What I find truly incongruous, however, is the outrage by chiropractors and some leaders of chiropractic organizations over this issue of endorsement for dollars. Some chiropractors have now donned the righteous robes of indignation against the AMA and asked, "How could they do such a thing and betray the public trust?"
Before we get too far off this issue of the AMA endorsing products, we'd better stop a moment, get a large mirror, and take a long look into the reflection. Chiropractic trade organizations, from the ICA and ACA on down to state associations and many other groups, have been, are, and will be willing to put their name and logo on a product for dollars. As a profession, we are individually and collectively endorsing everything from mattresses and personalized brand vitamin supplements to exercise machines and diet programs. Is that so bad?
Well, not if the endorsement is truly a valid endorsement and not simply a quid pro quo for money. Do the associations who endorse mattresses have bona fide committees who truly test the product to see that it is really worthy of endorsement? Have they investigated the benefits of one product versus the others on the market and then determined that product A is better than product B? Are there truly standards of comparison by which one product is measured against another? Has due diligence been performed in a meaningful and defensible fashion? If so, what's wrong with the product maker providing a fee or royalty to the association or individual for the endorsement?
On the other hand, if no testing was done, no evaluation in place, no monitoring process, no other motivation except for who will pay the largest dollar amount for the logo and endorsement, then the questionable issues of "ethics" and "propriety" begin to emerge as valid and legitimate concerns by the public, and (one hopes) the ethics committees of the various organizations.
The issue from an organizational standpoint is reasonably clear. What happens, however, when the product now endorsed by the organization and wearing the logo of the organization decides that it should encourage individual practitioners to endorse the product? This will naturally result in better sales. And if the doctor is telling patients about the product, should the doctor be entitled to a "cut" of the profits?
This is where the real difficulty begins and serious ethical considerations come into play. If doctors endorse products to their patients because the national association has taken the time to evaluate the product and, when sold, the organization gets a royalty, that is quite different from the individual doctor having a personal financial interest if the product is sold.
How many scams have been foisted on DCs under the guise of doing what is right for patients, while the underlying theme is to get dollars to the doctor any way they can? It has been demonstrated that financial interest in clinical laboratories and MRI units have resulted in a 44% increased utilization of the facility, compared to those who had no financial interest. Can the justification for the test or product be rationalized? Yes, but when stripped away to the bare essence, money motivates and self-interest incapacitates the ability to think clearly.
The AMA was perhaps at fault for not disclosing the entire Sunbeam deal up front to the house of delegates and engaging in healthy debate on the propriety and ethics of the issues rightfully confined behind the closed doors of the delegates conference. I wonder how many of the post facto, self-righteous delegates would be speaking out against the deal if they had participated in the pre-discovery debate. It is easy to cloak oneself in the blanket of ethics when the press and the public are already engaged in the condemnation. We'll never know for sure, but now the AMA must defend what would otherwise be a "standard" negotiated contract in any other arena in business today. This is analogous to the indignation of some legislators in Washington after the revelations about Senator Packwood. Later we found out that the many of the legislators knew about his conduct, but they didn't speak out until the "light and heat" from the press was seen and felt.
Sports, pharmaceuticals, cosmetics and the apparel industry are perhaps the worst offenders of paying big bucks to celebrities to endorse their product line. The AMA and others have truly lowered the organizational ethical bar; unfortunately, if you look around, who hasn't? That is the real problem, not the AMA and Sunbeam. How well I remember the fury and rage during the debate over the ethics of advertising. Then the Bates decision came along and the "right to advertise" was no longer prohibited by law. Those very attorneys and medical professionals who previously denounced the chiropractic advertisements in newspapers were in effect mimicking them to a point where it is now impossible to tell the difference.
When the public either laughs or simply shrugs its collective shoulders at the fact that the White House has become a Motel 6 for high campaigners, the very issue of ethics and how far the bar has been lowered is obvious. When the American Heart Association would consider selling its very "soul" for perhaps an endorsement for "sole" as being better for your heart than red meat, we're in trouble. When legislators own tobacco farms and are in positions of deciding on the potential harm tobacco does for society, we're in trouble. When financial institutions we have long trusted have been exposed for wrongdoing and knowing it, we're in trouble. When our justice system condones the criminal actions of individuals because they are celebrities and a dual system of justice is sanctioned, the downward spiral of decay is inevitable, and we are in trouble. When the press (under the cloak of the First Amendment) is permitted to invade personal privacy and literally kill in the process so their very own tabloids can profit, we are in trouble.
The chiropractic profession should not gloat about the AMA's recent debacle, because if we as a profession were big enough to be consequential, close scrutiny of our actions would reveal a plethora of scams, schemes and multi-level programs disgraceful enough to make the AMA-Sunbeam deal look like a Disney production. Well, on second thought, the way Disney is going, that might not be such a good analogy.
We need only to look introspectively and recognize that in each and every decision made by organizations to endorse products for money, there will always be the dilemma of endorsement for economics vs. product value as the underlying issue. We can learn from Sunbeam and the AMA and insist that the organizations we belong to endorse products which have been tested properly or disclose the financial arrangement in advance of overt discovery.
The issue comes down to credibility. Is the AMA a professional association, as Dr. Arnold Relman, Emeritus Editor of the prestigious New England Journal of Medicine claims, or is it a trade association, as Charles Inlander, MD, president of the People's Medical Society, claims? There are differing standards of ethics and values which come with each designation. Only the AMA can decide which rung on the ethical ladder it wishes to stand.
As for chiropractic, we have not had ethical debates in this profession to air the very questions now being posed to the AMA after the Sunbeam debacle. Maybe it is time for some healthy debate on the ethics of being a chiropractor and a chiropractic organization. Maybe it is time we examine the issue of product sales to our patients. Maybe it is time we review the new multi-level marketing programs being sold every day to DCs. What responsibility do we have to our patients and our profession, and perhaps more importantly to society? The need for this debate is long overdue. Maybe we can get one of the vendors to sponsor a conference; or maybe, that might not be such a good idea.
Louis Sportelli, DC
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