Modern armies have long trained to fight against other similarly equipped modern armies. These combatants have assumed that conflicts would involve firm objectives, a defined battlefield and a specific definition of victory.
However, we have learned all too well that resistance forces with no chance at all in a stand-up fight have resorted to what was coined in the early 1990s as asymmetrical warfare to achieve their goals. Asymmetrical warfare refers to the use of a small and lightly equipped force attacking points of weakness in a stronger opponent.
The goal of asymmetrical warfare is not the outright destruction of an enemy. The goal is to humiliate the opposition, to cast doubt on its supporters and, most importantly, to change public opinion. Our profession has been suffering from asymmetrical cyber attacks by a small group of activists seeking to bring about public doubt and to change public opinion - and our losses have been substantial. Go to your favorite search engine and key in the word chiropractic. Check out the results on the first page. The ACA site is usually on top, but on that crucial first page where most searchers linger are two to three extremely critical Web sites maintained by only a few individuals. If you were a member of the public, a student or a medical doctor interested in finding out about chiropractic, you would be exposed to the most opinionated, biased and prejudicial sites you can imagine while searching the word chiropractic.
If you visit these condescending sites, you will find they are sustained by only one or two strongly opinionated cynics. These sites are based mainly on opinion, apologetics, cherry-picking of data, testimonials and hyperbole. Ironically, they are employing the same strategies they accuse chiropractors of using. It would be comical - if not for the damage done to patients who could have been helped by chiropractic.
How did these sites get to the top rung of the search engine's list? One reason is the repeated use of the keywords, "blah, blah, chiropractic, blah, blah, chiropractor, blah, blah, blah chiropractic." The more a site uses the key words, the higher in the listings the site will be placed. Since these sites mainly use chiropractic as the subject of everything they say, it is easy for them to rank high in the list of search results. Another way to get ranked high is to have other sites or blogs link to your site. These derogatory sites must have several sites linking to their site. Finally, if a lot of people enter a site, it appears more relevant to the search engine and nudges it higher in the search engine's ratings. Ironically, when chiropractors enter adversarial sites to see what our critics say, they boost that site's standing higher within the major search engines.
Studies have shown that a major trend in Western society is to turn to the Internet to find out information about health issues. One study, the Pew Internet & American Life Project, revealed that 113 million Americans, representing 80 percent of Internet users, search the Internet for health care information. When the public searches the Internet for the phrase "back pain," the search will render results predominately medical or orthopedic in orientation, not chiropractic. If by chance they do search specifically for chiropractic, we are not assured their efforts will result in finding sites that present chiropractic in a positive light.
Most of our organized attempts at public outreach have been designed to introduce the public to chiropractic through passive exposure - ads in magazines, newspapers or broadcast media. This passive exposure hopefully will provoke people to seek to know more about chiropractic. Unfortunately, even a great publicity campaign will fail if we do not plug the holes in the search engine bucket.
Holes in the Bucket
It does not matter how many people are enticed to learn more about chiropractic through our outreach efforts if they are exposed to the extremist views of a group of cynics when they search the Internet. To have a comprehensive outreach program that covers all aspects of modern media, the chiropractic profession needs to dominate the first 20 sites that appear when the word chiropractic is entered in a search engine. Chiropractic also should maintain high-quality evidence-based sites that specialize in back pain, neck pain, public health, wellness and the risks of CVA following manipulation.
Maintaining a Conscientious Web Site
Type the word subluxation into your favorite search engine and examine the sites that pop up. Not only will you see some (unintentional) comically entertaining sites, the usual anti-chiropractic sites and some very unscientific schematics depicting vertebral subluxations, you also will see much of the fodder our detractors use in their sites. At least one cynical site links to chiropractic sites maintained by chiropractic outliers. While every health care provider has the right to establish a Web site, every provider also has the responsibility to temper their Web site with an adherence to evidence and ethics. The use of hyperbole or inaccuracies is a violation of the public's trust and gives the entire profession a public-opinion black eye.
Pushing Back the Tide
How can chiropractors gain the upper hand in the cyberwar? By developing and supporting pro-chiropractic sites with links from our Web sites and blogs. Unfortunately, we do not have many sites that are germane to the general public, potential students or other health care professionals. Our main sites are oriented toward chiropractors, not toward outside information-seekers. The sites oriented toward patients are created by regional chiropractors who maintain their sites in an attempt to attract local patients specifically to them.
We need to create some non-commercial sites (sites that are not selling a technique, piece of equipment, association or school) that have high-quality graphics, photos and content. These sites should be professional and avoid hyperbole, testimonials and the like, but have useful information to those seeking more information about health concerns and chiropractic. These sites also would need to be weighted heavily with key phrases and words to boost them in the search engine ratings. I would even recommend we devote evidence-based sites to specifically address chiropractic's relationship to CVAs, and to our training. This would allow us, rather than those who loathe our profession or are in competition with us, to define these issues.
I would challenge the major players in chiropractic - every association (state or national) every college, every major vender, every publication - to each create and maintain one high-quality, non-commercial, chiropractic outward-oriented site. By distributing information, graphics and knowledge, we can create a network of sites that would allow chiropractors to define chiropractic, rather than being defined by a couple of cantankerous malcontents. As these sites mature, it would be nice to establish advisory boards to hold the Webmasters accountable for maintaining evidence-based content.
In addition to creating great comprehensive sites that would represent the profession at large, every chiropractor, chiropractic student, chiropractic academician, vender and association that maintains a Web site, blog, personal e-space or other Web-presence should link to at least 10 of these favorable sites. It will take time to create the sites I envision, so we need to start today and collaborate within the profession to share this knowledge. Publications will allow the non-commercial use of their content as long as you abide by their requirements, credit them for the work and link back to them. I also believe most chiropractors will allow the use of their articles, photos, art and other content as long as they are credited as the source of the article and link back to their site. That certainly is true about the content on my sites.
I had intended to include 10 high-quality sites geared for the lay public that would be appropriate to link to, but unfortunately, I could not find any sites that fully met my criteria. This underscores the need to purposely move forward with a plan to create quality sites designed to rank high in the search engine listings.
In addition to linking to high-quality patient-centered sites, you also may link to your alma mater (or other college that you support), as well as your state associations. The war for a favorable public opinion is being waged in the search engines of cyberspace. If we do not proactively seek to define chiropractic within the preferred medium of the day, our advisories will.
Author's note: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense or the U.S. Government.
Dr. William Morgan, is the president of Parker University. He previously served as the White House chiropractor (2007-2016), and as the chiropractor to the United States Congress and Supreme Court (2000-2016). He was credentialed at Bethesda Naval and Walter Reed military hospitals, and was team chiropractor for the U.S. Naval Academy football team.