Mixed Messages: Are We Getting Them or Sending Them?

I'm struck by the mixed messages that are appearing more frequently in the traditional press, as well as within the chiropractic profession. Why is all this happening? What is precipitating this bag of mixed messages?

For example, the November 8, 1999 issue of Time magazine carried a cover depicting the theme "Beyond 2000, 100 Questions For the New Century, Your Health, Our Planet." In the middle of this wonderfully informative feature (p. 77) was the article, "What Will Happen To Alternative Medicine?" The author apparently relied exclusively on the opinions of William Jarvis and John Renner, well-known critics of chiropractic. It should come as no shock to anyone that the article was negative. It predicted an end to hucksterism and health deception (i.e., chiropractic) and the demise of the "quack-laden" Office of Alternative Medicine. Naturally, anything that was not "allopathic medicine," or what they considered inappropriate, was doomed to fail.

There then appeared a flurry of articles in the Canadian press analogous to the hysterical warnings of another "outbreak of the Hong Kong flu," except this time it was "stroke" caused by those "stroke-causing chiropractors." There is much more to this "stroke" story, which will eventually be unraveled as the details unfold. Putting aside the specific factual issues, there remains a serious and potentially harmful public relations dilemma created by this series of negative articles. The press significantly influences the general public, and those in the press who see sales dollars from continuing the controversy will milk this for all it is worth. The eventual outcomes cannot and will not be resolved by who shouts the loudest, but by the weight of research evidence that will support or refute allegations made against the profession.

In the area of stroke, NCMIC has invested considerable dollars in the research of CVA and the role and risk manipulation may have in any negative outcome. Thanks to the research published in prestigious peer-reviewed journals, most responsible people can see the fallacious nature of these kinds of sensational stories in the press.

Then there is the reporter, herself a chiropractic patient: satisfied and convinced that chiropractic is legitimate. She is challenged by chiropractic detractors to visit 15 chiropractic offices and see for herself what is happening out there. She finds to her amazement that 11 of the 15 offices are engaged in activities she deems questionable. Questionable by whose standards is not the issue. The fact that a reasonable reporter is shocked should be signal enough to at least take a step back and review. The domination by the press and the power of perception are incredible forces with which to contend.

While not totally negative to the profession due to her personal experience with chiropractic, the reporter is nonetheless dismayed at the activity that could be considered "fringe" going on in chiropractic offices. She will, in all probability, author an article about this experience. It will likely have great weight, because she will appear unbiased and reasonable. The kind of activity she witnessed is irrelevant for this article, but suffice it to say that impartial people will have their judgment about chiropractic molded by this kind of story.

Just when your hopes are faded and your spirit a bit disheartened, a positive article appears in JMPT dealing with infantile colic. (Editor's note: See "Chiropractic Found Effective for Infantile Colic" on the front page of this issue.) The Danish Chiropractors' Association, in conjunction with top researchers in a credible institution, researched infantile colic and published the results. The National Health Services participated in the trial, and the media coverage of this trial brought significant numbers of infants into the offices of doctors of chiropractic.

The research was readily accepted, and the results of this trial embraced, because of the credibility of the individuals and institutions involved in the project. The University of Southern Denmark, which has a large medical school, featured this study in the October issue of their alumni journal. The media generated positive reports culminating in a significant groundswell of positive activity. Highly prominent doctors of chiropractic were principal investigators; the research, scientific and general public were unhesitatingly positive about the study.

The mixed messages chiropractic is sending become rather disconcerting. We have DCs who denounce medicine and DCs who want to use drugs. We have DCs who want no guidelines and those who want restrictive practice guidelines. We have those who want acceptance and believe it is achieved by circus type promotions devoid of any semblance of professionalism. Others hope and wish for acceptance and recognition, yet do absolutely nothing individually to advance chiropractic. We have DCs regularly arrested for fraud and DCs who make the news by engaging in conduct unbecoming any professional. We fortunately also have those DCs who advance the profession with their positive activities in sports, research and other community efforts.

Other Mixed Messages

Have you seen the SAAB television commercial "SAAB versus the chiropractor? I think the ad is great, but some DCs denounce the commercial as being derogatory to chiropractic, while others tout it as positive. Many respond to SAAB with equally opposing viewpoints.

Then we have the sitcoms that demean chiropractic. Some DCs go postal in their denunciation of the programs, writers, actors and directors. Some DCs advocate writing letters to the shows, the sponsors and the networks threatening withdrawal of a viewing audience. Other DCs view this as positive evidence that the profession has "arrived," and that is why they can and do take liberties with the profession.

There are DCs who write letters to the editor claiming to "cure" everything and challenging medical writers to a duel of philosophies. There are others who write to editors of journals and denounce most or all of what chiropractic purports to do. They each claim affiliation with organizations that are representative of chiropractic.

Then there was the October 13, 1999 issue of JAMA that gave a positive review of Behind Closed Doors: Gender, Sexuality and Touch in the Doctor/Patient Relationship. The book was authored by Angelica Redleaf,DC, along with journalist Susan Baird.

Those who attend the National Managed Health Care Congress (NMHCC) will recall that only three years ago, talking about complementary and alternative health care occurred only in the hallways. This year the topic almost dominated the program.

Business groups and consumers are demanding inclusion of CAM - chiropractic, acupuncture, massage - and wanting it as part of a basic health care plan. Still others, often within the profession, are advocating what I termed "CAM-SCAM," where the consumer is able to access the DC with a discount and pay the DC directly. The patient receives no reimbursement from the health plan, but the plan gets credit for being visionary by enabling the enrollees to access these services. DCs join these negative programs and then wonder why they are not being included in core benefits. We seek legislation for parity and support those who would deny equal inclusion.

Mixed messages.

The movement of society away from drugs is self-evident, but we have those in the profession who are pushing hard for "drug" licenses. Society has finally caught up with the chiropractic model, but now some DCs are moving away from a "high touch-low tech" approach to health. The consumer is demanding education via the internet, educational brochures and credible research, and yet many DCs try to see how little time can be spent with each patient and place little value on the material provided to the patient.

Mixed messages.

This article will resolve nothing, but within the profession are many areas of disagreement and no internal forum to debate and discuss professional issues. With that in mind, we challenge each other (often in harsh and personal pejorative terms) in our own journals for the world to see and read. We air our dirty laundry and our disagreements, often in the most vitriolic manner possible. Civility appears to be lost. Common courtesies appear to be a figment of hope that exists with less and less frequency. Ethical and professional consideration for each other is lost in the quest to be right. Ad hominem attacks appear more commonplace than intellectual debates on the issue. Individuals are used as lightning rods to provoke and foster internal debates and divisiveness, rather than objective discourse discussion. (Editor's note: There's a DCs Only Forum on [url=http://www.chiroweb.com]http://www.chiroweb.com[/url] that allows DCs to debate issues without the prying eyes of "outsiders.")

Mixed messages.

We lament about not gaining ground in Congress or our state legislatures, yet the percentage of DCs participating in their associations is infinitesimal compared to the number of DCs practicing. We then ask our "leaders," "What are you doing about (insert the issue du jour)," not, "What am I willing to do to help you accomplish our joint and common goals?"

We have those with agendas who continue to stir the proverbial pot to advance their personal agenda and economics, as if no one can see through the charade. Yet the silent majority remains silent. We have those individuals and organizations that attempt to illuminate the discussion with lucid and rational articles, and yet many do not take the time to read or respond. Again, the large silent majority who are truly the strength of the profession remains unheard.

Mixed messages.

As we approach the end of this decade and the 20th century, perhaps it is time to do some personal introspection and reflect on the challenges before us and what we can accomplish when we are focused, committed and involved.

Will we solve all the problems of the chiropractic world with a bit less hostility and acrimony? Probably not, but it will sure be a good start. Perhaps Y2K really means "Yours 2 Keep." We can keep the status quo, or we can elect to do something different in 2000. Like snowflakes, each is delicate and gentle, but what power they have when they stick together. The next decade will be significant because of the rapidity with which the changes will take place.

Maybe, just maybe, we will reflect on the mixed messages and decide to actually do something about them. We can-I know we can-but will we?

As we end this year, I want to thank you all for your words of support, your words of disagreement, your words of encouragement, and your words of challenge. It is your words that make the most powerful weapon we have. I invite the silent majority to take the time to put pen to paper and begin the next millennium with a note to the profession. Let the silent not be silent in 2000.

Let the messages become mixed messages of confidence, of inspiration, of clarity, and of hope for a profession that should flourish in the next millennium. Happy Holidays.