Professional Advertising: What Have We Wrought?

It will come as little surprise to most readers that I am a less than enthusiastic supporter of personal advertising, particularly those tasteless, self-serving ads, which cause the profession to be tarnished and open to contempt by the general public and/or regulators and policy-makers. My sentiments are at least well enough known to apparently encourage doctors from all over the country to mail me advertisements from local newspapers and direct mailings that they find particularly tasteless, gaudy, or patently laughable. Unfortunately, my collection is growing.

A recent barrage of such mailings convinced me to devote this article to take a serious look at the changing marketing climate for all health care professionals. For the most part, the entire climate for marketing has changed almost everything - from the way mutual funds are sold, to lawyers personally advertising for clients on television. Society is changing its views on marketing overall, so while this article is limited to health care professionals, it should be recognized that all marketing has changed. I did have to chuckle, however, that some things aren't really changing all that much. One of the pieces I was sent was a small-town newspaper insert, consisting of one page, on brightly colored stock. There in his Speedo, flexing his gargantuan muscles, was the photo of the DC, hawking his concern for humanity and publishing testimonials with only initials to identify the source. I hadn't seen this one in a good while, but it hasn't improved any with age. Nothing tacky or self-serving here, because for just $29.95, you can get $400 worth of regular services.

Thus imbued with less than warm fuzzies about my task, I set out to find out what's going on with chiropractic advertising and what we might learn from the efforts of other professions. There were some familiar tableaus; our friend and his Speedo are not the only marketing peccadillos that just seem to never go away.

Minnesota is apparently the most recent state to struggle with the solicitation of accident victims. That state's Supreme Court decided in July 2004 that a DC using runners or cappers to solicit business, standing alone, is not enough to conclude that his conduct was "unethical, deceptive or harmful to the public." There seems to be little uniformity in neither the manner in which the disciplinary boards and legislatures seek to prohibit such practices nor how their state supreme courts react to those attempts.

That's not to say that such issues are no longer important. A Minnesotan recently involved in a collision reported receiving at least 20 solicitation letters and more than 100 e-mails, mostly from chiropractors, since her accident. That state's DC involved in the Supreme Court case reportedly paid his accident solicitors $95,000 in one year. Clearly there is still much to be done in this arena before the profession is not viewed with suspicion. DCs look fairly innocuous in comparison to some of the lawyers playing this same game, but some other group being worse than us is little consolation.

Nonetheless, there is nothing particularly dynamic or striking there ... just more tumultuous uncertainty and re-wrangling of old news. I try to write these articles about things that stir my blood. Frankly, my heart just isn't in some of the same old battles.

I did stumble across something else during my online perusing that certainly got me rankled ... and it does not involve DCs this time. I invite each of you to also take a peek at the search results for "medical advertising" or "medical marketing" or "new patients." Do you know what you'll find? A virtual firestorm of controversy on what has come to be known as "DTC marketing." DTC: Direct To Consumer. Now our friends with the accident solicitation pipelines are also marketing "direct to consumers," but that's not what this ballyhoo is all about.

At the eye of the storm are the pharmaceutical companies. Those of you who succumb to the guilty pleasure of television are probably more keenly aware of this than I ... but I did tune in after reading some of the reports and was flabbergasted at the frequency, blatancy and audacity of the pill peddlers' bravado.

Some of them didn't even tell viewers what they were to be used for ... but the messages were clear that the user could become young, virile, carefree and surrounded by willing women if they would only "ask your doctor if ____ is right for you!" Now, I will confess that my sensibilities may be ever more easily offended as I enter my declining years, but c'mon! It was bad enough when the purveyors of personal OTC products paraded TV ads with wriggling theatergoers wishing they'd remembered their Preparation H, but at least those products had little potential for causing serious harm to the lemmings who lined up at the local Wal-Mart to "get some." But wait ... even that wasn't true, as evidenced by some of the livers damaged by analgesics.

But this? These are drugs we're talking about now folks, with serious side-effects. The ads are almost hilarious in that the litany of potential side-effects often takes longer to recite than the "body" of the message, and they're worse than the embarrassing burn and itch of hemorrhoids! We're talking death here - or even worse, anal leakage.

We've long since prohibited cigarette advertising. Liquor, while apparently about to re-enter the boob-tube milieu, has been long banned. Why? Because those products have such potential for harm. Are we really of the mind that pharmacological excess is any less personally harmful or culturally addictive?

"So what?" you ask. Potential buyers still can't just run to the store and "stock up"; they've still got to have a script. Well, forgive me if I harbor a shred of doubt about the efficacy of the allopathic community to reign in the clambering masses. Take a look at the statistics for the famous ubiquitous anti-anxiety drug whose brand name I will not mention. Take a look at the criminal prosecutions for over-prescription of Oxycodone, and the new controversy over Vioxx. No ... all of the driving forces that encourage MDs to overprescribe are going to be exponentially increased by this newly discovered power of the tube.

Think of the number of times you may have continued to use therapies or perhaps continued to adjust beyond what could be supported as being "chiropractically necessary," but because the patient had some emotional need for ongoing care, it was provided just because the patient wanted it. There's a thin line between providing valuable maintenance-type care and using services to just assuage and placate demanding patients. Look what the MDs have done to their patients with the prescription of antibiotics for every viral infection that walked through their doors for years. Today there is a huge and costly effort underway to educate patients from asking, and doctors from prescribing, antibiotics indiscriminately

So, what's my point? I elect not to rail against perceived problems without conjuring some affirmative steps to employ to minimize the results, if not remove the cause (not so different from a solid chiropractic premise, is it?). What can we do?

First, let's talk about what we can't, or at least shouldn't, do. The temptation and considerable ammunition are certainly present to launch an all-out assault on the transparent conspiracy between the pharmaceutical reps and the MDs. Much ballyhoo has already been made of the perceived and real social ills in the courting of MDs by pharmaceutical reps. Strict limitations on such gifts are now firmly in place. Doubtless there is much chicanery in circumventing those constraints, but at least some are making the effort. We need to avoid finger-pointing and divisiveness, at least in this arena. I am poignantly reminded that in our historical battles with the allopathic community, there were doubtless many who genuinely believed that we were a danger to our patients. Misdirected though those sentiments were, they were probably just as fervent as my belief that DTC drug advertising is calamitous. It would be good if we could temper our zeal to the protection of the public rather than the self-righteous denigration of our "competitors."

Now that I have dismounted from my soapbox, what can we do?

A New Program on the Drawing Board

There is a program soon to be unveiled by Kent Greenawalt in Las Vegas in January 2005. This program will provide the basis for a national and grassroots effort that can be the beginning of a long-term strategic plan to expand market share in a professional and ethical manner. Watch for details: I am certain the chiropractic media will provide proper coverage for this seminal event.

My optimism is simply fueled by the fact that the program was not created by chiropractors, but rather deliberated, developed and designed by thoughtful PR professionals. They formulated their plan and design after surveying the potential end users (our patients and potential patients) and devised a program to reach them, move them, motivate them, encourage them, and ultimately persuade them to seek out the services of a doctor of chiropractic.

Having been around as long as I have, there are some of you who may not like the program because you want to "tell the public what you want them to hear." Some will not like the program because "it does not sell chiropractic." Some will not like the program because it does not sell ongoing care. Some will not like the program because it does not contain chiropractic language. And still others will not like the program because it does not (you fill in the stated reason).

I am convinced, however, that the vast majority of DCs in the United States are now ready, willing and eager to support a PR program, developed by professionals and geared at the singular objective of expanding market share, because they know this is not just a nice program to hear about, but it is a program that has at its core the survival of the profession. The chiropractic percentage of utilization for chiropractic is less than 10 percent, and we need to expand the population base to 15 and 20 percent over the next 5 years if we are to prosper and flourish as a profession.

Many individuals who may fall into the "never have used chiropractic before" category are not necessarily averse to using our services; they just don't know why they should seek the services of a chiropractor. For others potential users, there is a negative connotation surrounding chiropractic from years of internal and external controversy within our profession. For still others, the thought of a chiropractor conjures up negative images that must be changed, can be changed and will be changed with the proper message: from exploiter to caregiver, from unethical to professional, from charlatan to evidenced-based practitioner.

One important key in this new program is that it is not going to tell you how to practice, but rather focus on how to increase market share. How to individually educate this new prospective patient is up to the individual DC when he or she finally gets that patient into their office. After a patient has committed to seek your services is the time to educate that patient to your practice style. A national program can help to bring about a cohesive and understandable message for the majority of patients; the implementation of that message will be up to the individual DC.

There are several other things that can be done and are not as obvious as participation and supporting the new program financially, enthusiastically and professionally:

1. Develop a program and process in your office to "educate" every patient about the chiropractic program. Begin to engage your staff and patient behind the effort to increase market share. Have a patient education program in place in your office so that each and every current patient understands about chiropractic. We need to begin our educational process one patient at a time.
2. Rally behind your state and national associations to enable them to have the resources to take the national program to each state and then to have individual doctors take the program to his or her local area.
3. Encourage membership in your state and national organization to better enable them to provide ongoing legislative and legal challenges when appropriate.
4. Work to foster relationships with the many MDs who are also horrified at the trend they see in the proliferation of DTC marketing. Many of these doctors care for their patients and want to do what is best for them. They will only refer to providers they "trust," and building that trust is something that needs to be worked on individually and collectively. A good individual program to help educate the medical community will go a long way to build bridges and cooperation.
5. Give some PAC money to enable your state and national organizations to lobby for strict legislative regulation of DTC advertising. Lobby for something other than a direct benefit for chiropractors, a novel approach to demonstrate that the chiropractic profession is concerned about and willing to address social issues and work for the betterment of humankind by helping to remove and restrict those unscrupulous tactics which serve only to entice the unsuspecting consumer.
6. Mobilize a grassroots complaint group to let programmers know that you disapprove of their ads.
7. Be proactive in monitoring, attending and using legislative and governmental public hearings on these matters.
8. And if all else fails, sit in front of your TV set, watch the DTC commercials, and call me in the morning.

Seriously, I am hopeful some of these steps will at least slow the slide down this slippery slope. Call me an alarmist if you will, but I really don't want to see the day that our high- and middle-schoolers are trading and selling Viagra the way they do Ritalin. The legalized drug culture of this generation is in dire need of a paradigm shift in order to stop escalation of believing that everything can be cured or made better by the popping of a pill.

We have an opportunity to support a program to help counter the negative effects of the DTC programs hawking drugs for every ailment. We have an opportunity to produce a common message, with a common theme and a common purpose, for the common good of the entire profession and the individual benefit to each DC.

Will there be support for such a program? Or will there be a rush to buy Speedos and run tacky ads in the hope of getting more patients or schemes to get more visits from the patients we now treat? I certainly hope that we elect to see the vision of a common message and then support that for a long-range plan for success. The program can work; it will take a commitment by each and every DC who shares the dream of expanding our marketshare with integrity.

Louis Sportelli, DC
Palmerton, Pennsylvania