Chiropractic Public Relations and
Practice-Building Outweigh Health Concerns
According to a story circulating within the profession, one chiropractor who holds seminars to teach colleagues how to increase their revenues seats them in a room and leads them in a chant of "HMMMMMMONEY!"
An Illinois chiropractor claims to have seen 3,000 patients per month in 1980 and to have made nearly $800,000 that year. Those who take his course are promised a $60,000 jump in income and counseling on how to avoid paying income tax.
Another practice builder offers a program that includes "How to Launch Your Millionaireship and Millionaireship Mastermind Session."
Stories like these have prompted widespread criticism of chiropractic, and not all of the complaints are coming from outside the profession.
A few years ago, the top lawyer of the largest chiropractic organization in the world addressed a group of practitioners who had come to Los Angeles to celebrate the inauguration of a chiropractic college president. Instead of offering the standard pep talk expected at such occasions, Harry Rosenfield, a distinguished Washington attorney and counsel for the American Chiropractic Association, stunned his audience by comparing their trade to "a boat without a rudder or a captain without a map." "Chiropractic," Rosenfield continued, "has failed to establish a planning mechanism which will help to establish its goals, the means for achieving them, and an evaluation system for continuous study, research, and planning for the future ."
Study, research, and planning—activities crucial to the success of any professlon—have been dwarfed by public relations and legal concerns that reflect chiropractic's obsessive drive for parity with other health care fields.
A report prepared several years ago for the American Chiropractic Association counseled the organization "to maintain and strengthen more than ten years of positive public relations activities" and "to out-compete other associations in the public relations arena." This is precisely the kind of advice that chiropractors have heeded, and it has paid off handsomely.
The profession is prospering. In 1981, 8.9 million Americans paid 21,000 chiropractors $1.9 billion. The number of chiropractors in the U.S. is expected to increase 45% by 1986. The American Chiropractic Association states that they represent "the second largest primary health care field in the United States.''
Political victories of the past decade are impressive. Today chiropractors are licensed in all 50 states and most of their colleges are accredited by an agency recognized by the U.S. Department of Education. Chiropractic is included in Medicare and in most state Medicaid programs. Recently litigation forced chiropractic's arch enemy, the American Medical Association, to drop its ban discouraging MD's from associating with chiropractors, and other medical groups have also promised greater cooperation.
Chiropractors believe that they have an important ally in the Reagan administration. After meeting with Health and Human Services Secretary Schweiker last November, the two major U.S. chiropractic organizations issued a press release that stated, "The Secretary . . . showed a keen understanding of chiropractic's situation and made it clear that he was a friend of chiropractic." That friendship was demonstrated not long ago when Schweiker appointed the first chiropractor to serve on a HHS panel. Moreover, he reportedly told the chiropractic leaders that his administration had no plans to eliminate or reduce chiropractic participation in any federally-funded program.
Chiropractic is derived from the Greek words "cheiro" and "praktikos," meaning "done by hand." It was founded in 1895 by Daniel David Palmer, a Davenport, Iowa grocer and magnetic healer. Palmer noticed a lump in the spine of a deaf janitor and with a thrust of his hands allegedly restored his hearing by "adjusting" his vertebrae. Palmer theorized that diseases result from the impingement of nerve energy produced by spinal misalignments. Consequently, good health could be achieved by manipulating the vertebrae back to their proper positions. Attempting to reduce its conflict with modern science, in 1975 the ACA went on record admitting that other factors besides spinal misalignments contribute to disease.
Defining chiropractic treatment is not easy because it may vary quite considerably from chiropractor to chiropractor and from state to state. Although spinal manipulation is central, some practitioners use a wide range of additional therapies such as electrical stimulation, vitamin supplementation, heat applications, exercise, and enemas. Once in a while a chiropractic device raises the eyebrows of a government regulator. In the early 1960s the FDA tested a chiropractic diagnostic tool that showed two cadavers to be in perfect health. Earlier this year the FDA asked chiropractors to refrain from using low-power lasers for face lifts and acupuncture.
Although many regard the chiropractor as a back specialist, this is not a characterization they fancy. The ACA considers the chiropractor to be a "primary health care provider." This insistence on a broad role draws fire from the medical and scientific communities.
"There's simply no scientific or empirical evidence that would substantiate chiropractic as a theory of disease and as a healing therapy," says Eugenia Carpenter, assistant research scientist with the University of Michigan School of Public Health. "To suggest that individuals trained in chiropractic are competent to provide the full scope of health care services is a mistake."
Chiropractors respond that their training, which includes a four-year program following two years of pre-chiropractic college, does indeed qualify them to serve as primary care providers. They are also fond of telling skeptics that unlike surgery and medicine, two procedures they eschew, spinal manipulation poses little danger.
That, too, is disputed. Dr. Herbert Poinsett is a Hollywood, Florida chiropractor who has investigated malpractice for the past four years. Ask him about the safety of manipulation and he'll reel off a series of cases involving injuries caused by chiropractic: "Say you have a neck case and you give a particular chiropractic treatment. Then the patient says, 'Gee, doctor, the pain in my right hand is worse, like an electrical shock.' The next day the chiropractor goes banging merrily away, not recognizing the damage he's done. "If the majority of lawyers and the public knew that they could win legitimate cases against chiropractors who have seriously hurt patients, I think malpractice cases would increase three or four-fold, maybe even five-fold."
"I don't want to be known as a family doctor," objects Dr. Poinsett. "I'm just a limited specialist in my field. Everybody knows what a podiatrist or optometrist is, but not chiropractic. Some chiropractors actually practice psychology and nutrition and do anything but manipulate. So what the hell is this profession?"
Not all of Poinsett's colleagues share his willingness to limit their scope of practice, as indicated by numerous instances of malpractice and fraud.
- God won't let your son die," an Iowa chiropractor told the parents of a nine-year-old boy suffering from cystic fibrosis. On March 30, 1980, after the chiropractor administered electrical impulses, the boy died. A seven-year-old girl with kidney disease treated with electrical impulses and nutritional supplements at the same clinic died the day before. A month earlier, another patient of the chiropractic clinic, a young woman with cancer, also died after receiving "natural healing" treatments.
- Colored lights and psychic vibrations were used by a Virginia chiropractor to treat children with cerebral palsy, brain damage, and retardation.
- A chiropractic clinic ran an advertisement in a suburban Detroit newspaper advising parents not to have their children immunized before school and instead to take them to a chiropractor for a spinal examination. In reporting this incident last year, the FDA pointed out that one of the few cases of diphtheria reported in the U.S. in 1979 involved the death of a five-year-old. His father, a Ca1ifornia chiropractor, waived immunization.
- In Los Angeles, an epileptic died 10 days after his chiropractor advised him to stop taking his medication.
- Seven persons died in Colorado between 1977 and 1980 from exposure to a contaminated enema machine.
Another dilemma facing chiropractic is the absence of scientific validation.
When HEW looked into the profession for a 1968 report, they discovered that a landmark chiropractic research study examining the effects of spinal misalignments in rabbits used only two animals—one was the "test " and the other the "control." In 1981, chiropractors were still funding rabbit research, presumably using more than two per experiment.
Dr. Murray Goldstein, director of the National Institute for Neurological and Communicative Disorders and Stroke, would like to see more legitimate chiropractic research conducted. He notes that since 1975 only one chiropractor has asked the National Institutes of Health for research funds. "I'm not aware of any clinical study that has adequately tested the chiropractic hypothesis," he adds.
The medical establishment is the culprit in chiropractic's shortcomings, according to Dr. Bruce Nordstrom, executive director of the International Chiropractors Association. "If we had not had to face incredible legal and financial barriers imposed by organized medicine," he argues, "you would see a more mature profession."
Again, Dr. Poinsett disagrees, denouncing his profession as "too cultish." He laments: "Sometimes at chiropractic conventions I think I'm with a bunch of astrologers."
Despite the relentless opposition of the powerful medical lobby, a complete lack of scientific justification, and bitter intraprofessional feuding, chiropractic continues to grow. Unquestionably, psychological factors play an important part in its success. A study conducted by the University of Utah found greater patient satisfaction with chiropractors than with MD's. Chiropractors were perceived as more sympathetic and less hurried. Evidently chiropractors help enough patlents—or convince them that they have been helped—to stay in business.
Leonard Oliver, a special assistant to the chairman of the National Endowment for the Humanities and a former Olympic soccer player, is typical of many chiropractic patients who found conventional medicine unsatisfactory. He first started seeing a chiropractor as a teenager with knee injuries. When he returned to competitive sports many years later, he again sought chiropractic care.
"The thing I like," he explains, "is that they look at the whole body. They don't just treat symptoms and try to relieve your pain; they look at the basic cause. I like the positive approach, someone who says, 'This is what seems to be wrong, let's work on that,' rather than, 'We'll reduce the pain, then live with it."
But not every evaluation has proven to be as flattering. The experience of the United Rubber Workers union highlights the gap between chiropractic's public relations and performance.
Last year, the American Chiropractic Association ran an advertisement in 36 union publications carrying the endorsement of the president of the United Rubber Workers who characterized chiropractic as a means of "economic relief."
But administrators familiar with the reimbursement claims were decidedly less enthusiastic. By the time the advertisement appeared, they had gathered evidence that suggested a number of shady practices, such as excessive treatments and dubious diagnoses. For instance, the same day a chiropractor performed an adjustment on a 9-day-old baby diagnosed as having acute traumatic cervical strain, he treated other members of the same family—all with the same diagnosis.
"I think our employees, your members, as well as the company are being abused," complained a rubber company official. "Can't we do something about it before the monster gets so big that it can't be trained?"
Can chiropractic handle the increased scrutiny that will surely accompany its growing political and legal acceptance? If the profession is to become more than a public relations "overachiever," responsible chiropractors will have to institute uniform standards of treatment, establish legitimate research programs, kick out the charlatans, and accept a limited role in American health care.
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 written the early 1990s.
This article was pposted on November 18 2018.