The Appeal to Fear in
Chiropractic Subluxation Advertising

J. Keith Simpson

The article presents the chiropractic portions of the article Appeal to fear in health care: appropriate or inappropriate? The full article, which begins by discussing the appropriate use of fearful messages in public health initiatives, was published in Chiropractic & Manual Therapies on September 20, 2017. It is copyrighted by the author and distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted distribution in any medium, provided you give appropriate credit to the original author and the source and indicate if changes were made. Simpson is a Senior Lecturer in the chiropractic program at Murdoch University in Australia.

It is now appropriate to examine fallacious use of appeal to fear using chiropractic advertising as an example. The putative lesion that chiropractors 'treat' is commonly referred to as chiropractic subluxation, vertebral subluxation complex (VSC) or simply 'subluxation' [differentiating the chiropractic lesion from orthopaedic subluxation]. Broadly speaking within chiropractic today the term 'subluxation' has two meanings: the Traditional Palmerian Subluxation (TPS), whereby the presence of subluxations leads to ill health and the second: The Modern Subluxation, whereby subluxations have a local biomechanical effect.

The TPS is the focus of this discussion. DD Palmer, who 'discovered' chiropractic in 1895, proposed that 95% of all disease (dis-ease) was due to subluxations of the spine and that the remaining 5% was caused by subluxations of the extremities, particularly the joints of the feet [68]. DD and his son BJ Palmer hypothesized that the chiropractic vertebral subluxation differed from the medical "subluxation" in that it interfered with the transmission of Innate Intelligence (a fraction of Universal Intelligence) [69], independent of what has come to be recognized as the action potential. However, Innate Intelligence remains a metaphysical construct [70].

The more contemporary position is that Palmerian subluxations cause interference within the nervous system, which leads to suboptimal health and symptomatic dis-ease, and that chiropractic health care is primarily involved in the detection and removal of subluxations [71]. Chiropractors who still adhere to the founder's paradigm—and there are many such practitioners—depict and market subluxation as an enemy that needs to be contained and eliminated.

Before examining examples of subluxation marketing, it is cogent to briefly discuss the history of chiropractic and its embracing of marketing to attract clientele. Chiropractic emerged in the late nineteenth century and, in spite of fierce opposition, grew rapidly in practitioner numbers and patient numbers during the first half of the twentieth century [72]. This is in part attributable to chiropractic adopting a unique professionalism. Unlike traditional professionalism wherein altruism is a central tenet [73], chiropractic professionalism favoured entrepreneurialism with recognition of financial success as a strong indicator for accomplishment [74]. While medical professionalism witnessed an ethical ban on advertising as early as 1847 [75], the emerging chiropractic profession embraced marketing. In fact, even chiropractic students were encouraged to advertise heavily [74,76]. The Developer of Chiropractic, BJ Palmer advised his many readers:

What you want to keep out of a newspaper is news.
What you want to get into a newspaper is an advertisement [74] p. 44.

Whether or not current chiropractic advertising is a legacy from the early days of chiropractic is moot. It is evident however that advertising claims made by some chiropractors and indeed by some chiropractic colleges are suspect [77, 78]. A few examples of subluxation marketing are in order.

WH Koch, a chiropractic author makes the danger posed by subluxation abundantly clear:

We must now look at this condition of 'disease', Vertebral Subluxation Complex, which is so disturbing to the flow of life force and innate expression in your body that it causes pain and the progressive breakdown of the body tissue known as pathology. The V.S.C. is the silent killer, one of the most serious health threats known to man [79] p. 34.

The World Chiropractic Alliance (WCA), is a worldwide organisation promoting subluxation based care. The WCA represents the interests of more than 70,000 doctors of chiropractic and chiropractic students, In 2006 the WCA issued a position paper stating that "chiropractic care to detect and correct vertebral subluxations offers benefits for all people, including those who do not demonstrate symptoms of a disease or health condition".

'Patient education' materials prepared by Chiropracticis aims to educate patients to "believe choosing to be checked for the presence of vertebral subluxation throughout a lifetime is the only logical choice". Once patients understand 5 facts about their health, they are well on their way to being chiropractic patients for life.

The five facts are:

  1. Your Spinal Cord is located in the spine and is your Nervous System's information highway.
  2. Your Nervous System controls and coordinates every part of your body.
  3. Misalignments of your spine can DISTORT nerve messages and contribute to a wide range of health problems.
  4. Misalignments of the spine are known as vertebral subluxations and negatively affect your nervous system, health and well-being.
  5. Maintaining the health of your spine and nervous system should be a regular part of a health lifestyle and can dramatically improve your quality of life.

Koren Publication's What is a Subluxation? brochure tells readers that chiropractic has become so popular because "chiropractors are the only professionals trained to locate and remove subluxations. If subluxations are in your body, you cannot be truly healthy".

JC Smith, a prolific chiropractic author and subluxation advocate advises in his paper "Killer Subluxation".

"The idea of sudden cardiac arrest from a vertebral subluxation is just too far outside the consciousness of most people … [however] "killer subluxations" actually may not be that far from the truth.

The subluxation brochure produced by Patient Media, Inc., is perhaps the most alarmist publication. Its Subluxation pamphlet provides a succinct description of how vertebral subluxations operate as well as the importance of their detection and removal.

Maybe you've never heard of subluxations. That's OK. There probably was a time when you'd never heard of AIDS or Alzheimer's.

There are three basic causes of subluxations. Physical causes include slips and falls, accidents, repetitive motions and improper lifting. Stress, anger and fear are examples of emotional causes of subluxations. Alcohol, drugs, pollution and poor diet can be chemical causes of subluxations. The result is the vertebral subluxation complex, or more simply, a subluxation.

Subluxations are serious!

However, the most important aspect of a subluxation is its effect on your nervous system. Compromising the way your nervous system controls and regulates your body can have grave consequences. Distorted communications between your brain and your body can cause all kinds of health problems beyond just headaches and backaches.

You can have subluxations and not even know it. Like tooth decay or cancer, subluxations can be present before any warning signs appear. The results of a thorough examination can show the location and severity of any subluxations you may have.

In an essay entitled 'If You Don't Know Subluxation, You Don't Know Chiropractic' Dr. Carey N. Pabouet-Sigafoose alerts readers to the dangers of subluxations:

There's loss of motion in the body causing death because of a subluxation. It's a major problem, a major killer, a major cause of disease in man and we've got to understand that. We've got to take ourselves in and give it the time and the space and the effort to get these things cleared up, not in just you, but your friends and your family. It's imperative.

These are but a select but indicative sampling of the 176,000 results obtained by conducting a Google search using 'subluxations kill'.

Chiropractors adhering to the TPS theory or its contemporary interpretation believe that subluxations have an effect on the overall health of the individual while those adopting the modern subluxation theory hold that the subluxation has a more local biomechanical affect. It is often reported that TPS practitioners represent only a small portion of the overall profession [80]. This is not the case. A survey of North American chiropractors found amongst respondents, in excess of 75% of those adhering to the modern subluxation construct believe that the adjustment of the vertebral subluxation complex usually elicits improvements in select visceral ailments [81]. Compounding the problem is the commonly relayed message that subluxations are only detectable by the skilled hands of a qualified chiropractor. Given this, one must ask: what is the evidence supporting the TPS ideology that minor vertebral displacements cause visceral disease?

Nansel and Szlazak [82] carefully examined this very question and concluded scientific consensus does not support the theory that nerve interference caused by vertebral misalignment or subluxation is a cause of visceral disease. Further, Nansel and Szlazak clearly state "there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy [manual therapy] represents a valid curative strategy for the treatment of any internal organ disease". It is noteworthy that Nansel and Szlazak's findings have never been challenged.

Worse yet, from an epidemiological perspective (strength of association, specificity, temporality, dose response, experimental evidence, biological plausibility, coherence and analogy), the subluxation is found to be wanting [83]

Many chiropractors argue for the 'neurological effects' of the adjustment. While it is safe to say that the high velocity low amplitude thrust employed by chiropractors has a neurological effect, as does stubbing one's toe, it is a stretch to suggest that the adjustment's effect is predictable, lasting and always positive. Haldeman, a qualified chiropractor, medical neurologist and holder of a PhD in neurology, wrote on the subject of the purported neurologic effects of the chiropractic adjustment.

A significant leap of faith is required to accept and present a convincing argument about the various theories on the neurologic effects of the adjustment. …

What must be avoided at this stage of understanding of the neurologic effects of the adjustment is the unreasonable extrapolation of current knowledge into speculation and presentation of theory as fact [90].

Thus we have a large portion of the chiropractic profession, a group recognized as being the third largest primary-contact health care profession in the Western world [80], telling health care consumers that undetected subluxations, if not removed, will result in adverse health consequences and an untimely death. This is a position unsupported by evidence. In short, it is an unsubstantiated claim the purpose of which is to drive asymptomatic members of the public into chiropractor's offices to receive examinations to locate subluxations and treatment to remove killer subluxations before they cause unimaginable harm to the individual. Undeniably, it is the appeal to fear fallacy exemplified.

Not only is it unethical [88] it is totally inappropriate. Some chiropractors have even gone so far as to suggest that subluxation based practice is a threat to the public health [91]. Given the best available evidence I suspect chiropractors marketing their care in this fashion could be faced with the unenviable task of defending against an allegation of unconscionable conduct under Australian Consumer Law.

Conclusion

I have briefly examined the appeal to fear as it is used in mainstream health care and established that for the most part its appropriate use is effective and not fallacious. It is however used fallaciously by a large element within the chiropractic profession in its marketing of the unsubstantiated effects of chiropractic subluxation.

Even though most people realise that the sky is not falling, gullible Chicken Little types still abound, particularly amongst vulnerable health care seekers. Most rational chiropractors realise that the sky is not falling and that subluxations are not a health risk. That said, the evidence presented is clear: appeal to fear marketing is alive in chiro-land.

The data demonstrates that appeal to fear as a marketing tool is of dubious value. After taking into consideration the best available evidence the conclusion is clear: the appeal to fear when used judiciously in some health care settings is acceptable. These settings include antismoking, anti-drunk driving and hypertension awareness campaigns.

Use of appeal to fear is totally unacceptable and fallacious when used to promote health care interventions for which there is no credible evidence such as chiropractic subluxation based care. Attempts to convince the unsuspecting public that subluxations present a clear and present danger is a falsehood at best and unconscionable conduct at worst.

It is well beyond time that the authorities governing the chiropractic profession, namely chiropractic registration boards as well as those advocating for chiropractic (the professional associations) take the appropriate steps to eliminate the appeal to fear from chiropractic marketing.

References

  1. Keating JC Jr. Philosophy - the art of skepticism. J Can Chiro Assoc. 2000; 44(2):79-84.
  2. Keating JC Jr. The meanings of innate. J Can Chiro Assoc. 2002;46(1):4-10.
  3. Keating J, et al. Subluxation: dogma or science? Chiropr Osteopat. 2005;13:17.
  4. Plaugher G, et al. Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study. J Manip Physiol Ther. 2002;25:221-39.
  5. Simpson JK. The Five Eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer. Chiropr Man Therap. 2012;20(1)
  6. Cruess, R. and S. Cruess, Expectations and Obligations. Professionalism and medicine's social contract with society. Perspectives in Biology and Medicine. 2008:51(4);579-98.
  7. Martin, S.C., Chiropractic and the social context of medical technology, 1895-1925. Technology and culture. 1993;34(4):808-34.
  8. Moser HR, Johns HE, Kittrell LM. How consumers view Chiropractice advertising. Health Mark Q. 1996;13(2):43-54.
  9. Gromala, T., Broadsides, epigrams, and testimonials: the evolution of chiropractic advertising. Chiropractic history: the archives and journal of the Association for the History of Chiropractic, 1984. 4(1): p. 41-46.
  10. Grod J, Sikorski D, Keating J. Unsubstantiated claims in patient brochures from the largest state, provincial, and National Chiropractic Associations and research agencies. J Manip Physiol Ther. 2001;24:514-9.
  11. Sikorski D, Grod J. The unsubstantiated web site claims of chiropractic colleges in Canada and the United States. The Journal of Chiropractic Education. 2003;17(2):113-9.
  12. Koch W. Chiropractic: the superior alternative. Calgary, Alberta: Bayeux Arts Incorporated; 1995.
  13. Chapman-Smith, D., The Chiropractic Profession. Its Education, Practice, Research and Future Directions. 2000, DeMoines, Iowa: NCMIC Group Inc.
  14. McDonald WP, Durkin KF, Pfefer M. How chiropractors think and practice: the survey of north American chiropractors. Sem Integrative Med. 2004;2(3): 92-8.
  15. Nansel D, Szlazak M. Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease. J Manip Physiol Ther. 1995;18(6):379-97.
  16. Mirtz T, et al. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropractic & Osteopathy. 2009;17(1):13.
  17. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manag. 2008; 35(5):544-62.
  18. Homola, S., Chiropractic vertebral subluxations: Science vs. pseudoscience.
  19. Nelson C. The subluxation question. Journal of Chiropractic Humanities. 1997;7:46-55.
  20. Young KJ. Gimme that old time religion: the influence of the healthcare belief system of chiropractic's early leaders on the development of x-ray imaging in the profession. Chiropractic & Manual Therapies. 2014;22(1):36.
  21. Nelson C, et al. Chiropractic as spine care: a model for the profession. Chiropractic & Osteopathy. 2005;13(9):1-17.
  22. Homola S. Real orthopaedic subluxations versus imaginary chiropractic subluxations. Focus Altern Complement Ther. 2010;15(4):284-7.
  23. Haldeman S. Neurologic effects of the adjustment. J Manip Physiol Ther. 2000;23(2):112–4.
  24. Homola S. Is the chiropractic subluxation theory a threat to public health? Scientific Review of Alt Med. 2001;5(1):45-53.

This article was posted on October 2, 2017.

Links to Recommended Companies