J.C. Smith, MA, DC
When was the last time any of us read in a newspaper or heard on TV a totally positive article about chiropractic? Indeed, it's a rare event when a newscaster bypasses the typical chiropractic bashing and presents an objective story about the many benefits to patients of our profession. For the most part, most articles follow the typical medically oriented format of casting our profession in a very suspicious light, projecting the overplayed medical message that, even if chiropractic has helped some, at its basic core, there is still something terribly amiss about this profession's image.
Generally, as with "20/20," Woman's Day magazine, the Wall Street Journal, and most recently a New York Times editorial, either they focus on anecdotal iatrogenic cases, or they make gross condemnations that fail to reflect the recent research, and merely reiterate the tired medical propaganda that never seems to change. Or they find the flamboyant and charismatic to embarrass our profession, as "60 Minutes" did years ago when they visited Life College, or their hidden cameras infiltrate the sleazy chiropractic offices operating workers' compensation scams, as "60 Minutes" did more recently. It appears that the common approach of journalists is to cast chiropractic in a bad light no matter what positive facts or cases there may be.
A May 21, 1996 NY Times editorial, "The Chiropractor's Bailout Bill," urged Gov. Pataki to veto an insurance equality bill. What made this suggestion ludicrous was their opinion that this bill would work against his pro-market position, saying that the bill would give DCs "what they could never achieve in the marketplace." Excuse me, but has the NY Times forgotten the fact that the medical marketplace is a sham, subsidized, closed marketplace? Have they forgotten the Wilk, et al. case that proved the antitrust nature of the AMA? Have they ignored the fact that as a result of the sham medical marketplace, devoid of any real free enterprise and competition, that the medical expenses have nearly bankrupted the entire health insurance system?
The editor also used the flawed Carey study to say that "studies show that the same service is equally well-administered, at a lower cost, by primary care practitioners." Excuse me, but handing out drugs to mask low back pain is a far cry from correcting the underlying functional cause of this problem. If the editor had done his homework, he would also have realized that the Carey study included orthopedic surgeons, but excluded the cost of any back surgeries! In effect, 15 to 18 visits to DCs were compared to 2-3 visits to MDs for drugs! If this isn't comparing apples to oranges, what is? Despite the obvious flaws of the Carey study, the establishment press has ignored these problems and has chosen to use it as a weapon against our profession, which was probably the whole intent of the Carey study to begin with. Forget about other, more reputable studies (Manga, Meade, Koes, Stano), that have proven chiropractic care is safer, cheaper, and more effective than the medical approaches, the editor of the NY Times chose this one skewer to slice our profession into bits and pieces.
Most incredibly, the editor also begrudged the chiropractic lobbying, calling it a "disturbing pattern," writing: "A legislature beholden to special interests is increasingly concocting the disconnected sets of medical benefits to satisfy those interests." Forget the fact that AMAPAC is the largest lobby in the country, but if DCs and their patients want to influence legislators, suddenly it warrants caution from the press. This double standard typifies the medical bias of the press. For too long if one chiropractic case causes a problem, the entire profession should be damned. But if one medical case is problematic, it's explained in the typical fashion: "The operation was a success, but the patient died."
Not only did the NY Times editorial ignore the idea that increased competition would actually improve pro-market trends, the editorial chose to ignore the AHCPR report altogether. Forget the fact that the Patient Guide from the AHCPR clearly states that only one in 100 back surgeries is helpful. Instead, the editorial mentioned that "BC/BS expect their cost to rise by over $90 million a year under the bill." Forget the cost offset reductions when 99 of 100 back surgeries are circumvented by chiropractic care. At the average cost of $14,000 each, the savings would be enormous, yet the editorial forgot to consider this obvious factor. Ninety million dollars a year for chiropractic inclusion vs. $50 billion annually for back surgeries and the medical mismanagement. Give me a break!
Another example of medically biased press ignoring the recent research and AHCPR endorsements, my local newspaper printed a five part series of articles on "Managing Pains." Chiropractic care was the last treatment mentioned and again was cast in a suspicious light ("alternative") with derogatory terms ("ridicule, skepticism, scorn") used in the opening sentence. None of the other treatments were described in any questionable terms, despite the fact that the AHCPR guidelines clearly stated that the other methods -- injections into the back, massage, acupuncture, biofeedback -- were of questionable value. "While these treatments may give relief, none have been found to speed recovery or keep acute back problems from returning. They may also be expensive."
Despite these facts, the paper portrayed each of these in a very positive light, even writing that acupuncture was a "proven method" for pain. Excuse me, but the AHCPR study never made that conclusion for acupuncture or the other medical methods. Alas, only the chiropractic segment was written in a suspect tone and the cub reporter totally ignored the AHCPR guidelines altogether. I imagine her hidden agenda was not to let the facts get in the way of her bias.
Unfortunately, these examples seem to happen each time the media focuses on our profession. The "conventional wisdom" of the press, as with the legal profession, is by nature to be suspicious of chiropractors. Believe me when I say the medical propaganda has been very effective in tainting the public, and has not diminished despite the positive research and governmental recommendations. Our professional image remains in the hands of these medically biased reporters, no matter what we would like to think. Forget the fact that your own patients may love you and your care because the mainstream public is conditioned by a press that loves to make chiropractors the scapegoats.
So what's the answer? Are we to continue to let the medically biased press slam dunk our profession without recourse? Are we to sit on our hands and let this trend continue despite the incredible research and AHCPR guidelines? Is there anything our profession can do, or are we to continue suffering from these intolerable media misrepresentations?
The only answer is to go on the offensive. Stop with the reactionary defensive posture that only reacts after our profession takes a media hit. For example, instead of spending a half a million dollars on a chiropractic documentary, why don't we spend the same amount on a year long set of TV ads? Instead of individual DCs advertising, why don't we have our local and state associations sponsor cable access TV informercials on a consistent basis. Rather than tacky, expensive Yellow Page ads, why don't we regulate them to a standard size and spend the rest on classy newspaper ads? In other words, why don't we organize our marketing efforts and produce a multifaceted program that includes the popular media? Being disorganized and individual oriented has not worked to create a profession wide image that can counteract the negative images of the medically biased press.
For example, the AHCPR guidelines on acute low back pain was a godsend, yet our profession has done painfully little to maximize its potential impact. We couldn't have paid millions for the US Public Health Service to write what it did in its AHCPR report. When our own government says only one in 100 back surgeries is helpful and recommended spinal manipulation instead, why haven't we exploited this until every person on the planet had heard it more than once? Why have we let this astounding report pass by with such little notice? Why hasn't every state association along with our national associations gone to the mountaintops and screamed these results to every hamlet in our country? The same can be said about the Manga report in Canada and the British government's report as well. The fact that we have failed to exploit these incredible studies illustrates the lack of proactivity of our leadership.
Forget the straight vs. mixer baloney, forget the ICA vs. ACA; forget the petty issues that fragment our profession and only adds to our dilemma, we need to unite and improve our image before managed care totally excludes us without comment. If the press can ignore the AHCPR results, so can the insurance industry. When I read that practices are 20-25 percent down in recent years, I cannot imagine why our profession has done so little to reverse these trends with effective PR results. Although the chiropractic documentary got a lot of press within our tabloids, I didn't see one mention in any other media. Not one patient said anything to me about it. The only thing mentioned was the fact that it didn't appear when it was listed in the local television guide, although Richard Simmons got added viewers that day!
While some may pat themselves on their backs for a job well done, what we have is a situation similar to the children's parable about the emperor wearing no clothes. With the emperor strutting around bare-buffed, everyone was afraid to say the obvious, until an outsider finally did. When will our profession realize how terrible our image is, how the medically biased media takes unfair pot shots at us without recourse, and how our members need to unite in an effective proactive PR program before our great profession is gone with the winds of managed care? Or are we, like the emperor, going to continue strutting around as if nothing is wrong, all the while having the public agog at our dire situation? Hello out there, is anyone listening? Or are we all little emperors imaging the best about ourselves while deceiving no one but ourselves?
We must hire a professional advertising firm and let them reconstruct our image. Give them the research findings and recommendations from AHCPR and Manga; give them positive stories about DCs doing fantastic jobs with cases; give them stories about DCs workings at the Olympics; give them all the ammunition we know exists, then let them package it and produce a PR program that can revitalize our downtrodden profession. Let's overcome the medically biased press with sensational ads, infomercials, and news stories about the many benefits of chiropractic care. But let's have professional PR experts do it for us. If the emperor needs clothing, let's have him dressed by the best!
J.C. Smith, DC
Warner Robins, Georgia
E-mail: jcsmith@hom.net
