April 2004

Spinning out of control

by Dr. Terry A. Rondberg

One of the most important assets any chiropractic organization has is its credibility. How can a group ask for support if doctors can't trust what it says?

That's the problem facing the American Chiropractic Association right now. In recent months, it has released a number of stories that have been proven to be totally inaccurate. This goes beyond the routine stretching of the truth by the ACA's well‑practiced spin doctors and into the realm of absolute fantasy. They are spinning out of control and more and more doctors are realizing it.

Take the Veterans Affairs fiasco, for instance. There are six doctors of chiropractic on the VA Chiropractic Advisory Committee (CAC).

One, Leona Fischer, D.C., is a member of the World Chiropractic Alliance International Board of Governors. One, Michael McLean, D.C., is the Legislative chairman for the International Chiropractors Association. Three ‑‑ including Cynthia Vaughn, D.C., Rick McMichael, D.C., and Reed C. Phillips ‑‑ have close ties with the ACA. The final chiropractor is Charles DuVall, D.C., president of the National Association of Chiropractic Medicine.

When the issue of direct access came up, these six doctors had an important decision to make. They could recommend to Sec. Principi that veterans be:

a) able to see a chiropractor directly, or

b) made to get a referral (known in VA terms as a "consultation") from a medical gatekeeper in order to see a chiropractor.

If you were on the committee, what would your recommendation have been?

The WCA and ICA members on the committee voted for direct access. The ACA and NACM members voted for referral.

It's hard to understand how the ACA can spin something that straightforward, but that's what they've been trying to do.

First, they tried to tell the profession that a consultation wasn't the same as a referral. In defending himself, Dr. McMichael actually stated: "The term 'by consultation with' strongly infers that the providers will engage in a 'conference' regarding the patient and how the patient will be best served...including chiropractic care. This further implies a congenial discussion regarding the patient, and working together for the best of patient care. ... The term 'referral' infers a one‑sided action on the part of the referring provider."

That may be true in the dictionary, but in the real life world of the VA health system, such nuances don't exist. The recommendation McMichael, Vaughn, Phillips and DuVall endorsed said ‑‑ and implied ‑‑ nothing about conferring with a chiropractor concerning the need for chiropractic. It stated: "Access to chiropractic care should be by consultation with the patient's primary care provider or another VA provider who is treating the patient for the condition(s) for which chiropractic care is indicated."

Since D.C.s are not primary care providers under the VA system, nothing in this recommendation suggests that the medical doctor or other provider has to consult with a chiropractor about care. Or, as Dr. McLean so succinctly put it, "If you can't see a D.C. without permission, it ain't direct access."

The recommendation put forward by Drs. Fisher and McLean stated:

"VHA facilities shall offer information on, and availability of, chiropractic services and offer all patients with neuromusculoskeletal complaints the option of direct access to chiropractic care."

This recommendation was included in the final report, with detailed rationale written by Drs. Fisher and McLean, as the "dissenting recommendation." What about this recommendation did the other committee members find so objectionable that they could not endorse it? Why did they feel it necessary to vote along with the medical doctors on the committee for a "consultation" process that could put barriers in the way of any veteran wanting to see a D.C.?

The bottom line is, did they vote for direct access? Yes or No. The answer is no, they did not. There's nothing they can do to spin their way out of that reality, no matter how hard they try.

At one point, the ACA even tried to distance themselves from McMichael, Vaughn and DuVall by stating that they weren't there representing the ACA. McMichael's lengthy apologia (posted at the ACA website) notes: "NO association had (or has) a vote on the CAC. Although individual members may belong to a particular association, the CAC members have been carefully instructed that their service on the CAC is as individuals."

How disingenuous can you get? Of course, technically speaking, none of the members represented their organizations. But is there anyone out there who really thinks the members weren't in contact with their organizations' leadership about their recommendations and didn't at least reflect the viewpoints of their respective groups? When it came to some of the positive recommendations in the report (and there were many!), the ACA was quick enough to claim credit. You can't have it both ways.

The activity at ACA's "Spin Central" doesn't end with the VA bill.

For instance, recently the ACA has gotten a lot of mileage out of the "fact" that they were named a "top lobbyist group."

The ACA website headline shouts: "ACA Ranked High Among Washington's Elite Lobbying Groups." The article goes on to claim: "The American Chiropractic Association (ACA) runs one of the most influential advocacy operations in Washington, DC, according to a just‑announced listing of the 25 most effective grassroots lobbying organizations for health care in the United States."

Sounds impressive, right? What they don't mention is that the "list" was compiled by a University of Chicago doctoral candidate named Michael T. Heaney who was published in the Op‑Ed (opinions) section of two newspapers.

Heaney has no "official" standing with either paper, and was not writing on behalf of the American Political Science Association (as was implied by the ACA release) or any political organization. He made his personal list after talking with 77 congressional staffers. In addition, Heaney told Chiropractic Economics that his ranking method "does not measure how much influence the organizations have." When you know the truth, the whole thing isn't that big of a deal, is it?

The ACA's tendency to skirt the truth (or even to avoid it completely) isn't a surprise to many people who have read their press releases with a critical eye.

In October 2003, former ICA President Bob Braile, D.C., exposed the dishonesty contained in an ACA press release about a research report published in the Annals of Internal Medicine. The actual research report concluded:

"There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain."

Yet, the ACA's press release on the research glowed with these deliberately inaccurate interpretations:

"A new study showing that spinal manipulation is just as effective as traditional medical care for treating back pain should come as welcome news to patients looking for safe, drug‑free alternatives to medical treatment..."

‑‑ and ‑‑

"The June 3 study in the Annals of Internal Medicine proves what the chiropractic profession has known for decades ‑‑ that spinal manipulation, or chiropractic adjustment, is an effective alternative to drugs and surgery for back pain."

"Talk about spin and credibility," Dr. Braile noted. "Look at the ACA press release on this study ... Then look at the actual abstract from the Annals of Internal Medicine. This is not even close. This goes way beyond spin and speaks to basic credibility. We all know the amazing benefits of chiropractic. But doing this hurts our professional credibility in the scientific community and in the general press and public."

The ACA has been steadily losing credibility, even among its supporters. That's probably one of the major reasons it's been losing members as well. And speaking of members, that's one more thing the ACA has been caught lying about.

According to the ACA Weekly Report dated January 6, 2003, by Gary Cuneo, the ACA had 18,000 members and an annual budget of $6.5 million. Since the ACA sells everything from posters to book holders, and receives revenue from web sponsors and endorsement contracts, it's safe to say that no more than $5 million is derived from membership fees.

Using the same formula the ACA used to estimate the WCA membership (total membership revenue divided by full membership fee), the ACA would actually have about 8,333 members ($5 million divided by $600). Since they offer an "enhanced" membership category, which costs $1,200, the total membership figure is probably even less than that.

Either they are once again distorting the facts, or they have lost 10,000 members in about a year. Perhaps they've lost that many members BECAUSE they distorted the facts once too often.

In the months to come, as the presidential election draws near, we're going to see political spin doctors hard at work. But Bush and Kerry might both end up looking like George "I cannot tell a lie" Washington when compared to the ACA's spin factory. My only hope is that doctors of chiropractic, like the American public, will see the lies for what they are and make the effort to search out (and be guided by) the truth.