In September 1975, the first article from Consumer Reports hit the streets: "Chiropractors - Healers or Quacks?" This two-part series was not favorable. Part I hit right before the workshop on the Research Status of Spinal Manipulative Therapy at the National Institutes of Health (NIH). Chiropractic had just overcome several major obstacles in its quest for recognition and status: The Council on Chiropractic Education (CCE) was accepted as the recognized accrediting body by the United States Department of Education (USDE); chiropractic was included in Medicare and Medicaid; and the last two holdout states for licensure (Louisiana and Mississippi) were now behind us.
"Doctor of Chiropractic" had been listed as a "spurious" degree by USDE, but after the recent advances, students and colleges would be able to avail themselves of federal funding and financial assistance. We sometimes forget that just 25 years ago, this rag-tag group of dedicated, committed, competent (but vastly outnumbered) researchers went before the National Institutes of Neurological Diseases and Stroke (NINDS) of the NIH and presented the reasons why chiropractic should be recognized and funded. What a proud moment it was to witness this event and see the groundwork laid for decades to come.
The NINDS presentation was mandated by Congress. It seems that anytime chiropractic is afforded an opportunity to appear in these programs or presentations, it takes a "congressional mandate," as occurred with the Chiropractic Military Demonstration Project and the project to revamp the Dept. of Veterans Affairs. Much has changed, and yet little has changed. Chiropractic was not the choice of the Department of Defense or the VA. They were congressionally mandated by a few steadfast and dedicated senators and representatives. Even in the face of overwhelming evidence, they still categorically reject chiropractic inclusion, but that is another story you will hear more about in time.
A 1975 article by Joseph Botta, a senior editor of Consumer Reports, blasted the profession using every kind of yellow journalism trick in the book. He attacked the subluxation; the theory of chiropractic; the unscrupulous practice management procedures; the diagnostic training of DCs; and the conflict with science. He went so far as to quote an editorial from a college dean: "Requirements for a chiropractic case are threefold: 1) Does the patient have a spinal column? 2) Does the patient have a nervous system? 3) Is the patient alive?"
Part II of the report on chiropractic followed in the October 1975 issue of CR. The report ripped apart the placebo effect, discussed self-limiting illnesses, and elaborated on the exposure to injury and risk that patients may suffer at the hands of a DC. They concluded: "Any risk of injury is unwarranted." (When the Institute of Medicine in 1999 released a report on the 48,000 to 90,000 deaths from medical errors, which did not include illness or untold side-effects - just deaths - Consumer Reports did not do a two-part exposâ.) CR warned readers about radiation, the dangers of delay, and the risks of chiropractic to children. The two-part series listed a series of recommendations and concluded:
"Overall, CR believes that chiropractic is a significant hazard to many patients. Current licensing laws, in our opinion, lend an aura of legitimacy to unscientific practices and serve to protect the chiropractor rather than the public."After the articles, everyone - ACA, ICA, the colleges, the state organizations, private practitioners, etc. - sent letters to Consumer Reports protesting the articles as biased and the findings and recommendations unwarranted and unfounded. Were some of the issues outlined in CR accurate and truthful? Of course. There is some truth in most stories. Pointing out our shortcomings is not the issue. Where we take exception is the lack of credible data suggesting to the reader that the profession has accepted responsibility for its actions and is doing something to help advance research, to help clean up the hucksterism, and to advance chiropractic education.
However, it was too late to publicly make amends - the consumer had already read the articles. This was a powerful medium and a credible source for most consumers. I recall many patients coming in with the articles. Some were angry; some were concerned; others had their faith in the profession destroyed. It took a long time for the effects of the articles in Consumer Reports to subside.
Let's move to June 1994, when Consumer Reports attacked again (coincidentally just as managed care was being introduced) with "Chiropractors - Can they Help? Do they Harm?" by assistant editor Rochelle Green. I supplied her with as much material as possible. By ruler, it measured more than five inches thick, but she chose to ignore most of it.
When the story came out, it was patently obvious that the editor did not interview one single member of a bona fide chiropractic group to counterbalance the negative information presented. Not one credible DC or patient was interviewed. The article's advice? "See your medical physician first." Every negative or questionable practice was dredged up from the bowels of the profession. Practice-building schemes of highly advertised and well-known entrepreneurs were exposed, and once again, nutrition, safety, and the fundamental hypothesis of chiropractic were put under the microscope in the most negative fashion.
Emotionally-charged children's issues were resurrected and made into the most negative kind of article. It implied that chiropractors were harming children. Again, Consumer Reports failed even the most fundamental test of integrity and objectivity.
CR's May 2000 issue includes "The Mainstreaming of Alternative Medicine." Is it unbiased? No, but it does have something different to offer. Consumer Reports asked 46,000 of its readers what they were doing about their health ailments. Is the bias and prejudice gone from the article? No! Consumer Reports has a difficult time even printing the word chiropractic, but CR found that the consumers they surveyed said the "C" word. Today, the big "C" is not cancer, but chiropractic. However, the subtle omission of chiropractic in this article is so blatant that to deny it, Consumer Reports would have to finally admit their disdain for the chiropractic profession.
The article begins..."the Berlin Wall that has long divided alternative therapies from mainstream medicine appears to be crumbling. Acupuncturists, hypnotists, massage therapists, and meditation instructors are now working at new complementary centers..." Where is chiropractic, the largest and most organized of the "alternative" health care professions? Could it be they did not want their readers to see the word any more than necessary? They asked 46,000 readers and made certain to point out: "The majority of our respondents (65%) did not use alternative therapies. The reason? Most of this group told us they were satisfied with standard medical treatment. Many said they didn't know enough about alternatives and a smaller group said they distrusted them."
They then reluctantly point out:
"The 35% of readers who did turn to alternatives were looking mainly for relief from troublesome symptoms that had not yielded to conventional treatments. Those who said they were in severe pain or stress were more likely to try alternatives. Despite the boom in alternatives, mainstream medicine is still the people's choice. For nearly all medical conditions, readers said they got the best results from prescription drugs, and from surgery when it was recommended. Even among people who tried her bal therapies, prescription drugs won higher marks for all medical conditions."Even in their report card graph, Consumer Reports does not list chiropractic, but rather lumps the profession into a broad category of "alternative manual therapy," so the reader would not see chiropractic listed. They go so far as to define "alternative manual therapy" as: "includes chiropractic treatment, deep-tissue massage, (rolfing, myofascial release, and neuromuscular massage), and acupuncture/shiatsu." This not-so-subtle deception of Consumer Reports is highly suggestive of the clever manipulation of words and emphasis they use throughout the article. Given any other unbiased or objective reporting of this same data, the focus, emphasis, description and conclusions would have been considerably different.
The magazine's graph on back pain is also distorted. It lists deep tissue massage first, yet clearly the data demonstrates chiropractic to be superior. The letter "C" in chiropractic comes before "D" in deep tissue massage, so it can not be alphabetical. The graph indicates a higher percentage for chiropractic, yet it is not first, as indicated by the "first" or highest percentage findings in every other graph. Even in the graph, Consumer Reports cannot bring itself to make chiropractic first. (Oh, I get it - maybe it was the combined ratings...oh yes, we mustn't forget that the consumer who reads these graphs will understand combined ratings and not look from top to bottom to see what is first.)
The recommendation continues: "See your doctor first." That is the message of the entire article. Despite the fact that they admit most medical practitioners in the field today know nothing about alternative care, the reader is advised to seek their advice. How does this make sense to the consumer, who has lived through the times when telling the family physician he or she was going to a chiropractor or taking vitamins would invoke their wrath? Would Consumer Reports suggest to their readers that they seek the advice of their family physician about whether to undergo a complicated surgical procedure of which their family physician knows little or nothing?
Health care is undergoing radical changes. Nothing is being categorically dismissed. It is being questioned, evaluated, challenged, scrutinized and examined, but it is being "tried" clinically and empirically. The results of the "trials by consumers" will ultimately cause any product or service to prevail or perish. From the explosive acceptance of cold medications containing zinc, to the insurance premium reductions of the "Ornish" plan for reversing heart disease, to the inclusion of acupuncture anesthesia, to the taking of kava kava, the train of alternatives has left the station house and is gaining speed. The incorporation of mind/body techniques as commonplace as massage therapy in every hotel in America marks the beginning of the century for chiropractic, complementary and conservative care.
Chiropractic must put aside outdated views and unsupportable proclamations and begin the process of healing with credible commentary, appropriate research, competent practitioners, expanded education, and a deliberate message to remove consumer fears planted by a century of opposition.
The message from 2000 forward is reasonably clear. Consumers will vote with their feet and decide with their pocketbooks. If services do not provide value to their lives, they will reject them. Chiropractic has an incredible opportunity to meet the demands of a new and more sophisticated consumer who is not easily swayed by clever jingles and pressure from salespersons, and is not gullible or passive with health care decisions. We have new consumers, willing to try something new if given a rational basis upon which to make a decision. The consumers will require and demand evidence that fits into their "believability index." However, the messages and information cannot be so conflicting that the potential to believe or achieve cannot be conceived by consumers.
I view the Consumer Reports article of May 2000 as a wake-up call. It clearly demonstrates that individuals and organizations can prejudice and bias a profession, but when the ultimate end-user, the consumer, is asked to judge, they will make the right decision. It is difficult to con the consumer; we need to instill confidence and remove any image of duplicity, unprofessionalism, incompetence, or deception from the minds of those who will place their trust in chiropractic ... the consumer of tomorrow. Are we ready?
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