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Dynamic Chiropractic – November 4, 2009, Vol. 27, Issue 23

Ethical Purchasing and Selling by DCs

By Stephen M. Perle, DC, MS and Rand Baird, DC, MPH, FICA, FICC

"Ethical purchasing put simply is buying things that are made ethically by companies that act ethically. Ethical can be a subjective term both for companies and consumers, but in its truest sense means without harm to or exploitation of humans, animals or the environment."1

We would like to suggest another way of looking at ethical purchasing - from a chiropractic professional viewpoint. Chiropractic ethical purchasing occurs when chiropractors, chiropractic colleges and organizations make purchasing decisions based upon both the ethical purchasing model (above) and by purchasing goods and services only from vendors that support the chiropractic profession. "Vendors that support the chiropractic profession" means that the vendor has a corporate membership or sponsorship in chiropractic associations (international, national and regional/state/provincial/local), makes regular donations or other financial assistance to chiropractic colleges, participates in chiropractic causes (e.g., the Foundation for Chiropractic Progress) and/or exhibits regularly at chiropractic events. 

This includes the simple concept that, other things being equal (quality of the products, level of service, fair price, prompt delivery, convenience factors, what is best for the patient, ethical purchasing concerns, etc.), the chiropractic purchaser should give preference to the vendors who support the profession, not necessarily the individual chiropractor.

This means there are no kickbacks, improper rebates, or referral fees. Making one's purchasing decisions based upon what the doctor of chiropractic gets from the company make us no better than those in the medical profession who prescribe drugs based upon the free samples, pens, dinners and other perks they get from the drug companies. There has been significant discussion in journals, newspapers and on the Web about problems with drug company inducements.

Some years ago I [Dr. Baird] coordinated a group of chiropractors seeking to obtain hospital admitting privileges. A few months after gaining the sought-after medical staff appointments and concomitant hospital privileges, I was called to a confidential conference by the hospital administrator, who had been a strong chiropractic advocate. He regretfully informed me that one of the DCs was well-known to use a private radiology group for his MRIs and CT studies. This violated the administrator's expectation that DCs on staff would patronize the hospital's own radiology department - after all, we were now all members of the same fraternity, and certainly should have been patronizing the only hospital in the area that was chiropractic-friendly and had granted us privileges.

When I investigated, I found that both the private facility and the hospital had comparable equipment and well-qualified radiologists and technicians, but that the marketing manager of the private group was giving the DCs a $200 "rebate" for each procedure performed! Not only did this renege on the DC's commitment to the hospital and violate medical ethics, and was even potentially illegal, but it also was not an ethical purchasing behavior by the chiropractor. The hospital had shown its support for the chiropractic profession; we should have done the same and showed support to the hospital.

Other things being equal (or close enough to equal for valid comparisons), ethical purchasing by chiropractors means selecting vendors at least in part by investigating and determining if they support the profession. Not to do this, we believe, is a long-term self-defeating behavior that affects the future of the profession.

The World Federation of Chiropractic (WFC), the umbrella organization composed of the national chiropractic associations of some 92 countries, has numerous corporate associate members (visit and click on "Associate Members"), including vendors who sell chiropractic tables and equipment, X-ray machines, nutritional supplements, topical pain gels and creams, supplies, foot orthotics, mattresses, management software, orthopedic supports, technique seminars, media advertising space, management and marketing consulting, etc. - basically anything and everything a chiropractor would need to operate a practice. These companies all support the profession; so why, pray tell, would a chiropractor even consider purchasing from a company that does not support the profession?

For example, when a chiropractor is considering buying an expensive item such as a $40,000 cold laser instrument and system, would it not be more ethical and make more sense to buy from a company that has a reputation for generosity toward the profession? Should the DC buy from the company that is a supporter of the WFC, national or state/provincial/local chiropractic organizations, etc., or from some company that never gives anything back to the profession? To us, this is a classic "no-brainer."

And consider this: If more and more chiropractors let it be known that they only buy items, large or small, from companies that support the profession, would this not be a subtle (or not so subtle) inducement that would lead to even more vendors supporting our profession? Larger companies should be expected to support us more, and smaller companies to a lesser degree, but all should be expected to contribute a fair share.

Chiropractors should patronize only those vendors that support our profession year after year. Many include "corporate sponsorships" and "community goodwill" as regular parts of their annual budgets. On the other hand, surprisingly, some other companies that sell quality products actually have adopted a policy of "no memberships, no corporate sponsorships!"

Now let's talk about ethical selling for a minute. Some of the items chiropractors purchase from vendors are then sold to patients. Decisions about what to stock to sell to a patient must be made based upon the patient's best interest. Could the patient get the same or comparable product from an outside vendor at a better price? If so, why carry the product? Patient convenience or doctor's profit or perks? ]

Here are a few examples. I [Dr. Perle] had a patient once who was an insurance consultant. Her insurance company would not pay for a particular cervical pillow, as they said it was too expensive. She called me up and said she had seen the same pillow at a local department store for twice what I charged. The insurer paid the bill. Eventually, there was a vitamin store that sold "professional" label supplements for less than I could due to their volume. It was time to get out of the vitamin selling business. The point here is that, all things being equal, if you cannot provide patients with products at a price they can get the identical products for somewhere else, you should not try to sell them the products. That is ethical selling behavior personified.

We believe that the chiropractic colleges should be teaching ethical purchasing and selling in their business management, ethics and jurisprudence classes on campus, and suggesting this to students during their clinical clerkships. We believe every chiropractor should consider the degree to which various companies support and give back to the profession when making their purchasing decisions.


  1. "Ethics in Business and Its Relevance to Consumer Behavior." Posted on on Aug. 5, 2009.

Click here for previous articles by Stephen M. Perle, DC, MS.

Click here for previous articles by Rand Baird, DC, MPH, FICA, FICC.

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