February 2007

What do you claim to 'cure'?

by Timothy J. Feuling

I know that adjustments to correct vertebral subluxations "work" because I've received chiropractic adjustments for years and they've kept me healthy and addressed a number of specific health problems.

Being a doctor of chiropractic, I know you must share this view and it's tempting to fill your ads and newsletters with stories of the miracles you've seen in your office. There's nothing wrong with educating the public about the positive effects of chiropractic. In fact, you need to do this so more and more people can receive its benefits.

But there's a fine line you can't cross. If you do, your state board will come crashing down on you and you could face hefty fines, a suspension, or even a revocation of your license. The process alone can be costly since board complaints can cost you as much, or more, than a malpractice lawsuit.

Advertising is one of the top causes for board complaints and investigations and can result in the most severe punishments.

The Texas Board of Chiropractic Examiners is typical. Over a three year period, advertising was the third most common type of complaint, topped only by fee complaints and the vague "unprofessional conduct" category.

Recently, the problem with chiropractic advertising once again came into the spotlight when chiropractic ads touting the benefits of the DRX‑9000 spinal decompression device were disputed. Apparently, the claims made by the company, and repeated by doctors using the device, were unfounded and overstated. Yet, though the claims originated with the manufacturer, two California DCs were fined $25,000 for using the claims in their ads.

Other cases have involved doctors claiming that chiropractic can "successfully treat" specific diseases or health conditions such as diabetes, hypertension, otitis media, etc.

To be perfectly honest, many of these complaints were actually attempts to harass subluxation‑centered chiropractors who were simply informing the public about the negative impact of vertebral subluxations on the human body and the potential benefits of chiropractic. These DCs often went out of their way to emphasize that chiropractic did not "treat" or "cure" anything (other than the subluxation).

However, other ads actually do cross the line by making unsubstantiated claims about the doctor's ability to treat diseases. Although the profession is in the process of compiling hardcore scientific evidence, it does not yet have the kind of convincing proof needed to justify advertised health claims.

A technique developer, for instance, may tell students that the technique has a 90% success rate in averting back surgery. But if the "proof" consists solely of that doctor's own clinical experience, it will not stand up in court or before a board.

In case you think chiropractic advertising is being unjustly targeted, keep in mind that medical advertising was outlawed because of ridiculous claims made by early medical doctors and "patent medicine" vendors. If the pharmaceutical industry wasn't so rich and politically powerful, drug ads might be likewise banned for their outlandish claims.

So far, chiropractors are allowed to advertise ‑‑ but the laws regulating those ads can be very complex, vague, confusing and even arbitrary. The laws are often open to interpretation by board members who may have their own professional agendas or biases, as well as personal or professional animosities. To compound matters, laws differ greatly from state to state.

Some laws are highly general. For instance, the Alabama statutes states: "Any chiropractor who disseminates or causes to be disseminated or allows to be disseminated any advertising which is in any way false, misleading, or which has the capacity or tendency to deceive, or mislead the recipient in any manner, shall be deemed to be in violation..."

Others are very specific, such as the Kentucky law that mandates: "An advertisement must include the business name and address, chiropractor's name, telephone number, expiration date if any, and suitable words or letters designating the particular doctor degree held by the chiropractor. 'D.C.' shall designate a doctor of chiropractic. Any deviation from this requirement must first be approved by the board."

Most ads prohibit any language that can be construed as making "unsubstantiated claims" about chiropractic care. The New York Board noted that it has seen "an increase in the use of advertisements that employ false or misleading statements that may deceive or defraud the public. These advertisements typically make unverifiable claims or cite studies from unreliable sources."

Here's another vaguely worded prohibition: "Any advertisement or advertising shall be deemed by the Board to be false, deceptive, or misleading and in violation, if the Board determines that the advertising ... has the capacity or tendency to create false or unjustified expectations of beneficial treatment or successful cures."

That means the ad doesn't have to actually state that you can cure or successfully treat people, but merely suggest or raise that expectation!

Another important point to keep in mind is that advertising laws don't only apply to paid newspaper, magazine or telephone directory ads. They apply to any educational material aimed at current or prospective patients.

To minimize the chances of violating your board's advertising rules, be sure to obtain a copy of your state's current advertising regulations and read them thoroughly. Then carefully review all your ads and other promotional and educational material to make sure nothing can even remotely be interpreted as breaking any of the rules.

Also, take a few minutes to review your malpractice insurance policy and make sure it covers defense of board complaints. If a complaint is filed against you, you'll need to be represented by counsel. Without proper insurance, this can be extremely expensive.

Don't shy away from educating your patients and the public, but don't let your enthusiasm for chiropractic, your adjusting techniques or office technology tempt you into crossing that line into dangerous territory.

(Timothy J. Feuling is president of Chiropractic Benefit Services (CBS) and a member of the Board of Directors of the World Chiropractic Alliance. He assists doctors in maximizing their practices through the proper choice of insurance and related services. Mr. Feuling is also available for speaking engagements at state conventions and other chiropractic events. Doctors may contact him with questions, comments, and requests for insurance quotes at 2950 N. Dobson Rd. Ste. 1, Chandler, AZ 85224, by phone at 800‑883‑0412 or by e‑mail: feuling@cbsmalpractice.com).