Commentary

Food for Thought, 1995

We are all proud of the great strides our profession has made in the last few years. We continue to graduate brighter students, increase production of quality research, and have individual DCs make the entire profession shine by accomplishing noteworthy "firsts" for chiropractic. The amount of potential positive stories on chiropractic is expanding rapidly. Sadly, the vast majority of good news will only appear in our own periodicals.

As we close in on the 21st century, chiropractic is rapidly becoming less alternative and more mainstream. With our continued growth and acceptance comes the media spotlight. And we all know, bad news is what sells. As the competition for explosive stories increases between a growing number of tabloid news magazine shows, we should formulate a strategy to defend ourselves to defend ourselves against exploitative journalism. Our struggle for acceptance has been, and still is, so hard a negative story does more damage to our profession than bad press does to other disciplines.

The question we must ask ourselves: "What will future attacks focus on?" To answer this, we must think like an investigative reporter. These folks are looking for things like bizarre techniques, outlandish claims, deceitful marketing, and overutilization.

Until now, we have essentially been a reactive group to negative press. Although we have an idea of the vulnerable areas in our profession, we continue to sit back and do nothing about them until we are nationally embarrassed into action. We have still not learned that when outsiders report on our problems, they make a bad situation much worse. I feel it is time for chiropractic to be proactive -- that is, take an honest look at our problem areas and have the courage to publicly admit them.

Technique

Technique is our cornerstone. Technique is why people will come to chiropractors even though there are other groups who are now doing manipulation. I suggest we focus on the most-used techniques according to the national board of chiropractic examiners, which most recently appeared on the front page of the October 21, 1994 issue of Dynamic Chiropractic. Scanning this list, we should ask ourselves the question Dr. Robert Cooperstein did: "Is there anything here quasi-theological, purely philosophical, ascientific, anti-scientific, or irrational?" If there are any yes answers, I believe the ACA should publish official recommendations for the general public and referring health care professionals about that which is irrational or unscientific. This could accomplish many things:

1. Clearly separate substandard subsets from an entire profession;
2. Make potentially damaging situations "nonstories" by investigating and exposing our problems with recommendations for improvement (before it is done for us);
3. Possibly cause the technique(s) to drop unscientific or irrational aspects;
4. Discourage students from getting brainwashed by voodoo technicians;
5. Remove the confusion professionals face when referring to a doctor of chiropractic.

Claims

I think it is time we take a very hard line on claims. We should officially publish what is and is not reasonable to expect from a doctor of chiropractic. This will identify and isolate those few who practice the unscientific or irrational. This will help combat the ammunition our own popular press gives to our enemies by continuing to public pathetic anecdotes. I read two separate stories this year about DCs who proudly performed spinal manipulation on unconscious children. These doctors were so completely lost they actually thought they "cured" kids from a near drowning and a grade II concussion. One babbled about innate intelligence and the other about how meaningless medical facts and diagnoses are. They have absolutely no idea how incredibly lucky they were. Even worse, I fear, are those who after reading testimonials like this, will look for other unconscious people to "cure" with spinal manipulation. Talk about a field day for a "20/20" reporter and a potential disaster for chiropractic.

Marketing

We need to make life difficult for practice builders who teach doctors how to overtreat, overbill, and use various scare tactics to keep people on endless treatment plans in the name of wellness. They damage all good doctors' practices by keeping alive the stereotype many people who don't use chiropractors believe in. That is, "I'm not going, because once you start you always have to go back." If you winced at some of the techniques you saw on "20/20," wait until a hidden camera gets into a seminar showing these crooks who are proudly selling doctors information on how to con a naive public into unnecessary and excessive care. Our schools have got to keep these people away from our students. Our state associations must stop inviting them to their conventions. Our national associations must act before the fact and have dated press releases ready to distribute, stating what is and is not acceptable practice marketing. Finally, those who grant continuing education credit for practice builders to give their marketing/philosophical seminars must realize that unscientific, unethical, and irrational material taught in the name of license renewal can be used against us. Could we as a profession cry media foul if tabloid TV broadcasts what we call board-approved postgraduate continuing education? Can you imagine the PR nightmare we would face?

Overutilization

My biggest fear for the future of our profession is not ridding ourselves of the maintenance tag. We must come clean with ourselves and the world that manipulation performed on a patient with no subjective complaints or real objective findings (as opposed to marketing nonsense) will not prevent or maintain anything. If we wait for the press to do this for us, we will lose big. Imagine how damaging the stories behind these promotionals would be:

• This week on "48 Hours": Chiropractic Maintenance Care -- Who Really Benefits?

   

• People Ripped Off by Their Chiropractor -- on the next "Oprah"

   

• "Action News" investigation -- Are You Being Manipulated by Your Chiropractor?

There is no doubt that manipulation is here to stay. There is also no doubt that as more osteopaths return to manipulation and more physical therapists begin to manipulate, the only chance they have to significantly reduce our market share is to publicize that their treatments have an end and ours are endless. No discipline has the training or experience with manipulation and associated soft tissue techniques to get patients well faster than we do. This is the message that needs to be embedded in the minds of the public, the providers, the gatekeepers, and the specialists. The man on the street must know that, for example, what takes 10 treatments with our competition, a chiropractor will accomplish in six.

As we begin our second century, we have a simple choice. We can clean house on our terms with our own words, emphasizing the positive and admitting the negative. Or we can sit back and wait for outsiders to nationally ridicule and police our profession for us.

G. Douglas Andersen, DC, DACBSP, CCN
Brea, California