Elephants & Galllup

The recent release of the Palmer/Gallup Poll on chiropractic, Americans’ Perceptions of Chiropractic, was a fascinating study of Americans’ attitudes and patronage of our profession. It was certainly long overdue and, as the Gallup presenter Cynthia English suggests, this data should make us think “what to do with this information.”

Okay, I’m all for that since this poll raised more questions than it answered. Let me address the major findings in this Gallup poll and give my answers to this problem of our low perception.

In the video presentation of the Gallup study at the Palmer Homecoming in August, 2015, Ms. English did a good job in her one-hour talk and raised three questions:

1. What do Americans really think?
2. Who are chiropractic users and what do they think?
3. Who does NOT use chiropractic and why?

First of all, she mentioned some good news that 63 million people have used DCs in the last five years—33.6 million adults who have used a DC in the prior 12 months at an average of 11 visits and 29 million adults have used chiropractic in the last five years. This equates to 14% of the adult population that is an increase from 8.5% in 2012. This is an increase of 13 million since the 2012 estimate of 20.6 million users, which is a 63% increase.

Considering the Gallup poll suggests DCs saw 33.6 million adults in 2014, of the ~190 million who suffer a back attack annually[1], this still equates to ~156 million people who sought medical care, took OTC meds, did something else or did nothing for their pain.

Here’s how Gallup determined these figures:

Gallup validated the figure of 13.7% (rounded up to 14% in reporting) using three separate, nationally representative studies in 2015. All results fell within the margin of error. The 2012 National Health Interview Survey (NHIS) reported 8.5% of adults say they received a chiropractic or osteopathic manipulation in the 12 months prior to the study. While these two numbers are statistically different, the margin of error of ±2 percentage points for the Gallup study estimates the true number to be between 11.7% and 15.7%, which is slightly higher than the NHIS study conducted three years prior.

There was a ton of data involved in this poll that you can read in the study published in the JMPT by the brain trust at the Palmer Center for Chiropractic Research—William Weeks, Christine Goertz, Bill Meeker, and Dennis Marchiori. (At the end of this article there will be additional data for your review.)

However, there was no discussion by Gallup concerning what we can attribute the increase to 14% of the adult population from 8.5% in 2012. Here are a few considerations:

• Efforts by the F4CP with paid ads in the WSJ and USA Today and WOC testimonials by sport celebrities.
• The increase of social media such as efforts by Dr. Jason Dietch @ www.AmpLIFEied.com. [BTW: 63% of 18 to 34—those most likely to use social media—have never been treated by a chiropractor.]
• The growing WOM (word of mouth) of satisfied patients.
• Individual chiropractors’ ads, websites, and blogs.
• The inclusion of chiropractic care in more group health insurance programs.
• The inclusion in the VA and DOD health systems.

Undoubtedly this increase was a combination of all of the above, but it most likely did not come from ‘earned media’—articles about the chiropractic profession in the mass media—since they are so few, especially positive ones.  

For example, when was the last time you’ve seen an in-depth, ‘fair and balanced’ article about the benefits chiropractors bring to a nation, military, and the world amidst a back pain pandemic?

This omission is more alarming considering we are the third-largest physician-level health profession in the world that specifically treats spine-related disorders, a point unknown by the public and press.

Earned media is the proverbial ‘elephant in our PR campaign’—that is, a critical missing link to educate the public about the benefits this profession has to offer as well as to improve our troubled public perception.

What’s the Pitch?

The latest Gallup/Palmer poll raised the timeless issue: what can we do to improve our image?

This re-branding is not as simple as changing logos or PR sales-pitches as we saw when “diet beer” flopped only to become a huge success as “lite beer.”

However, we can’t fool the public by simply ‘putting lipstick on a pig’ while our blemishes go untreated. Our image and reputation is one-of-a-kind—a function of many historical issues, political and legal battles, economic warfare, and the most profound defamation campaign ever waged by one profession upon another.

No other profession or product has undergone the immense storm fronts that we have weathered. All of these factors have created a perfect storm for the low public perception for our profession and all must be addressed if the public and press are to understand our plight and become receptive to our benefits.

In light of the Gallup study, if we are to reposition the public and press to the benefits of our brand of care, the F4CP might begin to pitch articles about the paradigm shift in spine care from narcotic painkillers, ESIs, and fusions to a conservative approach first as the guidelines suggest. If and when this story breaks and goes viral, we’ll see the biggest explosion ever for our services, but we must expose this medical mess since the AMA and its cohort medical news reporters have not.

The ACA or ICA could also highlight the recent Mayo Clinic review debunking the ‘bad disc’ premise undermining the need for spine fusions, a common ploy still used by spine surgeons that results in nearly half a million unnecessary disc fusions annually. Yet people today still believe they need surgery for their ‘bad discs’ and the surgeon will never tell them, “BTW: according to the Mayo Clinic, ,‘bad discs’ are found in pain-free people.”

Another example: Just as BadDrugs.com has exposed the dangers of many medications, imagine if BadSpine.com were to do the same by informing the public, “If you’ve had a failed back surgery based on a debunked ‘bad disc’ diagnosis and were not told to see a chiropractor first, we can help you.” That ad would get national attention overnight!

By pitching to the network news programs or documentary-oriented programs like 60 Minutes, CNN, NPR, and Aljezeera America, we could give their reporters ideas of our struggle and the new concepts about spine care they might find of interest to their viewers.

Until someone reaches out to them, it will be tough for them to come to these conclusions on their own since few understand the new spine research or the dynamics of the medical war against chiropractors. Indeed, there is a huge disconnect between the research journals touting our services and the mainstream media like Sanjay Gupta @ CNN who will never tell the public the truth about the paradigm shift in spine care due to his conflict of interest as a neurosurgeon.

Explaining our multifaceted story that spans over a century is our biggest challenge and too complex to be told in a 30-second ad, a half-page newspaper ad, or with 140 bytes to change people’s perceptions of our profession. Indeed, I wish it were that easy.

When the Rubber Hits the Road

Another positive stat from Gallup found nearly six in 10 adults either strongly agree (23%) or agree somewhat (38%) that chiropractors are effective treating neck and back pain—together this totals 61%.

Wouldn’t it be great if 61% of Americans actually used DCs as their primary spine care provider? Our worries would be over as Louis Sportelli, DC, noted after the AHCPR guideline:

“If the doctors of chiropractic only cornered the market on one condition, back pain, there would not be enough [chiropractors] now to handle the volume.”[2]

However, one of the most shocking findings by Gallup found the first choice by patients with neck and back pain, regardless of cost, was not DCs. As one would suspect, it was their medical physician who they have trust and confidence, real or ingrained, deserved or not.

The ranking revealed the public’s preference:

• MDs at 54%
• DCs at 29%,
• PTs at 8%,
• MTs at 7%, and
• Acupuncturist at 1%.

This ranking seems to contradict the former finding that 61% of people believe chiropractors are effective treating neck and back pain but, when the ‘rubber hits the road’, less than half (29%) chose DCs as their first provider.

While this may be disappointing, this ranking validates the entrenched mindset of the public who view their medical physician as the first authority to go for advice.

Of course, this flies in the face of studies that confirm most primary care physicians are inept in their training on musculoskeletal disorders,[3] more likely to ignore recent guidelines[4], and more likely to suggest spine surgery than surgeons themselves.[5]

Scott Boden, MD, renown spine researcher and currently director of the Emory Orthopaedic and Spine Center in Atlanta, admits that  “Many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”[6]

If Dr. Boden had said the same about DCs, headlines in the national news media would scream out, “Chiropractors Inept, Says Expert.” Since the shoe is now on the other foot, why not do the same? “MDs Inept, Chiropractors Preferred for Back Pain, Say Experts.” I’d love to see the F4CP run that ad in The Wall Street Journal or any of others I have made.

Trust Me, I’m a Doctor!

There is another ‘elephant in the room’ that needs to be addressed—why did the public’s perception that DCs were effective for MSDs fall from 61% to 29% when it came to actually seeing a first provider?

Obviously it is the element of “trust” that causes patients to seek medical advice, not the element of competence or the new science on spine care. Certainly the systematic campaign telling the public that DCs are dangerous and unscientific has undermined our reputations and Trust Factor.

The Gallup poll also found among the 51% of U.S. adults who have never been to a chiropractor, there was also uncertainty regarding cost, expected number of visits, trustworthiness of chiropractors, and the education required to become a chiropractor.

This resembles a comparable paradox in the 1984 poll in Oklahoma[7] that revealed a similar cognitive dissonance among the public—the contradictory good news vs. the apparent bad news:

• The number one attitude on a list of eleven offered to respondents was that “chiropractors were an acceptable part of the health care scene.” 
• Number two is the fact that most people do not have a good opinion of chiropractic and found that “Seventy-one percent feel chiropractors probably suffer under a stigma which may not be deserved.”
• The third most agreed with factor is the opinion that “chiropractors are highly underestimated regarding their benefit to the community and their patients.” Sixty percent hold or agree with this opinion to one extent or another.

So, according to this 1984 poll, people accept chiropractors as an acceptable part of healthcare, they understand DCs suffer from an undeserved stigma, and that our benefit to the community is highly underestimated, but the juxtaposition was most shocking:

• To many respondents, “chiropractors are seen as being fine for many people in the community,” but as one respondent admitted, “I wouldn’t want my daughter to marry one.”

Sounds like the 1967 movie, Guess Who’s Coming to Dinner, but instead of Sidney Poitier, it’s you!

Friends & Foes

Gallup discovered more disturbing data when the pollsters asked: “Have you ever had any of the following people discourage you from going to a chiropractor?”

This question was asked of all U.S. adults vs. those who saw a chiropractor within the last five years:

Family member or friend =      29% vs. 37%

Medical doctor =                       13% vs. 21%

Physical therapist =                     7% vs. 9%

Nurse =                                         6% vs. 8%

Assuming each respondent answered this question with only one answer, this means 56% of all US adults and 75% of existing chiropractic patients were discouraged to see a DC. Obviously the medical propaganda that began in the 1960’s is very much alive and remains a huge emotional albeit latent barrier to overcome for the majority of patients.

It is understandable that MDs, PTs, and RNs have an agenda to dissuade patients from seeking chiropractic care, but it was more disconcerting that half to three-quarters of people were discouraged by their family and friends.

Cynthia English mentioned her own family member who had a “bad experience” with chiropractic over 50 years ago when she was 16 years old in the 1960s. After Ms. English discussed the Gallup findings with her relative, she “opened her mind up” and “changed her tune” and later admitted she “didn’t have a good reason not to go.”

Unfortunately, Ms. English may not be aware of the history behind this psychological issue, but it should not come as a surprise to those DCs who study chiropractic history that the Committee on Quackery was formed in 1962-63, so her relative’s negative attitude undoubtedly stemmed from this medical propaganda in the 1960s.

I know both of my parents suffered from chirophobia. When I told them in 1975 that I would be attending chiropractic college, my mother began to cry and my father said, “why do you want to become a quack?” I’m not joking, either.

Of course, they were completely unaware they were also collateral victims of the AMA’s defamation campaign. The tactic of the medical misinformers was to remain behind the scenes and let columnist Ann Landers and other ghost writers do their dirty work for them, such as writer Ralph Lee Smith who authored the infamous 1969 anti-chiropractic exposé, At Your Own Risk: The Case Against Chiropractic, that was sent by the AMA to over 10,000 public libraries and schools.

“In the Public Interest” by William Trever, the Scientology whistle-blower who spurred the Wilk trial with a treasure-trove of incriminating evidence, summarized the propaganda strategy used by the AMA’s Committee on Quackery to destroy the reputation of the chiropractic profession:

Time and time again the AMA’s Merchants of Misinformation have subverted the truth for their own fascist ends. Using these tactics to “build up a case” against chiropractic they have taken objective reports, studies, and individual opinions in favor of chiropractic and reversed them into what appears to be anti-chiropractic views coming from many “non-medical” sources. Done enough, this tactic would give the appearance that “everybody knows that chiropractic is an unscientific cult.”[8]

Regrettably, that tactic still exists not only with medical misinformation as we witnessed with the AHA stroke clamor last year, but with our virtual absence in the news room.

Hyperbole & Fallen Life

The chiropractic profession also must bear some blame that discredits our reputation for the hyperbolic newspaper and Yellow Page ads we’ve seen from chiropractors for decades.

Indeed, the Big Idealists who advocate a cure-all philosophy in newspaper ads even surfaced during the Wilk trial as evidence used by the AMA to justify its goal to contain and eliminate chiropractors due to unsubstantiated claims that posed a danger to public safety.

Undoubtedly the most embarrassing hyperbole evident at trial was the infamous quote by the founder of Life Chiropractic College, Sid E. Williams, who often touted, “Rigor mortis is the only thing we can’t help, ya folla!”

George McAndrews even mentioned this comment in his closing statement at Wilk:

I have counted up the exhibits of the ads and there is no doubt that some of the ads were distasteful. I have seen one where the chiropractor has an ad that says “the only thing that can’t be cured by spinal adjusting is rigor mortis itself.” [9]

 

Dr. Jerry McAndrews, the ICA EVP during Wilk, recounted a conversation with his brother, George, that typified the legal dilemma this posed him during trial:

In the first morning of the Wilk case, George called me to ask, “What in the hell is the matter with you people?  I just spent the worst morning of my professional life trying to defend the behavior of some of the chiropractors out there who make claims far beyond any objective evidence.  I felt like I should get up from my chair and go over and sit with the attorneys for the other side.”

I apologized for the tough time “our” behavior had caused for him. 

“Don’t get me wrong,” George said, “the toughest part wasn’t the trash so many chiropractors put out, it was that I couldn’t find any evidence of a single chiropractor speaking out against the atrocious behavior.”[10]

The problem of tacky ads and embarrassing news articles illustrates how the action of just one DC may affect the entire professional image with the public we wish to serve but are skeptical.

Another big example how chiropractic’s reputation was tarnished by one man occurred when Life lost its accreditation in 2002 under the leadership of Big $id. During and immediately after the loss of Life’s status, never once did anyone there show any contrition or apologize for the transgressions. Indeed, it’s a tribute to the current Life administration that it has regained its status after digging itself out of a very deep hole left by Williams.

We still see the headline news of fraud and abuse perpetuated by our colleagues in our trade magazines as well as the occasional false advertising claim as we witnessed recently on August 5, 2015, in the Des Moines Register, “Chiropractors accused of exaggerating healing abilities.”

The licensing board said Woods “claimed to be able to ‘cure almost everything,’ including ear conditions, eye conditions, stroke, kidney stones, hernia, tremors, blindness and high blood pressure.”

The board said Woods “invited people from the clinic’s waiting room into the room in which he was treating a patient … so they might witness ‘miracles,’ causing the patient to feel uncomfortable.”

Of course, chiropractors making hyperbolic claims is not a new issue that has tainted our image. A 2003 Gallup poll on Honesty & Ethics in professions found nurses, MDs, veterinarians, pharmacists and dentists at the top, but chiropractors were tied with psychiatrists at the bottom of the healthcare professionals. However, DCs were ranked higher than senators, congressmen, governors, lawyers, business executives, journalists, stockbrokers, advertising practitioners, insurance salesmen and HMO managers.

Along with the perception of low honesty and ethics is the public’s skewed perception of our image comprised from decades of medical misinformation in the news (strokes), bad ads with hyperbolic claims, biased MDs defaming our reputations, and our own bad actors—philosophers chanting the Money Hum and the Million Dollar practice gurus teaching unethical tricks-of-the-trade (NOOPE, TWIP, Free chicken dinners, etc.) as I mentioned in Biggest Challenge.

Certainly we have a huge PR problem to overcome we are to become the world’s primary spine care provider as we should.

Hear Ye, Hear Ye

Cynthia English suggests this Gallup data should make us think “what to do with this information.”

Okay, so hear me out on my thots on this matter.

Although the F4CP has led the charge to make progress in the PR efforts, after ten years and millions of dollars spent in the paid media, I suggest the foundation’s board seriously considering changing strategy and that begins by changing leadership.

Like any football team, there comes a time to change coaches to establish a new culture and game plan.

Instead of the present ad placement group, CPR Communications, that the foundation now has, I suggest the next step the foundation must take is to hire the Wharton School of Business’s marketing department to craft a new strategy that will focus on gaining a presence in the earned media and on news programs featuring the paradigm shift in spine care and touting our effectiveness in the pandemic of back pain.

Until we make our presence know in the earned media, we will be stuck at 14% of the adult population rather than seeing the 85% that need our help with non-specific mechanical back pain.

You’ve read my ‘thots’ on what to do, so tell me, what do you think?

Specifically, I’d like to know what every chiropractic organization thinks about the Gallup/Palmer poll, what every member of COCSA plans to do in their state, what each chiropractic college president has in mind, and as well as every publication that influences our profession.

Indeed, it’s time for our ‘thought leaders’ step up to the plate to address the questions this Gallup poll broached. Instead of vendor-driven speakers or practice gurus teaching at our state associations’ fall conferences, perhaps an open discussion about our image would be more beneficial, especially at the ACC-RAC conference.

Your opinion really does matter in this instance since we need a collective consensus to “move the needle.” On the heels of the recent Gallup Poll, it is also important that a poll of how you, the everyday practitioner, views what our professional response should be doing.  Please consider voicing your view.

Bottom Line According to Gallup

Here are the highlights of the EXECUTIVE SUMMARY:

 “Most Americans believe chiropractic is an effective way to treat back and neck pain. More than 33 million adults in the U.S. have seen a chiropractor in the last 12 months, and twice as many say a chiropractor would be their first choice to see for neck or back pain if they had it. With the National Institute of Arthritis and Musculoskeletal and Skin Diseases estimating that eight out of 10 people will suffer from back pain at some point in their lives, the chiropractic industry could be poised for considerable growth in the future.”

• About half of adults in the U.S. have been to a chiropractor as a patient. 14% of adults say they saw a chiropractor in the last 12 months, 12% say they saw a chiropractor in the last five years, and 25% say they saw a chiropractor more than five years ago.
• Nearly two-thirds (61 percent) of adult Americans believe chiropractors are effective at treating neck and back pain.
• The majority (57 percent) of adults are likely to see a chiropractor for neck or back pain.
• More than 1/2 of all U.S. adults have visited a chiropractor, and more than 1/4 of them would choose chiropractic care first for back or neck pain.
• 66% of the public have a positive attitude that DCs have their patient’s best interest in mind; 52% believe DCs are trustworthy; Less than 10% disagree with either of these.
• Nearly one in four U.S. adults strongly agree or agree somewhat that chiropractic care is dangerous, while more than a third say they don’t know if it is dangerous.
• Among the 51% of U.S. adults who have never been to a chiropractor, there is also uncertainty regarding cost, expected number of visits, trustworthiness of chiropractors, and the education required to become a chiropractor.
• A lack of knowledge about health insurance coverage for chiropractic care and sensitivity toward costs are also barriers for some.
• Overall, about four in 10 adults in the U.S. believe chiropractic care is too expensive (43%) and think it requires too many visits (44%).
• Nearly half of U.S. adults do not know whether their insurance covers chiropractic care. More awareness about the coverage of chiropractic care and its costs could help potential clients consider chiropractic services.

Don’t Know

Within each issue in the Gallup poll, the biggest percentage of response was the “Don’t Know” category indicating the public’s lack of knowledge about chiropractors’ training, coverage, and scope of care:

• 60% of adults who did not say a chiropractor would be their first choice were not likely or didn’t know if they would see a chiropractor if they had neck or back pain.
• 48% don’t know if covered by insurance.
• 39% don’t  know if DCs are trustworthy.
• 29% don’t know if DCs have their patient’s best interest in mind.
• 28% don’t know if chiropractors are effective at treating neck or back pain.
• 27% don’t know if they would visit a chiropractor for neck or back pain, but only if other treatment methods didn’t work.
• 74% disagree they would see a chiropractor first as a general healthcare provider.
• 59% do not want to talk to a chiropractor about general health and wellness issues, such as diet and nutrition.

Never Been to a Chiropractor

Other stats were revealing, such as:

• 49% have  never been treated by a chiropractor,
• 63% of 18 to 34 have never been treated by a chiropractor,
• 44% of 35+ have never been to a chiropractor,
• 44% of whites have never been to a chiropractor,
• 59% of blacks have never been to a chiropractor,
• 47% of Hispanics have never been to a chiropractor,
• 52% of men have never been to a chiropractor,
• 47% of women have never been to a chiropractor,
• 42% agree chiropractic care is too expensive.
• 43% agree chiropractic care requires too many visits.
• 46% would visit a chiropractor more often if it didn’t cost so much.
• 29% people have had a family member or friend discourage them from going to a chiropractor.
• 24% would visit a chiropractor more often if it didn’t cost so much.
• 60% of adults only want to see a chiropractor when they have pain,
• 31% say they want to see a chiropractor on a regular basis, even if they don’t have pain.