate resistance to disease, the evidence-based world will continue to view us as a “pseudo-science” as we heard at the FSU debacle. While the Big Hypothetical sounds ethereal to our faith-based colleagues, there’s painfully little clinical proof, and as long as we spout unproven hyperbole, many rational prospective new patients will seek care elsewhere. Perhaps this is one big reason why the NACM has found a foothold in the media since its members are unwilling to recite the hyperbole associated with too many chirovangelists?
If the FCP PR campaign is to succeed, it must appear the rational voice in chiropractic by disassociating itself with unproven claims, as enticing as they sound to some. A few announcements such as the example written by Clark Kent would also be helpful to show the public that mainstream chiropractic is no longer in denial—we know the problems, the issues, the players and we have a solution—stick to what we do best as non-drug, non-surgical NMS specialists, which also includes those “N” conditions known to be amendable to SMT, as few as they may actually be.
Besides, there's a huge market in this epidemic of back pain that's just waiting for us to help--why try to convince the public that chiropractic is a cure-all when most are already sold that we can help with NMS disorders? It's simply dumb marketing to sell chiropractic as a cure for pimples when most already believe we can help with LBP and neck problems—a much larger and more costly epidemic than pimples.
But what do I know?