How to Earn our Media
Historically, chiropractors have relied upon the traditional WOM ads touting our effectiveness. While this is may be good for your local reputation, it will not move the needle in regards to create an updated and accurate cognitive dissonance we need to have in the public sector if we are to assume our rightful role as the POE for MSDs and spine-related disorders (SRDs).
However, this is a steep uphill battle. The recent Gallup-Palmer survey indicates the chiropractic dilemma: although 57% said they were likely to use chiropractors for neck and back pain, when the rubber hit the road, only 29% sought chiro care; 54% sought MD care instead.
Recall these are the MDs who know nothing about MSDs and they alone created the opioid pandemic of addiction we now see. As the CDC revealed in a 2014 study, “Opioid Painkiller Prescribing,” MDs prescribed 259 million prescriptions for opioids, equivalent to one for every American adult.[1]
Considering 29.9% of opioid use is for low back pain cases according to a study, “Trends in De-facto Long-term Opioid Therapy for Chronic Non-Cancer Pain,” [2] finding a nondrug solution for this pandemic of pain is crucial if we are to over this opioid addiction and deaths.
If we are to wrap our heads around this complex issue, let’s look at this problem as a psychologist might. Robert B. Cialdini, PhD, in his book, Influence, the Psychology of Persuasion, gives his insight how public opinion is formed and how to influence it.
According to Cialdini, public opinion is characterized as a “click, whirr” stimulus/response situation. In our case, click on the topic of chiropractic and then, whirr, out rolls the pre-recorded medical tape, that is, the propaganda they’ve learned for nearly a century from the ilk of the AMA’s Committee on Quackery.
Judge Susan Getzendanner at the Wilk v. AMA antitrust trial spoke about the whirr damage done to our reputation by the AMA:
“The activities of the AMA undoubtedly have injured the reputation of chiropractors generally…In my judgment, this injury continues to the present time and likely continues to adversely affect the plaintiffs. The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”[3]
Let’s be frank: no other profession has endured the massive defamation campaign that “continues to the present time” as we chiropractors have suffered at the hands of the AMA. It was an illegal albeit effective ploy to destroy a competitor’s image in order to dominate the healthcare market, particularly the lucrative spine care niche.
If the public understood such critical scientific opinions about medical spine care, instead of the usual click, whirr skeptical response about chiropractic, it could illicit new attitudes, such as:
- “I didn’t know spinal manipulation was a ‘proven treatment’ for acute low back pain in adults.”
- “I didn’t know guidelines now recommend chiropractic care before drugs, shots, and surgery,”
- “I didn’t know only one in 100 back surgeries were necessary.”
- “I didn’t know ‘bad discs’ appear in pain-free people,”
- “I didn’t know epidural shots were never approved by the FDA for back pain,”
- “I didn’t know OxyContin was heroin,”
- “I didn’t know a medical witch hunt had 12,000 chiropractors arrested in the first half of the 20th century,”
- “I didn’t know in 1930 the AMA jumped into bed with the tobacco industry to fund its war against chiropractors,”
- “I didn’t know the AMA declared war to contain and eliminate the chiropractic profession,”
- “I didn’t know the AMA was found guilty of antitrust activity by a federal court in Chicago,” and, most of all,
- “I didn’t realize chiropractors were right all along.”
Now is the time to drop the other shoe of skepticism about medical spine care—that is, “everybody knows to avoid opioid painkillers, epidural shots, and spine fusions before seeing a chiropractor first.”
Media Proof
The call for reform in spine care is growing not only in the scientific and academic circles, but today we see a continuing flood of news articles revealing the abuse, expense, dangers, and fraud within medical spine care.
The following is a short list over the past few years of recent news articles critical of medical spine care:
- “Highest-Paid U.S. Doctors Get Rich with Fusion Surgery Debunked by Studies” by P. Waldman, Bloomberg News, Dec. 30, 2010
- “Procedures: Sharp Rise in Complex Back Surgery Among Older Adults,” by Roni Caryn Rabin, New York Times, April 9, 2010
- “An Operation to Ease Back Pain Bolsters the Bottom Line, Too,” by Reed Abelson and Melody Petersen, New York Times, Dec. 31, 2003
- “Surgery May Not Be the Answer to an Aching Back,” by Joanne Silberner, NPR, April 6, 2010
- “Unneeded, Riskier Spinal Fusion Surgery on Rise” by Carla K. Johnson,” NBC News, 4-6-2010.
- “Why You Should Never Get Fusion Surgery For Plain Back Pain” by Robert Langreth, Forbes, Jan. 10, 2011
- “600,000 Americans Have Back Surgery Each Year,” TODAY, September 11, 2012
- “Study Says Back Surgery Often Makes Things Worse,” The Daily Hit, Oct 14, 2010
- “New Study Reveals That Back Surgery Fails 74% of the Time,” SPINE 2011 (Feb 15);36 (4):320–331
- “Back Pain Eludes Perfect Solutions” by Leslie Berger, The New York Times, May 13, 2008
- “Back Pain Is A Complicated Issue” by Karen Ravn, LA Times, April 4, 2011
- “Epidural Steroid Shots Debated Amid Meningitis Scare,” USA Today, Oct 6, 2012
- “Opioid Painkiller Prescriptions Pose Danger Without Oversight,” by Barry Meier, The New York Times, April 8, 2012
- “Back Surgery May Backfire on Patients in Pain,” by Linda Carroll, MSNBC.COM, Oct. 14, 2010
- “Top Spine Surgeons Reap Royalties, Medicare Bounty,” by John Carreyrou and Tom McGinty, Wall St. Journal, Dec. 20, 2010
- “Medicare Records Reveal Trail of Troubling Surgeries” by John Carreyrou and Tom McGinty, Wall St. Journal, March 29, 2011
- “How Back Pain Turned Deadly” by Elisabeth Rosenthal, The New York Times, November 17, 2012
- “Fee-for-service rewards volume: Our view” The Editorial Board, USA TODAY, July 7, 2013
- “Back Pain: Doctors Increasingly Ignore Clinical Guidelines,” The LA Times, July 29, 2013
- “Patients With Back Pain Often Get The Wrong Treatment,” USA Today, July 29, 2013
- “Worrisome Trends in Back Pain Management,” Medscape Medical News, July 30, 2013.
- “New solutions for long-lingering back pain – CBS News,” CBS This Morning, July 31, 2013.
- “Former Hospital CEO, Calif. Senator Charged in Insurance Fraud Case,” California Healthline, Feb. 24, 2014
- “Outpatient Back Pain Treatments: Not What the Doctor Should Order,” by Jaime Toro, MD, NEJM, August 20, 2013
- “The Back Pain Most Surgeons Won’t Find,” by Dr. Nick Shamie, CNN.com, September 18, 2013
- “Worsening Trends in the Management and Treatment of Back Pain,” JAMA Internal Medicine, July 29, 2013
- “Hospital Executive Pleads Guilty in Bribes Case,” by John Carreyrou, WSJ, Feb. 21, 2014
- “Rethinking Spine Care” by Jaimy Lee, Modern Healthcare, March 22, 2014
- “Tapping Into Controversial Back Surgeries” by Ben Eisler CBS News April 24, 2014
- “Epidural Corticosteroid Injection: Drug Safety Communication – Risk of Rare But Serious Neurologic Problems,” FDA, April 23, 2014
- “Medicare Data Cast Spotlight On Most Prolific Spinal Surgeons” by Joe Carlson, Modern Healthcare, April 23, 2014
However, due to chirophobia, pitifully few articles mention chiropractic care as the preferred treatment, illustrating that journalists still suffer from ‘professional amnesia’ as we inexplicably remain missing in the media as a ‘proven treatment’ for this pandemic of back pain.
Earned Media vs. Paid Ads
It is past time the public understood why medical spine care is considered a “national scandal” by the editor of The BACKLetter. As chiropractors, we’ve seen the collateral damage of this scandal—the failed back surgeries, the opioid addicts, and the wasted money and lives. Finally the media is revealing this medical mess.
Never before in this medical war have we had such powerful ammunition with which to fight in this war of words. It’s our turn to drop a few PR bombs on the medical glass house, and rightfully so with the big guns of academic and scientific proof, luxuries we’ve never had before.
Now is the time for the F4CP to diversify its strategy to emphasize “earned media” (aka, free media) that refers to publicity gained through promotional efforts other than advertising, such as interviews, op-ed articles, investigative journalism like “60 Minutes.”
For too long, we’ve been the proverbial “elephant in the newsroom” where medical propagandists dominated the news media. Today with the plethora of evidence falling on our side that is highly critical of medical spine care, it is our time to push the agenda to expose the corruption in spine care.
This approach will actually save the F4CP money since there is no great expense except to hire a publicist to make a concentrated effort to get interviews and articles in the earned media. But we need qualified spokesmen/women/ and writers who know the issues, historical events, and the paradigm shift in spine care.
It is past time the public understood why medical spine care is considered a “national scandal” by the editor of The BACKLetter. As chiropractors, we’ve seen the collateral damage of this scandal—the failed back surgeries, the opioid addicts, and the wasted money and lives. Finally the media is revealing this medical mess.
Never before in this medical war have we had such powerful ammunition with which to fight in this war of words. It’s our turn to drop a few PR bombs on the medical glass house, and rightfully so with the big guns of academic and scientific proof, luxuries we’ve never had before.
Wanted: Speakers & Writers
Rather than retaining celebrities, I urge the foundation to retain a publicist with a big rolodex to arrange TV or radio talk show interviews with our spokespeople. The F4CP already has potential spokes-people on board such as Gerry Clum, Mike Flynn, Tom Klapp, Michele Maiers, Fabrizio Mancini, Carol Ann Malizia, and Bill Meeker. This program can be expanded with other people later as it gets roots.
The F4CP should sponsor a program of writers to produce newspaper/magazine articles and electronic, TV, and radio news programming about the new spine science, evidence-based guidelines, and our benefits in order to change the chirophobia of the old medical tape.
The following examples of headlines will draw much more attention in the media and public as well as create the expected push-back from the medical trolls, which would gain added attention in the media.
Here are a few possible pithy headlines:
- “Ruptured Discs Not Always a Pain” (1994 AP news article)
- “Medical Spine Care: Poster Child for Inefficient Care” (The BACKLetter)
- “Chiropractic Care May Re-boot the Brain” (Haavik-Taylor and Murphy)
- “Chronic Back Pain Shrinks the Brain” (Apkarian)
- “Anyone Who Has A Back Surgery Without Seeing A Chiropractor First Should Also Have His Head Examined.” (Robert Mendelsohn, MD)
- “Medicare Accounting Contractor Denies Payment on 65% of Spine Fusions”
- “FDA Report: Epidural Steroid Injections Not Approved for Back Pain”
- “One in 100 Back Surgeries Necessary” (AHCPR guideline)
- “MDs Replace Street Corner Drug Dealers for Narcotics” (CDC news release)
- “Spinal Manipulation Rated ‘Proven Treatment’ by Federal Agency” (AHCPR)
- “Chiropractic Care Vaults from Last to First” (Tony Rosner testimony before IOM)
- Researchers Confirmed Spinal Manipulation Before Surgery (October, 2010, edition of The Spine Journal)
- “Patients Who First Saw a Chiropractor Underwent Surgery 1.5% Compared to 42.7% of Patients Who Saw Surgeon First” (Keeney BJ)
- “Dartmouth Institute of Health Policy Says 30-40% of Spine Surgeries Unnecessary”
- “Fusion Surgeries Associated with Significant Increase in Disability, Opiate Use, Prolonged Work Loss, and Poor Return to Work Status.” (Nguyen TH, Randolph, DC, et al.)
- Spine Researcher Admits Most Primary Care Providers Inept in Musculoskeletal Disorders.” (Boden)
Such controversies may cause other media outlets to jump on the bandwagon when the chiropractors finally fight back rather than acquiescing to the medical muck. Indeed, we can’t take a spoon to a knife fight. Until the media helps us to create a cognitive dissonance among the public sector, our image will languish in this medical misinformation and the public will remain collateral damage to the ravages of a greedy medical spine care industrial complex.
The tipping point in the public’s image of our profession will not improve with celebrity endorsements or periodic newspaper ads citing a positive chiropractic study. The tipping point in the public’s perception of chiropractic care will happened when the public’s “click/whirr” of our profession repositions them to the emerging facts rather than to the medical demagoguery we now see that formed the “chirophobia” we now face.
We’ve seen this most recently when the LBGT community rallied the support of the media and government officials who finally jumped on their bandwagon. Stephen Colbert mentioned this paradigm shift on his TV show: “Five year ago the LBGT community was in the closet; today if you’re not gay, something’s wrong with you!”
Indeed, wouldn’t it be great if the public were to assume a new “whirr” about our profession, such as “Chiropractors were right all along”?
Changing Minds
Of course, challenging core beliefs in this cognitive dissonance shift is difficult. For example, during my 4-hour class on the Sociology of Chiropractic at the Life U. Fall Conference, I mentioned my own cognitive dissonance from transformational experiences while a student at the University of California at Berkeley in the ‘60s.
Arriving just after the Free Speech Movement began, I immediately experienced many issues, such as demonstrations for Civil Rights, Voting Rights, Women’s Rights; the assassinations of MLK, Jr. and RFK, as well as protest against the Vietnam War and draft. Then People’s Park and Watergate protests followed with mass arrests of innocent bystanders by the Alameda County Sheriff Goon Squad that certainly fueled these emotional conflicts as we’ve recently witnessed with #BlackLivesMatter.
As I mentioned to the class, an education at Cal was much more than classrooms, exams, football games and fraternity parties.
To my surprise while discussing my own transformation at Cal during Life’s Fall Conference, a DC attending my class suddenly shouted out, “If you’re from Berkeley, you must be a leftist.”
Actually, as a Cal grad living in middle Georgia, I’ve encountered this attitude many times. I like the terms “liberal” or “progressive” rather than leftist. Little did he know what my beliefs were, but that did not stop him from expressing his prejudice and displeasure.
I asked him if he had ever attended Cal or visited Berkeley. Of course not, he told me, as if it would taint his conservative ideology. I suggested his twisted prejudice about Cal was the “click” of Bill O’Reilly at FOX News, not a learned viewpoint about the role Berkeley has played in the social consciousness and academia of this country.
Fortunately, an erudite class member spoke up, “Berkeley is one of the greatest universities in the world.” Her comment was hard to swallow for our irate colleague, so he suddenly left the room. “Love it or leave it” echoes still today among these haters.
Although I was briefly annoyed at his “whirr” about Berkeley, it was a blessing in disguise because he exemplified my point exactly about the dilemma chiropractic now faces—although he had no accurate or personal experience with Cal, he was committed to his viewpoint, right or wrong.
In the same manner, millions of Americans have formed their opinion of chiropractic with the same narrow-mindedness from medical haters. This is the same prejudice we must confront about our profession. We cannot let the haters go without any push-back with the facts.
[1] National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, www.cdc.gov/vitalsigns/, July 2014.
[2] Denise Boudreau, PhD,et al. “Trends in De-facto Long-term Opioid Therapy for Chronic Non-Cancer Pain,” Pharmacoepidemiol Drug Saf. 2009 December ; 18(12): 1166–1175. doi:10.1002/pds.1833.
[3] Getzendanner, Memorandum Opinion and Order, p. 10