Between Rock & Hard Place

Between a Rock & a Hard Place

     It never ceases to amaze me how difficult it is for the public to hear positive accounts of chiropractic. Whether it is local hearsay from medical doctors who scare patients about our care with their “voodoo” diagnosis, or it’s anecdotal stories about chiropractic accidents embellished by the “elite media,” or embarrassing exposes about fringe members of the chiropractic profession, there seems to be an endless supply of negative stories that bombard the public. Just how anyone can learn the whole truth about chiropractic is a paradox that remains a pivotal issue for this profession’s public image.

Although media misrepresentation of chiropractic most prominently began in the 1960s with Ralph Lee Smith’s book, At Your Own Risk: A Case Against Chiropractic[1], the media onslaught against chiropractic seems to have increased recently despite the numerous research findings and government endorsements that actually have supported our cause (RAND[2], Manga[3], Meade[4], AHCPR[5]). The medical media has been able to turn the table on this string of positive events to make chiropractic still appear controversial in order to minimize the impact of this new research on upgrading chiropractic’s dogged public image.

The examples of media misrepresentation of the recent research revelations are plentiful. I recall watching ABC’s Evening News when the RAND Corporation report on manipulation for low back pain was reported by Dr. Timothy Johnson, ABC’s medical reporter. After minimizing the significance of the RAND study[6], Dr. Johnson reported that MDs and PTs also do spinal manipulation, not just chiropractors! According to RAND, DC’s do 94 percent of all manipulation and, I might add, do it best of all with more training and expertise. In light of the historical condemnation of manipulation, Dr. Johnson had a lot of gall to suggest to viewers that the ill-trained medical imposters were just as competent as DCs to adjust the spine. Aside from his misrepresentation of this fact, his real ploy was simply to take the luster off chiropractic’s obvious victory. After a century of bashing chiropractic spinal manipulation, now that the research has proven its effectiveness for low back pain, these medical hypocrites not only want to jump on our bandwagon, they want to be in the driver’s seat! Gimme a break!

Before the dust had settled after the release of the RAND report, a shocking article about chiropractic appeared in The Wall Street Journal about one Vermont DC’s supposed mismanagement of a child’s ear infection that led to deafness.[7] This WSJ article was a classic example of the media’s double standard in regards to chiropractic – if one DC screws up, the entire profession is blamed, whereas if one MD screws up, he is an isolated case and medicine as a whole is unscathed. Not only does this double standard stink, I also questioned why the WSJ would print such an article on its front page inasmuch as this issue has nothing to do with financial news. The main thrust of this article was to cast dispersion upon chiropractic during the Health Care Reform debate by using one uncommon example to mischaracterize an entire profession.

The media misrepresentation of chiropractic’s newly found success didn’t stop with the RAND report. Examples of media misinformation occurred on several occasions after the AHCPR report was released in December of 1994. Many elite media reporters twisted the conclusions of this thorough study to misrepresent the findings about chiropractic care. Consumer Reports, Parade magazine, NBC’s Today Show, to name but a few of the more prominent sources, all belied the actual thrust of the AHCPR report which endorsed spinal manipulation as the only initial professional treatment for acute low back pain in adults.

Consumer Reports confirmed in a September, 1995 article on the AHCPR study entitled: “Back Pain: The Best Treatment Is Surprisingly Simple”[8] that most back pain is not caused by the disc, but refused to acknowledge that most back pain is due to joint dysfunction.

“But what, precisely, causes people’s lower backs to seize up in pain remains a mystery to this day. Since the 1950s, blame has tended to fall on the discs, the spongy gel-filled cushions between some of the backbones, which can bulge – the familiar herniated or ‘slipped’ disc. The assumption was that when the bulge pressed on a spinal nerve, it caused back pain.

“Now the assumption is crumbling in the face of new studies showing that when people with no back pain whatever are examined with magnetic resonance imaging scans, about a third of younger adults and virtually all older ones have some bulging discs. In fact, a back full of completely ‘normal’ discs is the exception, not the rule, even among healthy people. ‘Given the high prevalence of these findings and of back pain, the discovery of bulges or protrusions in people with back pain may frequently be coincidental,’ conclude the authors of one such study.

“Other possible explanations, also still speculative, are that the lower back muscles somehow go into spasm or that the spinal nerve roots are being compressed by arthritic spurs or bony overgrowth.”

Although the cause of back pain remains a mystery to Consumer Reports and the medically-minded writers whose erroneous disc assumptions were dispelled by the new research, back pain is not a mystery to the thousands of chiropractors who have been treating millions of patients for a century with spinal adjustments. It no longer should be a mystery that spinal joint dysfunction is the major cause of back pain, yet Consumer Reports could not bring itself to this conclusion despite the overwhelming research, instead downplaying the fact that the only treatment recommended in the new guidelines was spinal manipulation. Ignoring the truth about our profession is not new for Consumer Reports, which has never given a positive review of chiropractic.

As Rep. Dana Rohrabacher (R-CA) mentioned after the AHCPR study: “It only took them umteen years to discover that chiropractic care is effective… when we have millions of Americans who discovered that a long time ago, and are living healthier, happier lives because of it.” And it may take Consumer Reports another umteen years to admit it!

Another glaring example of media misrepresentation of the AHCPR facts occurred on NBC’s Today Show during the fall of 1995 when Dr. Art Ulene, no friend of chiropractic’s, recounted the results of this impressive two year study of over 4000 articles on back pain. In his week long series on back pain, Dr. Ulene mentioned the startling results of this study: Only one in 100 back surgeries is helpful; physio-therapeutics like ultrasound, TENS, hot packs and other standard treatments by PTs were also ineffective; and that spinal manipulation was the preferred initial professional treatment. When posed with the question by the host at the end of the interview that people should, therefore, seek a chiropractor first for their back attacks, Dr. Ulene almost choked and emphatically denied that conclusion, instead urging patients to seek an osteopath!

When I heard his remark, I almost lost my breakfast in disgust. Dr. Ulene’s obvious misrepresentation of the recommendations of the AHCPR study illustrated that these medical reporters just can’t give credit where credit is due. Inasmuch as the chiropractic profession has carried the banner of spinal manipulation for over 100 years, suffering the illegal slings and arrows of outrageous attacks from the AMA to give patients a freedom of choice in health care, I found his comment to recommend osteopaths instead of chiropractors insulting and a boldface misrepresentation of the truth as to who are the real experts in this form of treatment. Osteopaths sold out this type of care decades ago to seek medical acceptance, and if it weren’t for the beleaguered chiropractors who have carried on despite the lawlessness of the AMA’s propaganda and dirty tricks, spinal manipulation would have been lost long ago as a healing art. Osteopaths, poppycock!

Although anecdotal evidence is rejected in scientific circles, apparently it still makes good copy for the media. Two of the most damaging television accounts came from ABC’s 20/20 News.[9] In 1992 they aired “Magic? Myth? Medicine?”, a review of the RAND report which aimed to discount their conclusion with mixed comments from a neurosurgeon, their medical reporter Dr. Tim Johnson, and Dr. Paul Shekelle, head of the RAND researchers. By far their more infamous article on accidental cases with children, “Handle With Care”, aired in 1995. John Stossel interviewed DCs who had iatrogenic problems with a few children cases and he used Murray Katz, MD, and Charles DuVal, DC, both renowned chiropractic bashers who have united in a failed attempt to start a political entity called the Orthopractic Society, to ridicule the chiropractic treatment of childhood diseases and to cast another cloud over chiropractic’s image. It amazes me how the media finds the one-in-a-million iatrogenic accident to mischaracterize our profession, as if the majority of patients leave our offices in ambulances.

Woman’s Day magazine also used a similar anecdotal case to disparage chiropractic in May of 1995.[10] In an article by Marlys Harris, The “Well Adjusted” Child, she also used the loathsome threesome of Drs. Katz, Slaughter, and DuVall to bash chiropractic. Ms. Harris obviously had an ax to grind in her article, and she found this ignoble threesome to sharpen her blade. After I wrote a letter to the editor of Woman’s Day magazine, their letter in response mentioned that she “was inspired to write because of an experience in her own family several months before the 20/20 program on the subject was aired.” Once again, the double standard prevails – one accident and the entire profession is condemned! If this were the case in the medical world, the entire profession would be in dire straits considering their high rates of iatrogenic problems. Unfortunately, the public will never know of the spurious journalistic ploy to use anecdotal incidents to typify an entire profession; nor will the public realize how ludicrous for these three stooges posing as experts; nor will the public understand Ms. Harris’ personal hidden agenda to defame our profession. When embellished scare stories about chiropractic predominate in the press, we wonder why we only serve 10 percent of the public? Go figure.

The fact that the Orthopractic threesome have reappeared in other articles to blast our profession wasn’t just a coincidence. Another Consumer Reports three part article in the summer of 1994 about alternative medicine urged readers to call the Orthopractic Society (a.k.a. National Association for Chiropractic Medicine) for referral to DCs who agreed to their principles.[11] Can you imagine having these fringe obstructionists as gatekeepers for chiropractic? As well, consider the gall of Consumer Reports to snub the ACA, to misinform its readers and to recommend to millions of Americans this fringe group who have no scientific, political or academic expertise, but who are willing to talk trash about chiropractic. Obviously, this article clearly smacks of unethical reporting and was a total misrepresentation of mainstream chiropractic.

Another example of misinformation was the flawed medical study on back pain costs by Tim Carey, MD, from the North Carolina Back Pain Project that first appeared in The New England Journal of Medicine on October 5, 1995, and was quickly circulated by the Associated Press throughout the country.[12] While many flaws were discovered in this study, by far the most obvious problem was the fact that the comparison between primary care physicians, chiropractors, and orthopedic surgeons failed to include one back surgery! In effect, chiropractic care was compared to pain pills alone and, since 10-15 adjustments cost more than pills, their results suggested that chiropractors were the most expensive method of back pain management. Dr. Carey simply compared apples to oranges in a flawed scientific study paid for by AHCPR. Incredible!

More recently in the January 14, 1996 edition of Parade magazine, writer Earl Ubell again distorted the findings of the AHCPR report in his article, “What Works Best For Back Pain.”[13] His article discounted chiropractic care as “Controversial treatments…still under debate.” At best, he could only give chiropractic spinal manipulation a left-handed endorsement: “…the health-care study reported that it can work well in certain situations.” Unfortunately, Mr. Ubell then focused the remainder of his article on the surgical solution to sciatica (which he also admits occurs in only two percent of back pain cases) while completely ignoring chiropractic’s success in similar cases.

Rather than mentioning the AHCPR panel’s recommendation of spinal manipulation as the first form of professional care, Mr. Ubell also failed to mention the panel’s statement that only one in 100 back surgeries is helpful. Nor did he mention two reports by orthopedic surgeons (Scott Boden[14] and Maureen Jensen[15]) which undermined the basic premise of disc abnormalities as the cause of back pain in the majority of cases. In all, Mr. Ubell distorted the panel’s findings and simply sang the same old medical song of back surgery as the best solution to sciatica. My response to Mr. Ubell is simple: The debate is over and chiropractic came out on top. When a 23 expert panel researched over 4000 articles on back pain and recommended spinal manipulation as the best initial form of care and concluded that only 1 percent of back surgeries was helpful, how can anyone still endorse surgery or consider this issue under debate? Just what does it take to convince the media that the debate is over and chiropractic has won?

Although it may be difficult to admit for Consumer Reports, Parade magazine, Woman’s Day, The Wall Street Journal, The New England Journal of Medicine, the AMA, and other medically-minded media, the new guidelines emphatically recommended spinal manipulation as the best initial form of professional treatment for back pain. While it appears knowledgeable PhD and MD researchers are convinced of chiropractic’s effectiveness, much of the media and many medical practitioners have chosen to ignore the new research and guidelines. As an example of the medical world gagging on these new guidelines, Dr. Edward Handley, orthopedic surgeon and spokesman for the Academy of Orthopedic Surgeons, in response to the AHCPR news release, found it quite difficult to congratulate the chiropractic profession and justified the initial withholding of an endorsement by his group of the new guidelines:

“My personal view is that the Guideline absolutely reflects what science we know, and it is fair and appropriate. But medicine is an art and not just a science. It must not only take into account the scientific literature but also clinical experience and other factors as well.” [16]

If this isn’t sour grapes, I don’t know what is. The researchers did take into account every reasonable solution to this epidemic of back pain and objectively concluded that manipulation worked best in most cases whereas back surgery was helpful in only one in 100 cases. Even in light of the convincing research on this issue, many surgeons continue to mismanage patients with their ineffective and expensive methods while medical reporters continue to misrepresent the research to the public. Obviously, the truth is hard to come bye for the average patient who seeks the best spinal care possible.

Not only does chiropractic suffer from a medically-biased press, but some members of our profession seem intent on shooting our profession in the foot. In the January 17-18, 1996, editions of the Atlanta Constitution newspaper appeared a two part series about “The ‘Life’ and Times of Sid Williams”[17] as well as a revealing follow-up article, “Student DEBT”, about Life College leading all professional colleges in student loan defaults to the tune of $28.2 million.[18] The Associated Press picked up this story and distributed another embarrassing article entitled, “Life College Students Top Federal-loan Default List.”[19] Dr. Williams’ ineloquent response was just as embarrassing: “My students are not skunks or scalawags. They got trapped in something they can’t help.” I’m not certain if he meant they were trapped in Life College or in a poorly administered loan program, both of which may be true!

As a graduate of Life College myself, I find this high default rate perfectly understandable in light of the fact that their school song is the infamous “Money Hum”! Also in the news recently has been the arrest of DCs operating “runners” scams and insurance fraud here in Georgia. And combined with the endless stream of “Free Spinal Exams” and “Free Chicken Dinners” offered by “Spines ‘R Us” practitioners in our profession, the public’s image of our profession is soiled even more by these negative promotions. It seems most of the news about chiropractic are either distortions of the facts, embellishments of the remote cases, or outright embarrassments by DCs themselves.

Unfortunately, ethical and hard-working DCs are tarnished from both sides – or as they say down South, “caught between a rock and a hard place.” If it’s not the medical media bashing chiropractic, other DCs find ways to embarrass our profession on their own volition. The public’s awareness about our profession is not formed by the good work done daily by mainstream DCs  for millions of Americans, instead our public image is mainly formed by these outrageous examples. Without a proactive public relations program on a national scale to balance our critics, our image will remain a function of the medical media. We will never attract the multitude of Americans into our offices as long as their perception of us is solely a function of misinformation, embellishments and exposes of outrageous, fringe characters within our profession.

My call for reform is not new. In 1992 Mr. George McAndrews, the ACA’s legal counsel, wrote in the ACA Journal his opinion of chiropractic’s image:

“I believe this is the era of image. It is time for the ‘dewierdization’ of the profession… An aura of ‘weirdness’ is the necessary consequence of some chiropractic literature, advertisements… a sampling of yellow page ads makes one wonder if chiropractors are financial advisors or health care professionals… it is time to isolate the rascals.”[20]

Before the ACA House of Delegates on May 13, 1992, Mr. Mark Goodin, the ACA’s legislative consultant, was even harsher in his opinion of chiropractic’s dilemma:

“That enemy, of course, is this profession itself – and those elements within it that are unwilling to deal forthrightly with the charlatans, hucksters, profiteers, and wild-eyed ‘philosophers’ who put their own selfish interest ahead of science and the ethical and professional demands that every true healer must shoulder.

“You know who they are. They exist in virtually every community in which you practice. Their garish yellow page advertisements hawk free exams and x-rays – tests that, lo and behold, discover a variety of subluxation-related ailments which, if not treated immediately, threaten the life of the unwitting patient. They intentionally promote and practice the over-utilization of chiropractic.

“…They pass themselves off as ‘educators,’ but cut corners and counsel their students with messianic appeals on ego and self-promotion. They spend their out-of-practice careers in a cause to stop legitimate reform. They bring nothing of value to the future of this profession – but will resist, oppose, reject, undercut, and nitpick any effort to lift it up through higher accreditation, more comprehensive education, real standards of care and more ethical practice requirements.

“They are the small, but vocal class of professional nay-sayers who continue to enrich themselves, all the while dragging down an entire profession which now stands at the very brink of long-term success or instant failure and continued ignominy… The question that vexes me most is why? Why does this profession continue to tolerate their excesses?”[21]

So, what can be done to improve this tragic situation? In my estimation, it requires innovative leadership, an adequate budget and a commitment to a quality PR plan, including stricter advertising guidelines and damage control enforcement. In other words, it will require something chiropractic has never had, a professional strategy of smart marketing. There is a huge need to institute quality control in chiropractic advertising. Dumb ads and vicious newspaper articles are killing our overall image. Without a first-class PR campaign, all other political efforts are going to be less than effective. It would be equivalent to putting the cart before the horse. How can the ACA be persuasive with political influence when our image is that of the Rodney Dangerfield of health professionals?

Indeed, chiropractic is the mystery science profession that remains in between a rock and a hard place. Until our leaders formulate an effective national PR strategy that informs the public of our achievements, our image will remain tainted by our detractors. Honest DCs will continue to be perceived as second-class professionals who are cut out of the loop by political medicine and who suffer a poor public image from a medically-minded press as well as from dumb ads by “scalawag” DCs. As for me, I’m totally frustrated by both the rock – the medical media – and the hard place – those fringe DCs who soil our professional image. Just when will ethical chiropractors take charge of our future and unite in the goal to set the record straight? When will we be ready to re-invent our professional image? Or have we accepted being misrepresented by the press, insulted by insurance exclusion, embarrassed by fringe DCs, and generally being squeezed between a rock and a hard place?