One Bad Apple

A line from the chorus of one of the Jackson Five's big hits ("One Bad Apple," also a #1 hit for the Osmonds in Feb. 1971) claims, "One bad apple doesn't spoil the whole bunch, girl." However, if the song were written about the chiropractic profession, one would say that, in fact, one bad apple does spoil the whole bunch. This is because of the nature of bias.

When a person has a positive disposition or bias toward a particular group, and he or she encounters someone who exhibits positive characteristics associated with the group, the person thinks, "What do you expect? That person is a member of that group." On the other hand, when the person meets somone who exhibits negative personality characteristics, he or she thinks these bad characteristics are just representative of that particular person. Thus, as a young Michael Jackson sang, "One bad apple doesn't spoil the whole bunch (girl)."

However, when a person has a negative bias toward a particular group, and he or she meets a member of that group who has negative personality characteristics believed to be representative of that group, he or she assumes the member is just representative of the group. So, maybe one bad apple doesn't spoil the whole bunch - because the whole bunch is already spoiled! In fact, all another encounter with a bad apple does is reinforce one's negative bias toward the group to which the apple belongs. However, when we meet a member of that group who exhibits positive characteristics, we say these characteristics are attributable to that person only, not the group. In this case, one good apple doesn't rehabilitate the whole bunch.

An example of this happened to me years ago. Concluding a long conversation with an MD about patient care, I was told I was the only rational chiropractor in the world. I replied, "That is ridiculous; there are tons." I asked the MD, "How many chiropractors do you know?" He replied that I was the only one he knew. Thus, his opinion of us was so negative that meeting me did not change his opinion of chiropractors, only his opinion of one chiropractor: me.

There are still many people who have not made up their minds about the chiropractic profession and can be swayed in either direction, pro or con. I would say the profession is at a crossroads because we do not have as active a campaign against us, as the AMA once perpetrated. This is a precarious situation, because rather than the actions of those outside of our profession, it is those within our profession who have the potential to poison the public's opinion of us and prevent us from attaining the cultural authority we so desperately need and deserve.

Cultural authority occurs when a society empowers a group to define truth and fact, which, in reality, is defined by the authority's standards. For example, dentistry has cultural authority over matters of the teeth; when dentists say we should have cleanings twice a year, whether we actually need them or not, we believe this is true. Medicine did not have cultural authority until the 20th century, and chiropractic has not yet attained it. One of the things we have to do is show that the profession is moral by serving the public. Thus, are our actions as a group done to serve the public, or are they self-serving?

Some within the profession claim that chiropractors who work for the insurance industry as peer reviewers are really traitors to the chiropractic profession. I have heard them called "self-serving prostitutes to the insurance industry," who cut off chiropractic claims so they can earn a living. Are they traitors because they may actually tell the insurance company that another chiropractor is treating a patient inappropriately, and as a result, should not be paid for services rendered? Cutting off the income of a colleague may seem an improper action. However, the monopoly the state gives professions over the practice of each professional is given with certain obligations owed to the citizens of the state. One such obligation is that professions are self-regulating; this obligation is imposed on professions because, in theory, only their members (those who profess the specialized knowledge of the profession) are capable of evaluating fellow members.

If self-regulation is not undertaken - if we do not make our profession act in a moral way - cultural authority will not come to us. This happens when the public says you can't trust lawyers, for example, because they always stick together. I used to have a call-in radio show here in Bridgeport. In more than a year of doing radio, only one question from the public that was repeated: "Why don't you chiropractors police yourselves?" The perception that we don't fulfill our obligation of self-regulation - that is, that we are not a moral profession - is a serious problem for us.

Thus, I submit that the real traitors to our profession are those who have taken it upon themselves to do whatever they possibly can; to steal as much money as possible from the insurance companies. They also are stealing our collective professional reputation, which prevents us from realizing cultural authority.

I've talked to people working for insurance companies, many of whom have developed a negative attitude about chiropractic based exclusively on their interactions with a limited number of unethical chiropractors. I am sure that only a very small minority of our profession treats patients without "caps"; overbills; unbundles; or bills for services, or even office visits, never performed. But for those without cultural authority, one bad apple does spoil the whole bunch, and unfortunately, I suspect there is more than one bad apple in our profession.

Stephen Perle, DC, MS
Bridgeport, Connecticut