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In December 1980, when hired as a public-relations consultant to the largest chiropractic organization in the world, I approached the assignment with enthusiasm. Maybe chiropractic was, as its proponents argued, an unfortunate victim of the powerful medical establishment, punished for its "holistic" beliefs. After all, what's wrong with avoiding the excessive use of medications and unnecessary surgery? I was eager to help chiropractic tell Its story. But as I learned more about chiropractic and met many of its leaders, my enthusiasm was transformed into skepticism.
The American Chiropractic Association (ACA) was a bizarre, nightmarish operation overrun with internal politics, fear, and paranoia. The ACA leadership distrusted its own staff and many of its members, hated its colleagues in the International Chiropractors Association, and shunned opportunities to share forums with representatives of other health disciplines.
I concluded that the underlying insecurity was largely attributable to the poor educational backgrounds of most of ACA's leaders who attended chiropractic schools years before a four-year curriculum and any meaningful eligibility requirements were established. The members of chiropractic's "old boys" network simply lacked the quality and extent of training characteristic of their counterparts in the other health-care fields -- or just about any other profession, for that matter. Chiropractic suffers from a professional inferiority complex, and thus remains clannish and wary of situations that offer the potential of outside scrutiny.
The ACA has spent millions of dollars on external media campaigns designed to present the chiropractor as a "family doctor" and "primary care provider." A wide range of devices are used, including television and radio spots, syndicated newspaper columns, billboards, advocacy advertising. PR seminars, and journalism awards. These programs, masterminded by ACA's St. Louis-based PR firm, usually avoid live media confrontation by presenting "canned" messages that do not actually discuss chiropractic itself.
ACA's marketing strategy was revealed in a report prepared several years ago that recommended a series of radio and television public-service announcements featuring "sugar-coated messages... In tune with the personality of the public." ACA's spots indeed cleverly exploit topical subjects. For example, a TV announcement on inflation and health recommended exercising and a good diet. Chiropractic is only mentioned as the sponsor of the message.
ACA's Washington office, on the other hand, was obsessed with internal PR. I don't recall a single Washington press conference during 1981. The few attempts at communicating to the outside world were usually in the form of letters to the editor in response to negative press. These rebuttals were created at the request of an irate board member or state association leader. The letters employed stock answers and reusable clichés -- what one writer termed "factoids"-- statements designed to resemble facts. The repetition of a series of little lies or half-truths is essential to the perpetuation and legitimization of chiropractic.
For example, if someone attacked the quality of chiropractic education, we would point out that chiropractors attend colleges accredited by an agency recognized by the U.S. Department of Education -- implying that the schools must be of high quality. How good are chiropractic curricula? How qualified are the instructors? Are inspections of the colleges thorough? These are the kinds of issues best left unexplored.
Another popular chiropractic myth was brought out every time the ACA was queried about the latest incident of chiropractic fraud or abuse. The standard reply was that irresponsible practitioners constitute only a tiny minority of the profession. Yet in reality, a healing art based on an unscientific theory -- in this case, that spinal alignment is the key to good health - - will inevitably result in malpractice. Furthermore, liberal scope-of-practice laws in many states permit chiropractors to operate clearinghouses for untested and questionable therapies. Advertisements in newspapers and Yellow Pages show that many chiropractors treat organic problems with enemas, vitamin supplementation, hypnosis, various gadgets, and other unorthodox techniques. So ACA is forced to characterize problems endemic to the profession as isolated occurrences.
PR aside, there were few "true believers" in chiropractic among ACA's leadership and staff. Whenever a Dr. So-and-So would telephone ACA, a staff member would jokingly ask a colleague whether the caller was a "R.D." or chiropractor. "R.D." was our acronym for "real doctor."
However, ACA's leaders did believe in protecting and expanding chiropractic's $2 billion empire and doggedly pursuing the quest for parity with other health-care fields.
Chiropractic lobbying in the 1960's and 1970s was effective in securing important political gains, notably the federal recognition of its colleges and inclusion in Medicare. But during 1981, the lobbying efforts I observed were trivial gestures glorified and packaged for internal consumption.
Here's how it worked: ACA's political action committee would donate money to the Republican or Democratic National Committee, in effect "buying" an invitation to the White House or party function. Then -- and this even happened once or twice before the event occurred -- I would be instructed to write an account for a publication or release, using hyperbolic phrases like "another breakthrough for the profession." Over and over, I would concoct inflated pieces about dinners, receptions, and meetings, portraying them as momentous occasions. The less that happened, the more I'd write. The atmosphere could best be described as "Orwellian."
The membership was flooded with these materials and evidently was convinced that their leaders were hard at work in Washington scoring important political victories. But as far as I know, for a number of years ACA has been unable to achieve its prime political objectives of amending Medicare in regard to x-ray compensation and including chiropractic in veterans' benefits through CHAMPUS.
If chiropractic has in fact peaked in the national political arena, its leaders seem to be willing to devote considerable efforts to prevent their members from realizing it. Toward the end of 1981, I had done such a good job that it was twice suggested that I apply for the position of director of communications. Writing internal propaganda read only by chiropractors was one thing; but becoming their spokesperson to the outside world was quite another. Public relations is not, as some would argue, an inherently disgraceful profession, but it becomes tainted when that which is being promoted is unworthy. So the ACA and I parted company.
The selection of health-care providers is a serious concern, one that should not be clouded by dishonest or misleading information. The selling of the chiropractor as a "family doctor" is not justified by either chiropractic's philosophy of health care of training. The American public deserves better.
Mr. Baizer holds a BA degree in political science from the University of Michigan. Beginning in December 1980, he served as a public relations consultant to the American Chiropractic Association for approximately one year. Before that he had worked for five years as as executive director for the Association for Women in Science. Since leaving the ACA, he has done freelance writing and has held administrative positions with various university and nonprofit organizations in Washington, D.C., Los Angeles, and Santa Barbara, California (his current location). This article was originally published in January 1983 in the newsletter of California Council Against Health Fraud, which became the National Council Against Health Fraud in 1984.