ACA’s Chairman’s Award for
Outstanding Achievement in Chiropractic.
British Chiropractic Association
on Research Trends in Chiropractic.
Wither on the Vine
I’ve been given 15 minutes to introduce my new book, The Medical War Against Chiropractors, but let me take this time to give you, in effect, my State of the Profession address and how my book fits into solving some of our biggest problems.
For those of you who don’t know me, let me take a minute to introduce myself. I graduated from UC Berkeley in 1970 with a BS in pre-vet. I also played football and was an All-American in track in 1968.
After Cal I moved to New Jersey to begin a humanistic sports program at Livingston College of Rutgers University where I also attained my Masters in the Sociology of Sport in 1974. At the urging of my field chiropractor, I then enrolled in chiropractic college and graduated from Life Marietta in 1978. For the past 30 years I have been working in Warner Robins, Georgia, and in my spare time written five books, articles, and hundreds of online commentaries.
Some of you may also know me affectionately or maybe not so affectionately as the Lord of the Galactic Online Alliance for the past twelve years, writing admittedly caustic commentaries about notable demagogues, scalawags, and practice management shysters in our profession because I did not feel many were speaking out against this kind of element in our profession.
Wither on the Vine
I have now turned my attention to the biggest foe this profession has ever known—the AMA—and its policy to have chiropractic “wither on the vine.”
As you are painfully aware, there has been a substantial decrease in student enrollment from 15,000 to 10,000; practitioners like myself have also had a severe decrease in income; HMOs continue to “squeeze care to expand profits” as patients have had a decrease in insurance coverage; stats have shown a decrease in the meager percentage of people utilizing chiropractic care and, as Tony Rosner has said, our chiropractic researchers receive a “homeopathic dosage” in federal funding.
Most notably is the lack of good newsworthy articles in the media about chiropractic despite being the 3rd largest physician-level health profession in the nation. It is well established that the AMA influenced many journalists, such as Ann Landers, and the medical/media bias continues into 2112 if the recent NPR broadcast featuring Harriett Hall is any indication.
My goal now is to offer some achievable suggestions and to solicit your help to implement my plan. Let me paint a picture of my state of the profession’s paradox.
Great job, good results, bad image
Over the last three decades I have sought an answer to the Chiropractic Paradox—the fact that patients love our care, user surveys rate us highly, but we’ve gotten a bad rap in public media creating our poor image.
Good News: Our Job
Public polls like Gallup and Consumer Reports have given DCs top billing in regards to spine care preferences. A TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88 percent, which was 10 percent “higher than the overall satisfaction with all providers” that scored at 78 percent. Comparative studies and meta-analysis on LBP like Manga and AHCPR also rated chiropractic care and hands-on therapy at the top. Testimony at Wilk and the NZ Commission on Chiropractic also showed the superior benefits of chiropractic care.
According an article in The Wall Street Journal, “The Best and Worst Jobs,” in the latest 2011 jobs outlook the rank of chiropractic has improved from #56 in 2010 to #32 in 2011, higher than physicians, surgeons, PTs, dentists, and many engineers.
Bad News: Our Image
So, if chiropractic is a great job, why then we see less than 10% of the public? And why is the enrollment in our colleges down by 33% in the last 15 years?
A 2009 Gallup poll showed chiropractors ranked eighth of twenty two professionals: but higher than bankers, state governors, senators, congressmen, stockbrokers, and HMO managers who were all ranked lower than chiropractors.
Also in the 2009 Gallup poll on Honesty and Ethics Standards of Professions, only 34 percent of the public rated chiropractors’ image as VERY HIGH/HIGH. Chiropractors were ranked among the lowest of health professionals, only above psychiatrists.
Inexplicably, in an 1984 Oklahoma poll, one person said, “I wouldn’t want my daughter to marry one.”
This is the paradox we face as a profession—a great job getting good results with a bad image.
Medical Cold War
My latest book, The Medical War Against Chiropractors, answers these questions that, sadly, too few in the public understand. I have even found chiropractic students, staff, and practitioners also fail to understand why our public image is poor.
Some may think it is self-inflicted, which may be partially true, but I disagree when you realize the depth and length of warfare waged on the chiropractic profession by the AMA.
The answer to this problem rests with Morris Fishbein and his successors in the Committee on Quackery whose stated goal was to “contain and eliminate chiropractic.” They never minced words in their zeal to destroy our profession altogether, and their effort to ruin our reputation was mentioned by William Trever who revealed the AMA’s mantra that “everybody knows chiropractic is an unscientific cult,” a notion that still reverberates in the medical media.
Even Judge Getzendanner in her final decision mentioned the AMA has never made any efforts to restore our reputation.
This defamation campaign continues today when recently we hear Harriett Hall on NPR calling the study of CAM methods “quackademia.” We have read Edzard Ernst’s salacious article, “Deaths After Chiropractic,” (at the rate of 0.34 fatalities per year!) that still ranks among the top ten emailed articles at Medscape. The AMA HOD is again pushing back on the anti-discrimination bill in Obamacare; who says Jim Crow is not alive in medicine?
Nortin Hadler, MD, and past guest speaker at ACC-RAC, wrote in his book, Stabbed in the Back, that subluxations were “imaginary.” He also states, “I admit to chauvinism; I value my profession above all others…I also write extensively on how its practitioners hear a higher calling.”
His arrogant mindset is a big reason why the medical profession still fights us at every turn despite the evidence-based research promoting chiropractic care as well as studies critical of medical spine care of drugs, shots, and disc surgery.
Now the recent attack by the medical mob Down Under is too reminiscent to the FSU debacle. Once again, chiropractic is being called “pseudo-science” and we see academic freedom under attack by medical demagoguery.
The worst part of these attacks is that they fly in the face of the facts. If you recall during the NZ Commission and the Wilk trial, when the attorneys asked the medical leadership their opinions of chiropractic, their resounding testimonies claimed chiropractic was “dangerous, quackery, and pseudo-science.” When our attorneys then asked them to prove it, all were incapable—they were merely repeating their own propaganda.
Last year lay articles on spine surgery in the NY Times, Wall Street Journal, Bloomberg News, NPR and MSNBC were very critical of the medical treatments, corruption with device manufacturers, high expense, and disability rates, yet none mentioned chiropractic care as a viable alternative. Indeed, we continue to get short shrift with obvious omissions in the media.
Certainly, we continue to wither on the vine in terms of our image, your enrollment, and our livelihoods. This course is unsustainable for much longer. I don’t know about you, but I feel a sense of dread unless we change tactics immediately.
So, what can we do?
More legislation and litigation?
More F4CP celebrity endorsements and ads in The Wall Street Journal whose direct impact is difficult to measure?
More online patient testimonials and WOC stories?
My personal opinion is I don’t think those tactics get to the root cause of our problem—the century long war to defame our reputation by the AMA. We need to change tactics to get to the cause of this paradox. Both my book and new website address this problem.
The bias against chiropractic remains an “acceptable prejudice” when we are called epithets such as “quackery, pseudo-science, and dangerous” without any equal time for our response.
This acceptable medical bigotry is very much alive in the media, too. For example, when Rush Limbaugh calls a law student who wants birth control a “slut,” everyone is shocked. However, when Harriett Hall on NPR calls chiropractic education “quackademia,” nothing is said in response. Apparently medical bigotry transcends the normal decency standards in the media.
Obviously there is a double standard in the media when it comes to our profession, perhaps due to the lingering belief that “everybody knows chiropractic is an unscientific cult”?
We must first address this medical media bias before we will see a change in attitude in the public. Expensive ads in the WSJ or celebrity testimonials may work on one level, but until we address this underlying medical bigotry and media bias, we have not gotten to the cause of our problem.
Power of the Pen
If we are to have a tipping point or a breakthrough to draw attention to our dilemma, we need to tell our story in a different fashion. Basically, I believe in the power of the pen since we have no other weapons to fight with.
Here is what I suggest. People love stories about the underdog and chiropractic is certainly that, but our story remains untold. We have a fascinating history from persecution to vindication, but no one in the public knows it, except those very few who may have read my book.
The history of this persecution and defamation is shocking, but makes for a good story. Although sexism, racism and anti-Semitism have diffused origins, the medical bigotry toward chiropractic can be traced back to one man, Morris Fishbein, aka the Medical Mussolini as he was called by his contemporaries. Little do people know he was the tyrant whose goal was to destroy all competition with the medical profession. He was the voice and the face of the AMA for 25 years; he edited JAMA, wrote 22 books and was syndicated in 800+ newspaper in which he condemned governmental health programs in any form, as well as labeling all CAM professions as quackery. He also gave the tobacco industry the AMA’s endorsement in a multimillion dollar deal to fuel his war chest.
As Harper’s magazine wrote in 1949 about Fishbein, he changed the AMA from a “pantywaist organization to the most terrifying trade association on earth.” It was his policy that caused 12,000 chiropractors to be arrested 15,000 times in the first half of the 20th century. Chiropractic historian, Russell Gibbons, recognized the singular impact of Fishbein and concluded he was “the most important non-chiropractor to influence the chiropractic profession.”
Yet the public and many chiropractors have no idea of his man and the damage he caused our profession. This is a revealing part of medical history the AMA would prefer left in the dark (which explains why the medical media refuses to discuss it), and it’s our duty to shine light on this tragic story and the damage they did if we are to improve our image.
Paradigm shift in spine care
Not only does the public need to know about the fascinating history of chiropractors as freedom fighters in healthcare, but they need to understand the paradigm shift in spine care. For too long primary care MDs have been posing as experts in spine care that has been shown to be utterly incompetent according to researchers like Joy, Hala, and Bishop. We DCs need to be known as the primary spine care providers as Murphy, Perle, et al have suggested.
Medical researchers have constantly shown that the medical methods of addictive opioid drugs, ineffective epidural steroid injections, and expensive spine fusions based on an outdated disc theory are all ineffective for the majority of spine disorders.
It’s past time that we told the public that up to 90% of these cases can be helped with our brand of spine care. To be fair, medical care is certainly appropriate for the other 10% of cases with cancer, fracture, serious infection, true disc prolapse, or those cases that do not respond to chiropractic care.
The public needs a paradigm shift in its concept of the underlying cause of back pain. This is paramount to understanding our brand of care. Rather than patho-anatomical problems, we need to teach patho-physiological issues are the underlying causes of back pain, such as alignment, strength, flexibility, compression, leverage, etc. In other words, what’s important is how the spine functions, not what it looks like on x-ray or MRI images.
Instead of slipped discs that researchers like Rick Deyo now chide as “incidentalomas,” we need to teach them about slipped joints and joint dysfunction. Indeed, when people realize there are 313 joints in the spine as Greg Cramer touts, our brand of care makes more sense than slipped discs.
Furthermore, when people understand spinovisceral reflexes that may cause 10% of angina and other Type O disorders, then the Big Idea of neurophysiology will make sense to them. When they understand research by Heidi Haavik-Taylor and Bernadette Murphy showing with electroencephalographs the affect of SMT on cortico-circuitry to reboot the brain, then we all can better understand after an adjustment when some patients pronounce, “I can think more clearly.”
And I can’t begin to describe the very controversial yet equally fascinating work of Ted Carrick and his functional neurophysiology and neuroplasticity.
Since the medical media will never reveal this new paradigm in spine care or the atrocities committed by the AMA against chiropractic, we need to so ourselves if we are to win over the public for the first time in our history.
Think outside the box
Just as we ask our patients to think outside the medical black bag, we need to do the same. As educators, you must think outside the box, too; in this case, outside the classroom. It is time to educate not only students, but the public, press, and politicians to make this happen on a massive scale.
Each college has an enormous amount of talent and equipment at hand to write stories for the lay media, make videos for cable TV and the internet, and to monitor the media.
This is not to take anything away from scientific papers, but we need to take the scientific papers and re-write them to reach the public about our plight. We must convince the public since they determine whether or not you survive as colleges since they send their children to your colleges.
I suggest that the colleges collectively develop a “creative writing course” online for each of the students of every chiropractic college to participate. The cost is low, the return could be high, and the interest generated will compound when this is launched and goes viral.
I know there are honest differences within the profession about how to launch a PR campaign. I have been chastised for attacking the medical profession and I understand that viewpoint, but I also understand that we cannot play fair while the others play foul. We simply cannot depend upon the medical media to tell our story.
I understand your possible angst about this war, and I understand “blessed are the peacemakers.” But we will not find peace until the truth be told, and I believe the evidence-based truth will set us free. We will not stop withering until the truth is embraced by all sides in this war.
Moreover, we need to empower students and practitioners alike to speak out to defend our profession from future attacks, but most are not ready for this battle. Indeed, do you think today’s students and DCs have the same mettle as our forefathers who went to jail for chiropractic?
It appears that the desire for battle is not as prevalent today. So, when will we find the nerve to fight in the public arena for our survival—when enrollment drops to 50% or when more DCs go bankrupt or when HMOs continue to exclude or limit our care? Indeed, where is the tipping point for survival as we continue to wither on the vine?
Students and practitioners must be trained in these issues of poli-sci, history, and current trends in research in order to write and debate these issues in the media. We must confront the next quack buster like Harriet Hall, Edzard Ernst, Raymond Bellamy, Nortin Hadler, or the local MD who tells patients that chiropractic is quackery that may paralyze them.
We must call out the mainstream media and demand equal time and truth if we are to rebrand ourselves as primary spine care providers.
In fact, my book already has been used successfully as an instrument of change in a couple of political arenas. Richard H. Tyler, former associate editor of Dynamic Chiropractic, is now a member of the California Board of Examiners. He recently sent me a note about a state senator opposed to the inclusion of chiropractic in a bill, but after he was given my book, it turned him around to support us.
In Australia, the chiropractors are going through a rough time by a medical mob obstructing chiropractic programs in their university system similar to the FSU debacle. Fortunately, the DCs Down Under are using the information in my book to counter the medical claims that chiropractic is a pseudo-science as well as questioning the academic demagoguery of the medical mob.
In summation, Bill Meeker wrote that “JC Smith has written a fast-paced and jaw-dropping account.” It can be more than that. It can be enlightening to students and it can be an instrument of change for field docs to use in the political arena or in our PR.
But we need to carry this battle into the public forum on a consistent basis. I urge ACC-RAC to establish a workshop called “Writers’ Block” for journalists to present lay articles, new books, electronic videos or television programs about our profession.
I hope you will give serious consideration to my hope to begin creative journalism courses to train the next generation of chiropractic warriors armed with their pens. As one college president told me, “If you can help our graduates improve their communication competencies, it serves everyone.”
I will be glad to visit your college to implement or motivate your staff and students. But I first suggest they read my book and visit my new website, www.chiropractorsforfairjournalism.info that contains nearly 150 articles I’ve written over the past 30 years as well as four video infomercials, one radio talk, four books and five writing lessons.
Thank you for giving me an opportunity in a professional forum to germinate my advocacy for journalism—this may constitute my 15-minutes of fame.