To say the chiropractic profession is a paradox to the American public is an understatement.
After 20 years in this profession, I've waited for the tide to change in our favor. After the Wilk trial, I mistakenly thought hospitals would seek our services. After the RAND Corp. report on the effectiveness of manipulation for low back pain, I thought the scientific community would acknowledge our care. After the Manga Report emphatically endorsed chiropractic care and the AHCPR guidelines recommended spinal manipulation for acute low back pain in adults, I naively thought the Canadian and American public would demand total access to our care. Unfortunately it seems as the old saying goes: The more things change, the more they remain the same.
Does America really understand and appreciate chiropractic care? Let's be frank about this sensitive issue. To say the chiropractic profession is a paradox to the American public is an understatement. Despite celebrating our centennial, most people and the press seem uninterested about our historical tribulations and successes. Despite the incredible announcements by the AHCPR and Manga Report, most people remain unaware that spinal manipulation is the best form of care for acute low back pain. Despite the public's call for freedom of choice in health care providers and the government's concern to lower health care costs, the managed care insurance companies, HMOs and PPOs, for the most part, aren't interested in including chiropractic in their programs, inasmuch as only 15 percent presently do. Indeed, despite all the recent hoopla, the chiropractic profession at best remains as it always has been, rather enigmatic to the rest of the country.
For the most part, patients have little understanding about chiropractic and what chiropractors do, and it remains difficult for the public to obtain our services. While the AHCPR endorses our care, ABC's "20/20" scares viewers about chiropractic care for kids. While Manga suggests chiropractors should be gatekeepers for all back cases, HMOs still funnel spinal cases to MDs. While over 50 percent of all work injuries are spinal, workers' compensation insurance companies still make it difficult to obtain our care. While science verifies joint dysfunction as the cause of back pain, the disc model remains paramount in the public's mind. While AHCPR prints in its Patient Guide that only one in 100 back surgeries is helpful, discectomies continue unabated. In fact, chiropractors remain unappreciated and relatively outside the loop of health care despite the research that has applauded our type of care.
To illustrate the public's confusion about chiropractic, whether it's the "Big Idea" of neurophysiology and even our small idea about back pain and joint dysfunction, I recall once after what I thought was another stirring health care class, an informed patient mentioned afterwards that it reminded him of the Comedy Channel's "Mystery Science Theatre" on cable television. It wasn't that he didn't understand the principles of chiropractic spinal care or the idea of the body as a self-healing organism, he just was totally unaware of these concepts which appeared rather high-tech and alien to him because he had never heard anyone else ever speak in these terms: nerve interference; joint dysfunction; dis-ease; vertebral subluxation?! This predicament illustrated to me how far from the truth the public remains about understanding our concepts as well as it showed me the vast gap we DCs face in educating the public. Indeed, chiropractic is mystery science to most americans.
The chiropractic paradigm of spinal care and health care in general may be sweet music to our ears when we listen to the eloquent speakers, for example at the Adler Theatre in Davenport during the Centennial Celebration. We applauded the Big Idea that elevates our care to its highest level of restoring life and health, not just relieving back pain. We cheered the speakers who motivated us with calls for "principled chiropractic," not unlike the ministers who call for the return to old time religion. We decried the senseless overuse of drugs and surgeries, and hissed at the exploitation of the public by the medical mongers. We left the theatre ever more convinced we are on the right track, no matter what the rest of the world thinks. Hoo-ray for us!
Without a doubt, the speakers at the Adler Theatre thrilled everyone with their brilliant dissertations, but to the public chiropractic remains confusing at best. The medical profession and drug companies blast into the public mind their concepts on a daily basis. Over a half million MDs and pharmacists push billions of pills every year, rivaling only McDonald's in sheer numbers. Unfortunately, chiropractic's story appears in reality to be the lone wolf crying in the forest of medical trees, heard only by the few medical failures who use us as their "last resort." Indeed, to be a chiropractor is to swim upstream against the current of medical misinformation and negativity. And to keep our heads above water is becoming more difficult as managed care organizations seem to be ignoring our pleas and refusing to throw us the life vest we desperately need to survive in this new economic environment. In fact, despite the research verifying our effectiveness, the chiropractic boat appears to be sinking quickly as MCOs ignore our benefits and give the medical gatekeepers the bridge to control.
Compounding this confusion, chiropractic has never had an on-going public relations strategy that proved effective to reposition and to educate the public to our model of care. Even the CCF's chiropractic documentary will probably only be heard once on national TV and its "super straight" message (there was no mention of the AHCPR guidelines) will only add to the confusion about chiropractic and will soon be forgotten anyway. Instead, we have relied upon a sporadic, defensive PR campaign on television that would enhance our beleaguered image, as well as inform the public to our concepts, research, and patient satisfaction? Rather than a positive PR campaign, I see just the opposite with the "Spines 'R Us Free Spinal Exams" that send the message to the public that our practitioners are desperate for patients which, in turn, must make the public think, "If chiropractic is so great, why do they have to give it away?" If Andre Agassi was correct when he stated in a Minolta camera TV ad that "Image is everything," then chiropractic has an important lesson to learn about its own image that seems to remain controversial at best and unknown at its worse.
Despite the hard work by the ACA and FCER to improve our dire situation, I don't see our Mystery Science profession changing its image in the near future if we continue on the present course of action. Without an on-going PR campaign on national TV, the public's opinion of us will remain a function primarily of the medical misinformants. Without legislation providing insurance equality for everyone, we will remain the proverbial "last resort" and continue to see the crumbs of the medical world. Without political unity, we will forever be at the mercy of the medical monopoly. Without a doubt, chiropractic faces greater challenges than ever before, despite the scientific research and governmental endorsements.
Our greatest challenge is a simple one: to overcome the mystery science image of our profession. When our profession creates a marketing strategy that reaches into every home on a consistent basis, only then will we overcome the paradoxical image we've live with for 100 years. Only when our profession develops a proactive PR program in which chiropractic tells the nation what we are about, the positive research and patient benefits, can we expect the public to understand our great science. Until that day comes, every DC should sober up to the fact that we remain paradoxical to much of the public. Until that reformation occurs, every DC should expect to remain sitting in the back seat of the medical bus. Until our leadership understands that image is everything, the chiropractic profession will remain a marginal profession working on the edge of society taking care of a small percentage of the population. Until our entire profession gets off its butt and contributes to an effective PR campaign, we can expect to remain the mystery science profession. Just remember: If you want what you've always gotten, continue to do what you've always done! I say it's time for a change.
J.C. Smith, DC
Warner Robins, Georgia
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