AHCPR Gone with the Wind


Can Sex Sell Chiropractic?




JC Smith, MA, DC


IT’S A SAD FACT THAT THE CHIROPRACTIC PROFESSION has no electronic public relations presence or professional advertising campaign. Our absence on television has, in effect, kept us in the dark ages of marketing our services. Until we find a way to get on TV via publicity events, news events, public service announcements (PSAs), or an advertising campaign, we will remain the mystery science profession.

Regrettably, the only time we seem to make the news is when we’re under attack by some medical chauvinist parroting the medical party line, such as we’ve seen again and again with the stroke issue. They seem to forget the facts that now show the chance of a stroke by manipulation is 1 in 5.85 million compared to 15,600 accidents per one million neck surgery procedures. This emotionally charged issue gets the attention of the press and public alike and chiropractors are made to appear like dangerous buffoons once again.

If anything, our image is a function more of medical misinformation than a concerted effort of our own design. Even the recent flap over ugly comments by Jim Rome indicates our inability to appear strong enough to dissuade such bigoted nonsense in the first place. Indeed, if he’s concerned about those who “ruin people’s spines for a living,” why didn’t Rome rail about the ineffective and unnecessary back surgeries that leave a wake of disability behind? I’m sure he has more friends or family members with failed back surgery syndrome than he has friends who’ve been hurt by chiropractors. His bias is probably more a function of cultural iatrogenesis and medical misinformation than real facts, proving my point that our image is in need of damage control repair and PR improvement. We need a new image based on the evidence of our success and not on emotions from anecdotal accidents, bias reporters, or hidden medical agendas.

Medical Bigotry

Indeed, we’re the scapegoat for any bigot with an axe to grind. While it’s not politically correct to bash minorities, gays or lesbians, blondes or redheads, it’s still okay to bash the hapless chiropractors. I daresay nowadays Arab-American Muslims get more slack than we do when it comes to tolerance by the media. Just when was the last time you’ve heard the media come to the defense of chiropractors? When have they come to our rescue and made heroes of us? Rarely, if ever, has the media portrayed DCs as helpful practitioners saving folks from unnecessary surgeries, useless drugs, and a life of pain and impairment. In effect, we seem to be a taboo issue to many of the media folks. Some call it getting short shrift; I call it getting the shaft.

As I’ve found in my hometown, everyone’s an expert about chiropractic, and most of the time, they’re simply reiterating the baloney from their own MDs. Don’t you just hate it when some new patient with an IQ about room temperature feels obligated to share with you all the slander he’s heard about chiropractic? “My doctors says you’re a quack,” or “My father doesn’t believe in chiropractors,” or “Uncle Fred went to a chiropractor once and it didn’t work.”

My personal un-favorite remark is, “People say you’re not a real doctor.” Biting my lip to keep from swearing, praying to appear calm to lower my blood pressure, trying to relax my clenched jaw so I won’t scream, and uncoiling my clinched fist before I hurt anyone, I try to respond in a professional manner without wearing my emotions on my sleeve. Indeed, sometimes it’s tough being a chiropractor.

“Well, I don’t push drugs, and I don’t do unnecessary surgery, but I’m a real chiropractor, and that’s what you need now.” Indeed, everyone’s an expert, and a critic, about our profession.

Sometimes I just want to scream in disgust. Just last week I had three different patients tell me of their friends who needed my care, but the local back surgeon frightened them with the voodoo diagnosis, “If you’re stupid enough to let a chiropractor crack your back, don’t come crawling back to me when you’re paralyzed.”

I asked them all, “Did he mention the rate of chiropractic iatrogenesis is 1 in 5.85 million compared to medical iatrogenesis from neck surgery is 15,600 per one million?”

“Of course not,” they replied, but the surgeon achieved his goal because they all were now afraid to have a simple spinal adjustment, but not afraid of back surgery. Go figure.

Regrettably, I’m not making this stuff up as ridiculous as it sounds. For $30,000, this unscrupulous surgeon is happy to lie and laugh all the way to the bank. It’s unethical, illegal and a boldface lie, but it’s done everyday without any comment by the chiropractic profession or without comment by a medically friendly media, and certainly without any idea by the naïve patients who blindly follow their surgeon’s advice without being given honest, informed consent procedures.

Yet the damage is done and it would be next to impossible to change their fears since the cultural authority of an MD far exceeds that of us lowly DCs. After all, MDs are the heroes of every TV show, not chiropractors.

Politics of Guidelines

Not only do we need a sustained PR effort to transform the skeptical public, but also another blow to our PR effort occurred recently when the most persuasive PR material ever printed by the US Public Health Service had been discontinued for unknown reasons. The AHCPR Patient Guide on acute low back pain in adults, “Understanding Acute Low Back Problems,” is now out of print. This pamphlet was the most authoritative government-sponsored endorsement of SMT this profession has ever known; yet it’s now gone with the wind, killed by the hands of medical bureaucrats and never to be seen again if the orthopedic society has its way.

If you recall, the orthopedic society filed an injunction to stop the initial release of this publication back in 1994. After six months of “lawyering,” a federal court allowed it to go forth to the masses, which it did on December 8. Not dismayed, afterwards the orthopedists than attacked the AHCPR and had its funding cut, then forced it out of the guideline business altogether. “We ain’t gonna have no Washington bureaucrats telling us what to do,” they protested to their AMPAC Congressmen who gladly helped them to gut this agency.

The orthopedists then sued Richard Deyo and his research cohorts, who wrote a revealing article, The Messenger under Attack–Intimidation of Researchers by Special Interest Groups, (NEJM vol. 336, No. 16, pp. 1176-79, April 17, 1997) about this sordid event. As Deyo correctly surmised, what good is research if it conflicts with the status quo that then sues the researchers?  Then we will only see research that supports the status quo thereby limiting breakthrough ideas or technology. Indeed, how can the better mousetrap emerge if the good ol’ boys kill the mouse instead?

This was a good example of killing the messenger because they didn’t like the message that back surgeries don’t work well. Indeed, the AHCPR Patient Guide recommends for LBP: ice, aspirin, and manipulation, plus it states, “Surgery has been found to be helpful in only one in 100 cases of back problems.” Obviously the orthopedists were hell-bent to destroy it with such sentiments clearly opposed to the onslaught of back surgery nowadays.

This stoppage of the low back pain guideline is another victim of the orthopedists who hated the fact that the US Public Health Service recommended SMT over back surgery. Perhaps this is why the NAS admitted that it takes on the average 17 years for a new medical procedure to become mainstream—the medical status quo is resistant to any change, especially in health care and certainly if it takes money out of their pockets. Isn’t this the same resistance we’ve gotten of late on the VA issue from the AOA and APTA? Forget about evidence-based research and “best practices,” in fact, it’s all about money. As Gary Cuneo mentioned in his recent email newsletter, “Congressman Bob Filner (D-CA) put it all into prospective when he said that the physical therapists were simply trying to protect their turf. Amen!”


When I contacted the PR lady, Jackie Besteman, at the newly transformed Agency for Health Research and Quality (AHRQ) to ask why this Patient Guide on acute low back pain was no longer published, I was told that they’re no longer in the guideline business. Here is their new mission:

The 21-member panel is comprised of 17 private-sector experts who contribute a varied perspective on the health care system and the most important questions that AHRQ’s research should address in order to promote improvements in the quality, outcomes, and cost-effectiveness of clinical practice. The private-sector members represent health care plans, providers, purchasers, consumers, and researchers.

A scan of their 21 panel members showed not one doctor of chiropractic on this important panel. I guess being just the third-largest health profession in the US doesn’t carry much weight with these MDs, PhDs, MPHs, and related health professionals. Being snubbed is becoming a habit by these medical bureaucrats in HCFA, the VA, and AHRQ.

When I asked why this Patient Guide was no longer being published, I was told a committee of four medical directors there, Douglas Camero, John Eisenberg, Lisa Simpson, Christine Williams, decided it was outdated now that they’re using “evidence-based” criteria. So I asked what “new” evidence did they have that replaced the old evidence that SMT was preferable to medical methods? Being aware of much of the latest research and recommendations, none has shown evidence to the contrary of the old AHCPR guideline on low back pain. Of course, I was given no answer and quickly referred to their website, www.ahrq.gov, to learn more.

I view this simply as four medical bureaucrats out to undermine anything that supports the chiropractic profession, similar to what we’ve seen in the VA. After the most extensive study ever done in the history of the world on low back problems, the AHCPR guideline, along with its supportive research and recommendations for SMT, suffered the same fate as all other non-medical methods—the poison pen of the bureaucratic world of medical censorship, all done quickly and quietly behind closed doors without any intervention by anyone else, especially those radical chiropractors and “alternative” practitioners.

And where’s the outcry from the chiropractic profession? Here’s one of the best recommendations this profession will ever have, yet nothing is said by our press, most likely again asleep at the helm. The good ship ChiroTitanic hits another iceberg, yet nothing is said by Dynamic Chiropractic, The Chiropractic Journal, The American Chiropractor or any of our journals. Why is that—didn’t know or don’t care?

Ducking Duke

Just as the AHCPR guideline is now removed from the public’s eyes, the recent Duke University study that showed the effectiveness of SMT for cervicogenic headaches over other treatments like medications, massage, and biofeedback, also got short shrift when nothing was said in the mainstream media. Here we get the stamp of approval from Duke, and nothing is mentioned in the press despite the fact that millions of folks suffer from headaches who might like to know of a natural way to help with their pain and suffering (and without toxifying their livers, stomachs or kidneys).

The ACA sent out a nice news release for us to send on to our local papers about this Duke study. The response I got from the editor of the Macon Telegraph was short: “we don’t print news releases.” Uh? Since when doesn’t a newspaper print news releases? “But,” he wrote, “you can take out an ad if you want.”

I thought to myself: If a drug company had won in this Duke study with some new drug proving to be the best solution to this epidemic of headaches, I’m sure the Macon Telegraph would have printed a headline story, “New drug cures headaches according to Duke University study.”

Promoting Our Mystery Profession

Obviously we can’t rely upon the government or news media to promote our services if these AHCPR and Duke University experiences are indicative of their lack of help. Until we find the way to fund a proactive PR campaign on national television, preferably MSNBC or Fox News, we will continue to be the mystery science profession getting ignored by the mainstream media. So what are we to do?

Even a simple public service announcement concerning chiropractic would be nice. In the mornings when I work out on my NordicTrack, I often see PSAs for most every cause in America—runaway kids, drugs and alcohol addiction, sex and racial discrimination, child abuse, left-handed people, etc. You name it, and there’s a PSA promoting it, except for chiropractic, of course.

Why not make a couple of PSAs featuring the AHCPR guideline for LBP and the Duke study for headaches? Keep it simple for the stupid masses to understand, but just do it, please. Even if these PSAs ran at 4 am, a few million folks would still see them each time. That’s certainly better than no PSA being not seen by anyone anytime anywhere.

For special effects, we could have Big $id telling the public, “Rigor mortis is the only thing that we can’t help!” Yeah, that’s the ticket—make some outrageous statement that folks will remember in total disbelief. Maybe the shock treatment will work better than the logical approach. It’s work for him by selling, “Come to Life and you can be a rich chiropractor too, just like me, my lovely wife, Nell, my daughter Dim Kim, and my DE Dudes. All you need to matriculate is a student loan and a heartbeat.” Do I hear a Money Hum coming?

Since sex sells most everything nowadays, I keep thinking of a PSA with an attractive, tall woman with a low cut dress in the back below her waist stating simply, “If you want a great lookin’ spine like mine, see your chiropractor.” Or, perhaps, we could ask Arnold Schwartzenager to pose with his big muscles saying, “I’ll be back to see my chiropractor, and I suggest you do too.” Instead of a white moustache like the milk commercials, we could have these actors spines highlighted in a radiant, energetic glow. That ought to get some attention, don’t you think?

We could also use our impressive list of DCs who work for professional and Olympic athletic teams with the message that chiropractic helps their teams to win. Certainly if we could get the athletes like Barry Bonds to participate in an ad, it would definitely be a winner. With our sports-crazy society, this would have a huge impact upon the younger generation of Americans. How about an ad with Tiger Woods with his chiropractor saying, “My chiropractor keeps my swing in the right groove”?

The fact is our profession has just never projected itself in a positive, popular light in the mass media. We failed to take advantage of the original AHCPR guidelines that recommended SMT over surgery, nor the Manga reports, nor the British, Danish, New Zealand studies or the recent Duke study on headaches. We have a lot to crow about, but our silence fails to stimulate the masses to move our direction despite this epidemic of back problems. If it weren’t for word-of-mouth advertising, we’d have none, except for the infamous free spinal exams ads. Whether it’s PSAs with celebrities or ads with sexy models, we need to do something. Anything (tasteful and ethical) is better than nothing.

I seriously doubt a 30-second ad will do much to reposition the 30% of skeptical folks who need more convincing than 30 seconds will allow. I have shown 30-minute infomercials for years on our local cable station in my attempt to reposition the local folks to our scheme of things. With a million channels now available on cable television, I would think an underground type of 30-minute video that promoted our science, art and good clinical results, along with the supportive research and governmental recommendations would do wonders to enhance our image and to recruit new patients.

The main theme of my 30-minute infomercial was the fallacy of the disk theory. Until we educate the public of the massive MRI research that shows disk abnormalities are a natural part of the aging process and have little to do with back problems, the sooner we’ll reposition the public to our scheme. Indeed, let’s teach them that you don’t slip disks, but you do slip joints. The proof is there, the results are positive, the recommendations are supportive, yet the uninformed public doesn’t know because we haven’t told them. Indeed, the disk theory and spinal fusions are one of the biggest scams ever perpetuated by the medical profession upon an unsuspecting public, yet it continues to increase because no one is speaking out against them. If not us, then who will?

Until we blow our own horn on television, we will remain the mystery science profession that most folks are skeptical about. They don’t understand our paradigm, they never hear of the positive research supporting us, nor do they realize the many benefits of our services. Until we make some noise, our silence will be deafening. Isn’t it time to use the electronic media to promote ourselves, or are we destined to remain the mystery science profession forever?

But, what do I know? And I’d love to hear what you know about this huge problem.