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Dynamic Chiropractic – January 15, 2007, Vol. 25, Issue 02

The Wellness Bandwagon Is Full... Now What

By Louis Sportelli, DC

We've done it! We've convinced all of chiropractic's competitors that "wellness care" should be an integral part of every practice. Everywhere you look, on every street corner, billboard and certainly in the Yellow Pages, there is a "wellness center." Insurers are even paying for "wellness checkups." Nonsmokers get premium breaks.

Employers have workout rooms and incentive programs.

The very term "wellness" has become a buzzword for providers of every discipline, from acupuncturists to Zen practitioners. Chiropractic's message, and now even our most fundamental service, "adjustment/manipulation," likewise has been accepted by our competitors and increasingly adopted as a part of their patient management arsenals. "Alternative care" has become ever more popular and ever less associated with chiropractic. It's been said that imitation is the sincerest form of flattery. If true, then we certainly should feel flush with high praise.

In short, we have so effectively delivered our message that we've convinced not only our market, but also the entire industry. Now our competitors are spreading the message for us. Isn't that great?

Well, maybe not. I'm reminded of Xerox Corporation's overwhelming dominance in the 1960s. Xerox was so pre-eminent in its field that any photocopy was known as a "Xeroxed copy." Later, even that was shortened to "a Xerox," as in "Hey Millie, will you run me a Xerox of this?" For a while, Xerox was understandably delighted to have that kind of exposure. Its name was virtually synonymous with a photocopy. No matter what manufacturer's equipment generated a photocopy, it was called a "Xerox." (I apologize to my more seasoned readers, who hardly need this stroll down memory lane - but those licensed in the past 20 years or so might never have experienced this phenomenon).

So, why did it change? Did Xerox's competitors throw a snit and demand equal time? Did an association of photocopiers file an anti-trust suit? Did lobbyists prevail on a photo copier equality bill? Nope, none of those things happened. Xerox itself unleashed a concentrated drive to send out the message that its name could not be used to refer to any other photocopy. Other similar concepts in the marketplace are familiar; hand me a Kleenex when I mean tissue or a Coke when I want a soft drink.

Chiropractic already has experienced this "negative branding" when it was discovered that in peer-reviewed journals, most of the reported adverse consequences of manipulation attributed to chiropractors if the word "manipulation" were used, were in actuality, performed by non-chiropractors. This revelation received little attention from the scientific journals when it was brought to their attention. A too-little, too-late-to-set-the record-straight mindset prevailed.

Trying to stop someone from using your brand-name seems somewhat counterintuitive doesn't it? After all, having your name used as the generic name amounted to word-of-mouth advertising millions of times a day at no cost! Why would Xerox, for example, want that to change?

It must have been an agonizing process, but Xerox concluded that its "brand" was being diluted by being associated with competing products. Moreover, it didn't want its name to be unknowingly confused with what it believed to be inferior products. It's a fascinating story and valuable lessons can be learned from this chronicle about preserving identity.

What does all that have to do with chiropractic? As this article's title suggests, I submit that the "wellness bandwagon" already is overloaded. Our "brand" is getting diluted by every other provider's usurpation of the "wellness" banner. And our wellness message is being unknowingly confused with other so-called wellness programs.

We don't have the luxury of having "wellness" as a protected trade-name, so we can't keep others from using it like Xerox did so successfully - but we're in the same boat. When everyone in the marketplace is shouting out they have wellness for sale, the doctors of chiropractic shouting the same thing are lost in the crowd. That message has served us well, but its utility has run its course.

If we get off the wellness bandwagon, though, what should our message be - anti-drug, perhaps? There's certainly ample ammunition to use to mount a campaign. If you have been reading recent newspapers and/or current peer-reviewed journals, you might have seen several recently published articles of significance. An Oct. 17, 2006 JAMA article reported that reactions to some of the most widely used medicines, from insulin to a common antibiotic, sends more than 700,000 Americans to emergency rooms each year. We know the complications included diabetics on insulin passing out from low-blood sugar, excessive bleeding in patients on warfarin, and severe skin rashes in patients taking amoxicillin. Drug reactions were severe enough to require hospitalization in about 17 percent of patients. The study did not include information on whether any of the reactions proved fatal.

The article addresses a drug report from a 2004-2005 study, analyzing the first two years of data from a national surveillance project on outpatient drug safety. The project was developed by the Centers for Disease Control and Prevention. Without a doubt, this government study is going to rock the pharmaceutical industry right to its economic core, not to mention alerting the ever-vigilant pack of prosecuting attorneys salivating at the prospect of new malpractice and tort litigation targets.

Accidental overdoses and allergic reactions to prescription drugs are the most frequent cause of serious illnesses. If you've ever asked your patients to bring in their medications, you know many will deliver enough to fill a shopping bag. Moreover, the 700,000 annual allergic reaction estimate is almost certainly a conservative number. It's likely that "drug reactions" often are misdiagnosed, underreported or simply not severe enough to be recognized by the patient as warranting seeking care for the reaction. So, here is the bottom line. There are a tremendous number of consumers in the United States taking medication. The CDC has estimated that approximately 130 million Americans use prescribed medications every month. U.S. consumers buy far more medicine per person than anywhere else in the world.

Think about that statistic; since Oct. 17, 2006, when the U.S. population topped 3 million, the numbers show that approximately one-third of all Americans take prescribed drugs! Forget about drugs illegally "pushed on the street" or the "home-grown" variety. The facts are sobering. America is a country on drugs.

I emphasize again what undoubtedly will begin a pharmaceutical media spin circus: The JAMA study found that a small group of pharmaceutical cash-cow, long-standing, highly profitable celebrity drugs were most commonly implicated, including insulin for diabetes, warfarin for clotting problems and amoxicillin, a penicillin-like antibiotic used for all kinds of infections.

Will these staggering statistics and JAMA's influential voice significantly impact this country's drug "habit?" Bruce Lambert, a professor at the college of pharmacy in Chicago, might have astutely put our likely societal reaction in a nutshell. He said, "These are old drugs which are known to be extremely effective. We could not and would not want to live without them." He tempers that seemingly blind embrace of continued utilization by cautioning, "But you've got to get the dose exactly right. Variations, especially on the high side, are really dangerous."

Think about that reaction for a moment. Compare it with the response from the media, research authorities, expert spokespersons and others whenever there is a patient injury event in a chiropractic office. A vascular incident involving manipulation, for example, occurs perhaps "once in a million" adjustments, but whenever one occurs, various groups are lined up wanting to de-license and/or denounce the entire chiropractic profession generally, and manipulation specifically. Obviously, there are two standards at play here.

An anti-drug message? Every indication is that the population has not only accepted, but also embraced drugs as a "way of life" and as an acceptable health intervention. Chiropractic must come to the realization and recognize the mindset of the public; the public is not buying a "wellness" message that translates into no-drugs. The message we must communicate to a population that will not have its paradigm shifted easily, must resonate with what belief systems currently will accept.

What are we doing about communicating a chiropractic message that will resonate with the public? Doctors of chiropractic have an opportunity to look at the tremendous amount of research that is emerging and focus on those issues which have been the strength of chiropractic for 100 years.

Despite knowing the consequences and risks of these medical procedures, the consuming public has not said, "I will reject drugs and surgery." It takes decades for cultures to shift attitudes. Just think about the health and social issues associated with smoking. For decades, the surgeon general's warning appeared on every pack of cigarettes: "Smoking can cause cancer and be dangerous to your health." Smokers might have read it, but they continued to smoke. They not only smoked, but they did so with great gusto. The "Marlboro Man" was the very epitome of the rugged, masculine American prototype.

Today, entire cities have banned smoking. A recent stay at the Marriott hotel chain included a small notice in my envelope indicating that the entire chain is a nonsmoking facility. Ironically, the actor who portrayed the Marlboro Man succumbed to lung cancer. Who would have thought just 20 years ago that the trend away from smoking and the accompanying social ostracism, subtle and overt, would have made it more acceptable to stop smoking than to smoke?

Our long-term objectives might be more grand but, in the meantime, accepting the realities of the slowness of change, I submit that we are utterly failing to take full advantage of connections the public already makes between chiropractic and neuromusculoskeletal (NMS) conditions, and more specifically, the spine. That does not mean chiropractic has no benefit or value in other areas, but only that the public has a perception and recognition of what it has identified with chiropractic. The message must be clear, compelling and congruent or the public will not respond.

Evidence from every reliable source reveals that eight out of 10 Americans will experience back pain at some point. It's the second most common complaint relative to visits to a practitioner. The annual cost for standard medical treatment (which has not been proven effective, yet people still go) is in excess of $25 billion annually. Cost estimates of loss of worker productivity due to back pain add another $25 billion to the actual cost. Much of this productivity cost is due to unnecessary surgery, ineffective treatment, poor outcomes and simply a lack of understanding of spinal biomechanics.

Considering the huge impact of the biopsychosocial concepts in back pain and the strong influence of culture, placebo, belief and effectiveness of low-tech, high-touch interventions, the opportunity for chiropractic care is huge. The window of opportunity is limited and those seeking to replace chiropractic in the minds of the public are continuing to implement their plan.

So, what does this all mean for chiropractic? For years, the chiropractic community has lost its focus, and we have been fighting a battle of diminishing market share, eroding compensation and lack of cultural authority as a profession. Chiropractic has an opportunity to clearly enter into this now-public debate with the sound knowledge that today's consumers are going to have to pay a larger share of out-of-pocket dollars for their care. Whether that needed care is for conditions resulting from bad bacteria or bad backs; for old-type medications or newfound meditation; for surgery to remove something or a change in lifestyle to improve something; today's consumers clearly have a stake in the game.

This is the beginning of the paradigm shift from smoking to nonsmoking, from overmedication to a healthy lifestyle, and from undergoing surgeries that do not work to a paradigm shift demanding spinal manipulation that is effective at best, or at the very least creates minimal side effects.

I submit that the time is right to identify what consumers already want from doctors of chiropractic, rather than trying to "sell" them on something else - "wellness," anti-drugs or more esoteric coffee enemas and crystals. We need to accept from the incredible percentage of those who use drugs that consumers are not denouncing drugs; they simply want better alternatives, some relief from their pain and increased quality of life.

For NMS problems at least, the evidence is strong and patient satisfaction is high, making chiropractic services an excellent choice. I submit that our "new" message ought to be nothing more "snazzy" than that. Consider, for example, that on the popular television show "Dancing with the Stars," Emmett Smith hurt his low back. His chiropractor did a magnificent job of delivering chiropractic services to this famous patient in a most professional way. The bottom line is that Smith went back and danced through his next routine like he used to dance through defensive lines. Remember, millions saw chiropractic = back.

I recently saw a rerun of the show "Whose Line Is It Anyway," Drew Cary selected a word from the audience. You guessed it: "chiropractor." The incredible improv group did a very funny, spontaneous routine about chiropractic. You guessed it again - they talked about adjustment, lumbar spine, neck, back, and all of the focus was on the back. Again, chiropractic = back.

This is not something one can argue with; it isn't a matter of philosophy, interpretation or politics. It's a reality that wherever and whenever chiropractic is mentioned, discussed or publicized, the focus is on pain, back, neck, headache and spine.

I submit that the mindset of the profession and the mindset of the consumer are at odds. Chiropractic has a long way to go to become the dominant profession in health care. I submit that our interim goal should be to become the dominant health care profession in the areas of pain and NMS. The public already has preconceived bias toward chiropractic in an NMS model. We need to take full advantage of our already superior position of being the most conservative, safest and perhaps the most therapeutically effective approach to neuromusculoskeletal conditions.

We should learn from the drug catastrophe, the back pain surgery debacle and the findings of iatro-genic-caused deaths in the U.S. Maybe we can appreciate the fact that the World Health Organization recently published international guidelines on manipulation which are being used as the basis for chiropractic legislation around the world. Maybe we can recognize that despite the current shrinking patient population base, the chiropractic profession has an opportunity to emerge as the dominant profession and as the owners of NMS and spinal manipulation. Maybe the profession finally will come to the realization that we have enough evidence to claim ownership of this conservative approach to back pain.

The question is this: Will we continue to divide this profession and continue our thinking about dividing chiropractic into smaller and smaller niches within chiropractic, with no dominant segment providing enough of a base to survive? The future of the profession hangs in this delicate balance between internal perception and external reality. It's time for chiropractic to have a reality check.

There is nothing in this article to suggest that chiropractic has no value in many health care issues. What we know as clinicians and what we can prove with scientific evidence are vastly different. I'm certainly not advocating abandoning our attempts to encourage a chiropractic "way of life" philosophy; or simply giving up on discouraging the routine gorging on OTC meds and prescription drugs, or suggesting chiropractors have no place in nutrition, rehabilitation or pediatrics. Nor am I advocating that chiropractors become merely back-pain manipulation drones. All I'm suggesting is that while we pursue those lofty goals, we finally can formulate a profession-wide focus that can "create a model where demand for chiropractic exceeds the supply of practitioners." I would like to have that challenge facing our profession, wouldn't you?

Under this proposed common rallying-cry, nothing changes for the individual practitioner; patients come to the doctor of chiropractic with a clear focus on NMS or back-related issues/pain. Upon entering the office of the practitioner, the doctor will then, "one patient at a time," educate that patient according to the individual patient's needs and the individual chiropractor's interest. The confusion today, however, lies in the fact that we continue to ignore what the PR professionals are telling us, what the media clearly has shown us, what the public has identified as its view and what the public ultimately believes. If we do not have a common message, one that clearly takes advantage of the already preconceived view of what the public will believe, we simply are waiting for the inevitable.

With so many organized groups seeking to identify with the spine, manipulation and NMS, chiropractic will lose its current competitive edge, and once lost, it will be impossible to regain. We have an opportunity, we have some excellent evidence to support our position, and we clearly have an excellent opportunity to brand chiropractic, which is congruent with the public's already existing view, and this is a formula for success. Perhaps the brand should be Chiropractic: the safe, drugless procedure!

Think about your previous 50 patients - for what condition did they initially seek your services? What did you do in your patient education process to provide the value-added understanding, which will be mandatory as we move toward a health savings account (HSA) model in which patients will be responsible for the initial payment out of their pocket? Perceived value must be evident or patients will seek those services from someone else. That someone (whoever that practitioner might be) will have been identified by the consumer long before they seek the service. Will chiropractic be on the radar screen or not?

It really boils down to a question of branding. Has chiropractic become generic?

Click here for previous articles by Louis Sportelli, DC.

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