Articles by JCS
The trend to alternatives
The Chiropractor as Hero
JC Smith, MA, DC
With the growing publicity of “alternative” health care in the media, I have found it odd that the chiropractic profession has been, for the most part, ignored. Just recently, NBC’s Today Show did a week-long segment on this subject, and somehow the torch-bearers of alternative care, chiropractors, were never mentioned. Whether this is just an oversight or the construct of the medical editors, the omission of chiropractic from these articles continues to haunt our profession’s attempts to improve its public image and market share.
This awareness of the public’s use of alternative health care first came into prominence with Dr. Daniel Eisenberg’s research in 1991 at the Harvard Medical School that showed that over one-third of Americans were using “alternative” non-MD health care providers. Most interesting was his finding that this group of mostly college educated Yuppies made more visits to non-MDs (425 million) compared to 388 million visits to MDs. Of course, chiropractors were the foremost non-MDs among this group. Maybe “alternative” isn’t so alternative anymore!
Another similar study was recently done in Canada in 1997 by the Angus Reid Group revealing that of the 42% of all Canadians using alternative medicine, 59% use chiropractic care, more than any other alternative treatments such as acupuncture, homeopathy, nutritionists or massage therapists. Most interesting in this survey is the fact that the majority has an annual household income of $60,000 or more.
Despite these growing trends to alternative care methods, the medical press has been very reluctant to encourage such usage by the mainstream Americans. The tone of the media has been tainted by a medical skepticism that permeates their coverage. For instance, in the summer of 1995, the Today Show featured the new federal guideline on acute low back pain in adults done by the Agency for Health Care Policy and Research. This two-year definitive study by a 23 member panel of experts clearly recommended spinal manipulation as the first form of professional care for this epidemic of back pain. Their recommendations also stated that “Surgery has been found to be helpful in only one in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
Although the recommendations by the panel stated that spinal manipulation “should only be done by a professional with experience in manipulation,” the so-called medical expert on the Today Show segment, Dr. Art Ulene, refused to endorse chiropractors for this care. Although the RAND Corporation’s report on low back pain showed that 94% of all spinal manipulation is done by DCs, Dr. Ulene recommended that the public use DOs for this despite the fact that most osteopaths no longer practice this healing art, instead opting to practice medicine. In fact, spinal manipulation is not routinely taught and is considered an “elective” in most osteopathic schools. Yet, Dr. Ulene had the gall to endorse these practitioners rather than chiropractors when asked by the commentator.
The irony of his off-hand non-endorsement is most obvious to anyone who realizes that spinal manipulation would be a lost art today if it were not for the perseverance of chiropractors who keep this healing art alive despite the antitrust activities of the medical profession. The Wilk et al. v. the AMA et al. antitrust trial that ended in 1987 clearly revealed the “lawlessness” of the dirty tricks by the political medicine machine. While medical witnesses and researchers testified that chiropractic spinal manipulation was cheaper, safer and more clinically-effective than the medical approaches for many cases of back pain, the leadership within the medical societies, the insurance industry and workers’ compensation boards seem less than interested. This unholy alliance is more interested in bilking patients through their enormous fees than offering patients a freedom of choice in their health care decision that might be more clinically appropriate and cost-effective than the medical approach.
The fact that most hospitals still discriminate and refuse to include DCs on staff is a clear indication of this medical myopia and their intent to keep medical costs as high as possible. The flawed Carey study  comparing various approaches for LBP indicated that the chiropractic care cost on the average $800. On the other hand, MetLife studies indicated that the average non-surgical stay in a hospital for LBP was $7,000, while a surgically resolved case averaged approximately $14,000. It’s obvious that hospitals are more interested in these huge fees than the mere $800 a chiropractic case might bring them for a similar case of LBP.
Not only have chiropractors not be heralded for their persistence in bringing a better and less expensive treatment to the world of health care, but, now that alternatives to drugs and surgery are being sought by the public and acknowledged by the press, it strikes me as odd that our profession has ended up between the worlds of conventional and alternative without much recognition. Could it be that while the press considers homeopathy, acupuncture and such to be “alternatives,” apparently chiropractic has become mainstream enough not be included with these non-traditional healing arts? On the other hand, not being a member of the medical establishment leaves chiropractic in the lurch, falling between the cracks of recognition, or so it seems.
Being virtually ignored has been the plight of chiropractors who, for over a century, have fought for their own existence as well as the right to freedom of choice for patients in health care matters. No other profession has successfully fought tooth-and-nail against the dirty tricks of the AMA as well as against the discrimination of the insurance industry and hospital organizations. For over one hundred years, thousands of chiropractors have fought for their own right to practice without interference, and some have even gone to jail for their cause. While most every DC has suffered the slings and arrows of medical bigotry by taking the proverbial shots-across-the-bow in some form or another, these measures have gone virtually ignored by the press and the public. When we turn one cheek, we merely get slapped on the other!
The chiropractor as a hero in our society is a concept that is well deserved, but one that is incomprehensible to most people. Never has a chiropractor been portrayed by Hollywood as a hero, unlike the many medical heroes that appear daily on television. Few Americans understand that if it were not for the persistence of chiropractors, there would be no choice for them except for the medical profession’s choices of more drugs and more surgery.
If it were not for the thousands of doctors of chiropractic who were willing to go to jail for their principle, “alternatives” to medical procedures would be mostly gone with the wind. If it were not for the political actions of the national and state chiropractic associations, insurance equality laws would be non-existent. It has been the grass-roots effort by DCs that make Americans aware of alternatives to medical methods. It also has been the political lobbying by the ACA’s staff that make legislators aware that there is more than one way to get sick people well. Yet, few people today understand the warfare that has been waging for decades in order to bring “alternatives” to the forefront. Indeed, if it weren’t for the battles of chiropractors, I dare say there would be no alternative health care choices today.
But, where’s the recognition for these heroics? Just as Dr. Art Ulene couldn’t bring himself to recommend chiropractic care during his segment on the Today Show, other medical reporters also seem to have an innate bias against non-MDs, especially against DCs who, undoubtedly, have been vilified by the same reporters. It’s similar to asking a racist, Jim Crow reporter to write a favorable article about Martin Luther King -- it’s a task that questions the reporter’s very own journalistic integrity and generally is one that he is incapable of doing. Apparently bashing chiropractors is easier than eating a little crow!
For example, after the AHCPR’s report was released, my local newspaper, the Macon Telegraph, did a week-long series on “Managing Pains”. I sat down with their cub reporter for two hours reviewing the AHCPR findings, covering the ineffectiveness of standard physical therapy and back surgery, and noting the recommendation of spinal manipulative therapy for LBP. When their series of daily articles appeared, this newspaper cast the ineffectual methods in a favorable light and totally ignored the findings of the AHCPR report, never quoting or referring to it. One article actually claimed that massage therapy cured a woman of two ruptured discs! Other unsubstantiated anecdotal claims made by patients for other non-recommended treatments also appeared during this series.
Ironically, the only professional form of care recommended by the AHCPR report (other than drugs and ice/hot packs) is spinal manipulation, which was cast in a suspicious light by this reporter, even using local MDs to support her mis-characterization of chiropractic. As one local medical bigot said in the article, “Chiropractic is not taught to nor believed by most MDs.” The best form of treatment recommended by the federal panel was not even acknowledged by this newspaper despite the plethora of research I had shown the reporter. She just chose to ignore it all!
When I confronted the newspaper about their misrepresentation of the new guideline on LBP, I was rudely told by the managing editor that he “stood by his reporter.” When I again showed him the AHCPR report and pointed out that its recommendations contradicted his cub reporter’s article, he said to me, “You can find any research to support your position.” Any research, I queried? I told him this was a definitive two-year study of 4,000 articles by a 23 expert panel headed by an orthopedic surgeon, and its findings paralleled similar studies done in Canada (Manga) and U.K. (Meade). When he still did not budge from his position, I finally said to him, “Apparently your journalistic pride comes before your journalistic integrity.” He didn’t even flinch -- like water off a duck’s back!
Whether it’s the Macon Telegraph, McCall’s magazine, Art Ulene on the Today Show, Consumers’ Reports, the editors of the Wall St. Journal or the New York Times, the press has long dealt with chiropractic from an askew perspective. For too long these media misinformers have bought into the medical bias as gospel, only too happy to share their bigoted viewpoint with their readership despite what the research proves. Perhaps their intransigence is an indication of their complicity in this matter of discrimination against chiropractors, and admitting that the new trends and findings have validity would be admitting to their own guilt. As I said before, journalistic pride supersedes journalistic integrity when it comes to articles about the chiropractic profession.
Despite the progress the public has gained from our efforts, most people enjoy their freedom of choice in health care never knowing it was principally the chiropractic profession that has long fought for this freedom. Until the press admits its own bias in this matter, the public will never have a full and correct picture of the players in the health care battles. Until the public has a full accounting of the major players in the current health care reform movement, the involvement of the original health care revolutionaries, the chiropractors, will remain hidden at best. History may someday bare the truth on this matter, unless, of course, the medical revisionists have their say to again distort the truth.
So, the chiropractor as a hero remains unbeknownst to most Americans. Without any TV actors portraying a chiropractor in a positive fashion, with hospitals and political medicine’s continued boycott of chiropractors, with an biased press corps misinforming the public about our profession, with politicians’ hands deep into the insurance companies and AMA’s pockets, and without any proactive chiropractic PR of our own, chiropractors will remain the unsung heroes within health care reform. Despite the overwhelming positive research and governmental studies, chiropractic will remain unheralded by the press and unrecognized by the public as long as our opponents continue to define our role and image for us. As long as we are merely puppets, others will pull our strings and we must dance to their music.
What will it take to overcome this dilemma? When will chiropractors be seen as the liberators of the public from the medical monopoly? When will the public realize the battles we have fought and the obstacles we have overcome to bring to them a choice in their health care matters? What will it take to have the public realize that the benefits they enjoy today are due, in part, to the battles chiropractors have fought over the years?
The breakthrough that our profession needs has yet to occur, and it very well may never occur unless we make it happen with a national spokesman and a PR strategy that brings our message to the public. Along with the continuing battles we face every day with our medical detractors, the biggest obstacle today is the challenge to enlighten the public to the medical wars and chiropractic’s involvement. Perhaps then the tide will turn and the public will look upon our profession not with suspicion, but with praise and admiration. Perhaps then DCs will be seen as the heroes and heroines they really are bringing new choices to the dilemma of health care.
Until that day comes, chiropractors will remain the unsung heroes who treat a fraction of the population. We will remain the whipping boys for medical bigots. We will remain outside the mainstream health care loop, all the while wondering why the public doesn’t understand us. As long as we remain fragmented by “philosophy” or techniques, our professional power will remain weak and legislators will view us as the proverbial fly in the medical ointment. Until that day comes, we will be heroes and heroines only in the minds of our patients.
 Eisenberg, DM et al. Unconventional Medicine in the United States. New England Journal of Medicine. 328(4): 246-252 (Jan. 28, 1993).
 Dynamic Chiropractic, Dec 1, 1997, Canadian Poll Details “Alternative Medicine” Use, Angus Reid Group.
 Bigos, S et al. Acute Low Back Pain in Adults, Clinical Practice Guidelines No. 14. Public Health Service, U.S. Department of Health and Human Services, AHCPR Publication No. 95-0642, Rockville, Md.: Dec. 1994.
 Shekelle, PG et al. “The Appropriateness of Spinal Manipulation for Low-Back Pain.” RAND Corp. Report, Santa Monica, Calif. 1992.
 Carey, TS et al. The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by Primary Care Practitioners, Chiropractors and Orthopedic Surgeons. New England Journal of Medicine. 333 (1995): 913-17.
 Rosner, AL. Flawed Study in New England Journal Could Cause Backlash for Chiropractic. Advance. Foundation for Chiropractic Education and Research. 16(4): Nov./Dec. 1995.
 Mushinski, Margaret. Average Hospital Charges for Medical and Surgical Treatment of Back Problems: United States, 1993. Statistical Bulletin. Metropolitan Life Insurance Company, Health and Safety Education Division, Medical Department. April/June 1995.
 Manga, P et al. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Ontario Ministry of Health, 1993.
 Meade, TW et al. Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment. British Medical Journal. 300(67137): 1431-37 (June 2, 1990).