Articles by JCS

People Will Talk

Chiropractors Undergoing Public Image Makeover

People Will Talk

By

JCS

If you’re an old movie buff like I am, you’ve probably seen Cary Grant, Jeanne Crain, and Finlay Currie in the classic comedy-romance, “People Will Talk (1951)” Among other threads in this enjoyable movie, in one scene Cary Grant’s character is an MD being questioned by a medical board for practicing medicine without the use of drugs/surgery as a faith healer/naturalist while working as a small town’s butcher. When the local townsfolk discovered he was a legitimate MD, he was “almost run out of town on a rail,” as Grant described it, despite the fact that he had a thriving practice.

The medical board couldn’t accept the fact that his unconventional practice was effective, instead they tried to label him a quack for his unusual method of practice. After all, isn’t “scientific medicine” better than folk remedies and TLC? Nor could they understand why the townspeople would be enraged when they discovered the cover-up despite the fact that he had gotten patients well without the use of “drugs, potions or knives,” as Grant described.

To the viewers, neither position made sense—indeed, a true paradox that continues to this day in healthcare. Although some people may talk about non-medical “alternative” care, what people may say about unconventional health care methods has changed. Research from Harvard Medical School by Dr. David Eisenberg showed Americans made almost twice as many office visits to non-MDs than to MDs—a trend that obviously indicates a growing disenchantment with the present allopathic system.[1]

  In fact, according to Dr. Eisenberg’s survey, Americans made over 629 million office visits to non-MDs, principally chiropractors, acupuncturists, massage therapists, while patients made only 388 million office visits to MDs. As he concluded, “Maybe ‘alternative’ isn’t so alternative anymore.”

Yet, many people continue to talk about chiropractic care with skepticism. As a 25-year practitioner of chiropractic, I admit they have every reason to be skeptical. The more I’ve worked as a chiropractor, the more jaded I’ve become with my own profession. I’ll be the first to admit there are quacks in chiropractic, not because they practice without the use of drugs and surgery as the medical board in this old movie implied, but for other reasons such as making claims that are unsubstantiated and practicing more as faith healers than learned professionals dedicated to science.

Realistically, when the past president of the largest chiropractic college pronounced that “the only thing chiropractic can’t cure is rigor mortis,” it’s enough to make anyone flinch no matter how open minded they might be about CAM care. Quackery is a hard image to overcome once it’s been firmly established despite modern calls from within for reform and progress. Indeed, what people will talk about is not so much the benefits of chiro care as much as the outlandish claims some chiropracTORs continue to make.

Sadly, this enigmatic image has overshadowed the clinical effectiveness chiropractic spinal care has had with many types of musculoskeletal disorders ranging from migraine headaches[2], neck[3], mid-back[4], low back pain[5],[6], whiplash[7], and fibromyalgia[8]. While there is scant research evidence that spinal manipulative therapy (SMT) routinely helps organic disorders, some evidence suggests that some types of illnesses such as asthma[9], otitis media[10], and infantile colic[11] may be helped occasionally. Indeed, the Big Idea may not be as big as some chirovangelists would think, ya folla?

While some ol’ time chiropractic traditionalists lay claim that SMT will release the “power within” to heal the body of whatever ails it, this Big Hypothetical has been the bane of the progressive element within chiropractic for nearly 100 years ever since JHA Howard, instructor at Palmer Chiropractic College, left in 1906 to begin a science-based National College of Chiropractic. Like many other instructors and students at PCC, he was fed up with the unscientific musings of BJ Palmer who appeared more enamored with a faith-based, vitalistic approach to explaining the science of chiropractic that many chiropracTORs still profess. Indeed, what can be said of a so-called college prez who once said, “Education constipates the mind”?

Is it any wonder that people still talk about chiropractic with skepticism when some chiropracTORs sound more like uneducated faith healers than learned healthcare professionals? While this faith-based approach may have been more widely accepted before the modern era of EBM, and it may have made for an interesting story line in an old movie, but this neo-scientific attitude has kept this profession in the scientific Dark Ages and our image mired in the closet of skepticism for too long.

Vitalism is a hard way to build a profession, unless we’re speaking about a religion, of course, which explains why some fundamentalist DCs wouldn’t mind joining the Church of the Divine Spine as Rev. Reggie Gold once tried. This schism has remained ever since, now escalating into factions that have split this profession, soiled its public image, fractured its professional identity, and overshadowed a healing art that could be a huge blessing to the millions of people suffering from NMS disorders.

The irony of this dichotomy within chiropractic is that in the new era of evidence-based healthcare, chiropractic care now has emerged among the best solutions for the epidemic of neck and back pain, yet its old image has kept this fact hindered in suspicion. Long before research convinces the public of the benefits of chiro care, the trust factor must improve, our identity must become clear as spine specialists foremost, and we must improve our public image.

 

Move Over Martha

Chiropractors are not alone in rehabbing a soiled image and many experts have commented on this problem. According to an article, Brand Rehab: How Companies Can Restore a Tarnished Image,[12] from The Wharton School of the University of Penn, many companies can use a PR makeover, including Martha Stewart, McDonalds, Coke, and Merck, to name a few brand names that have been tarnished lately and face the challenge of restoring damaged reputations.

“Following a corporate scandal, managers [chiropractic] who acknowledge they have problems and launch communication programs to repair their tarnished reputations stand the best chance of rehabilitating a tainted brand or corporate image,” according to  The Wharton faculty website.

For example, avoiding this reality was a big mistake made recently by both Life Chiro College and the Georgia Chiro Association when Life was placed on academic probation by both SACS and CCE. Instead of being honest with the public, Life’s bunker mentality PR effort refused to accept responsibility and instead chose to smear the CCE, which only made them look defiant and in denial. No contrition, no mea culpa or tabula rasa—Big $id and his DECE boys chose to blame others and hide their mistakes rather than admit them and appear contrite.

The GCA also ignored this huge PR disaster by not distancing itself from Big $id beforehand for fear of losing members and the fact that many GCA board members were Lifers, so it basically did nothing but hide when the tsunami of bad press hit Atlanta. When Life went down, so did the image of the GCA and every DC in the state of Georgia.

Indeed, bad leadership in both camps has led to a tainted reputation that will take decades to restore, if ever, since the new regime of King Guy Riekeman has also failed to restore Life’s reputation with any reputable academic program other than more emphasis on the same chirovangelism that led to Big $id’s demise. What Life needed was a credible academician, not a cheerleader turned fund-raiser. While Riekeman may have temporarily plugged the hole in the dam, he has done nothing to stop the tidal wave of bad imagery that still haunts Life to this day.

Again from the Wharton School website, Lou Rubin, managing director of Prime Consulting, a marketing communications firm, says successful brand rehabilitation begins with openness and honesty, issues Life totally ignored. “The first issue is, you can’t hide. You must acknowledge the problem. People want to forgive, and contrition is an accepted part of our culture. Lying is not."

 And remaining silent is regarded as lying. By not being contrite for its errors, Life and the GCA failed to appear honest, so the public’s opinion has not forgiven them for the transgressions. No one stepped to the plate to admit the obvious facts about the academic corruption at Life, the largest diploma mill this profession, nay, this country, has ever seen. Ostensibly, when the prez of a small Podunk chiro college was the highest paid college prez in the entire country—more than the combined salaries of the presidents of Yale and Harvard—something’s  amiss, ya folla? Indeed, how can the public, press or medical professionals trust a profession that refuses to accept responsibility for its wayward actions?

Until the ACA and ACC comes forth with an open commitment to EBM and let the chips fall where they may in terms of “isolating the rascals” as George McAndrews once said, every DC will be tainted by the antics of our cultish few—the “5% of freaks and 5% of cultists, and the rest who keep their mouths shut.” Strangely, now we see Terry Wrongberg and his WCA ilk now using the call for evidence-based research as a selling point in their RCS scam. Next will hear Guy Riekeman citing EBM to verify chirovangelism, ya folla?

Depending on the nature of the scandal according to Wharton marketing professor Barbara Kahn, companies can take a slow and steady approach to brand repair, or a swift "silver bullet" solution. McDonald's, she says, could take the slow road in addressing charges that its fast food contributes to the nation's rising obesity. “What you would do is associate McDonald’s with more nutritious offerings and slowly move the image in a believable way.” For example, she suggests the company might begin by focusing ads on its use of high-quality beef, and then continue by promoting its salads.

In chiropractic’s case, our PR should focus on MSDs such as low back pain, neck pain, and headaches—those problems that the public already tends to believe. Then our PR might move into other areas later as clinical research shows chiro care to be helpful, such as asthma, wellness care, pediatrics or whatever type O disorder found to be helped by SMT.

But we must appear believable and credible otherwise we’ll just reinforce the mistaken belief that chiro care cures everything, an idea the public will never buy into. I’m still stunned that any rational DC still believes the Big Idea in light of the lack of credible proof, but that’s just me I guess.

"Each leap you are making extends the brand's meaning, but it is small enough that the consumer is willing to make the jump. This takes a long time," says Kahn, adding that the fast food giant went too fast when it introduced its McLean sandwich in 1991. "It didn't work. It wasn't credible. You have to do it in a slow, reasonable way that doesn't test the consumer's belief system."

Cart Before the Horse

If the F4CP makes too big a jump in the public’s belief system by suggesting to “Think Again, Think Chiropractic” in regards to allergies, colds, flu, or wellness, then we’ll be testing the consumer’s belief system that is unprepared to accept those conclusions despite whatever anecdotal evidence we may have. Indeed, if we want people to talk about chiropractic, let’s have them do it where we are strongest and most believable—in regards to MSDs—the epidemic of LBP that remains the largest epidemic in this country.

The recent F4CP is one attempt to improve chiropractic’s image with its “Think Again; Think Chiropractic” message, but methinks it fails to address the much needed mea culpa and tabula rasa that must precede this effort. This profession must clean house before we invite the public in. And putting our weird uncles in the closet or sweeping our internal problems under the rug is not the answer to cleaning house, ya folla?

For instance, has any chiro leader ever publicly apologized for the years of cultism professed that chiro cures all? Just when will the Palmer University leaders admit BJ’s philosophy was more cultism than realism? When will Life University admit the ranting of Big $id was the opinion of an academic charlatan? Indeed, when will these vitalists admit the modern era of chiropractic has turned over a new leaf toward evidence-based education rather than teaching outdated meta-physics from the past? Without these admissions, we cannot expect the public to believe we’ve cleaned house when we still have skeletons in our closet.

Has any national association ever announced a reform effort to reduce unethical methods? Has anyone ever waved a white flag of peace to the AMA and signed an armistice? Indeed, has any chiro leadership ever done anything to address the public image problems we face? It seems we just ignore these issues, hoping they’ll go away.

The medical profession, media and the public are waiting for good DCs to step forward to renounce the radical insurgents who have tainted our profession for too long. Resonating in my mind is the recent comment to me by Dr. George Lundberg of Medscape at WebMD:

“If some influential individual or group in chiropractic would follow your thesis, and would loudly and openly embrace EBM, let the chips fall where they may, and, if I may push further, openly repudiate the “vertebral subluxation and resulting nerve pressure is the root of all diseases” (presumably the Palmer belief structure), then I and many other physicians could openly and without fear and derision look at what 2005 EBM chiropractors actually do and go forward together.” 

 By ignoring these issues to openly renounce our cultish past and embrace the scientific future, we’re putting the cart before the horse in terms of PR. We must rehab our image before we go forth with an expensive PR campaign. Plus, a mea culpa would do more good than expensive ads to implement a tabula rasa.

Would it be too difficult for the rational groups within this profession to hold a press conference in which they admit the errors of our past, propose raising ethical standards, and announcing a commitment to EBM? As the Wharton School article and Dr. Lundberg both suggest, it would do wonders to show the public, press and medical profession a contrite attitude and a sincere effort by chiropractic to clean up its act.

Wouldn’t it be grand if someday soon in the Associated Press we might read a 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

By

Clark Kent

Daily Planet

 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, stake our claim to the epidemic of NMS disorders, and blow the lid off the ineffective, costly, and risky medical procedures/spinal fusions 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, or Dr. Jay Triano of the Texas Back Institute or Larry Wyatt of Texas Chiro College or the Donald Murphy of the Rhode Island Spine Institute or Stephen Perle of Bridgeport or whichever of the many knowledgeable (and good lookin’) chiro spokespeople available were to go on 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!

 

 [1] Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States -- prevalence, costs, and patterns of use. N Engl J Med 1993;328:246-252.

 

[2] Tuchin PJ - J Manipulative Physiol Ther - 01-Feb-2000; 23(2): 91-5

 

[3] Hoving, Koes et al - Ann Intern Med.  2002;136:713-722

 

[4] Schiller L - J Manipulative Physiol Ther 2001;24:394-401

 

[5] McMorland G - J Manipulative Physiol Ther - 2000 Jun; 23(5): 307-11

 

[6] Anderson GB - N Engl J Med - 1999 Nov 4; 341(19): 1426-31

 

[7] Khan S, Cook J, Gargan M, et al.  - J Ortho Med 1999;21(1):22-25

 

[8] Millea P &  Holloway R - Amer Family Physician - 2000 Oct; 62(7)

 

[9] Bronfort G, Evans R - J Manipulative Physiol Ther 2001;24:369-77

 

[10] Froehle, RM - J Manipulative Physiol Ther - 1996 Mar-Apr; 19(3);169-77

 

[11] Kemper KJ - J Pediatr - 2001 Sep; 139(3); 467

 

[12] Brand Rehab: How Companies Can Restore a Tarnished Image, October 2005, http://knowledge.wharton.upenn.edu/index.cfm?fa=viewArticle&id=1279


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