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Patient Media's Drug Ad Post-It Notes

Stephen Barrett, M.D.

Patient Media, of Palmer Lake, Colorado, markets many ideas and materials that chiropractors can use to educate their patients. It is run by William D. Esteb, a self-described "chiropractic advocate" who began his current career in 1981 by writing patient education videos for a practice-building firm called Renaissance International [1]. His materials are intended to help chiropractors as they "persevere in the detection, elimination, and prevention of the Vertebral Subluxation Complex," a term chiropractors use to describe their metaphysical basis [2]. Esteb's many books, seminars, tapes, brochures, posters and other tidbits use metaphors, glittering generalities, and dire warnings to suggest that everyone needs and can benefit from periodic spinal care from birth onward. His "Advanced Patientology" seminars teach what he calls "principles of retention and referrals." [3]

One way that Esteb promotes chiropractic is by criticizing the use of medically prescribed drugs. His Drug Ad Post It Notes, which cost $20 for 10 messages in pads of 50 each, are intended for use win reception room magazines. Five are intended to target the body of drug ads and five are intended to target the small-print technical information. His catalog states:

The reception room magazines that patients prefer are chock full of pharmaceutical advertising. Perfect! Use their ads (and their full-page disclosures) as the forum to communicate the advantage of chiropractic care.

Instead of shunning magazines containing drug ads, place one of our five 4" x 3" 3M Post-it" Notes on it. Each is a special message that gets patients thinking. Secure it to the ad with some tape and sit back and enjoy the patient reactions!

Don't overlook the full-page disclaimers! We have five other 3M Post-it" Notes for the page listing contraindications and side effects of the advertised drug. Each one is guaranteed to make patients squirm and see risky drug therapy for what it really is [3].

Here are my comments about the messages.

Post-It Message Why It is Misleading
Here's a typical example of the millions spent each month by the drug industry. Chiropractic doesn't use this approach. Instead, we depend upon delighted patients referring others. Thanks for telling your friends and family about our office! This implies that chiropractic care is so valuable that it does not have to advertise. However, many chiropractors do advertise. Their most visible ads are in the Yellow Pages of telephone directories, but radio, television, and newspaper ads are not uncommon. The message is additionally misleading because it suggests that chiropractic care is generally superior to medical care for the problems for which the drug is used. However, most types of problems where drugs are prescribed are not treatable by chiropractic methods.
You don't have a drug shortage! The symptom that a drug treats like this is a signal from the body that something isn't working right. What controls the way your body works? Your nervous system -- the focus of your chiropractic care. This is an unwarranted general attack on the use of drugs. Chiropractors who use this message would like you to believe that drugs merely suppress symptoms but chiropractors attack their cause. However, the nervous system does not "control the way the body works," and most disorders of the nervous system are not amenable to chiropractic care. The message also falsely implies that chiropractic's scope is unlimited.
This is the real drug problem! It springs from the misguided notion that being healthy is about not having symptoms. But consider those with undetected cancer, tooth decay, or high blood pressure. They may feel fine, but they are not healthy. This message is used to reinforce chiropractic claims that all people from birth onward should have their spine checked and adjusted frequently. It is correct that the early stages of cancer, tooth decay, and high blood pressure produce no symptoms and, in many cases, early detection leads to a better outcome. That's why medical authorities recommend periodic checkups whose frequency has been determined through scientific study. In contrast, no study has ever demonstrated that periodic spinal checkups lead to better health outcomes.
Drugs change your blood chemistry in a crude attempt to change the way your body works. Instead, chiropractic adjustments reduce interferences to the controlling impulses of your nervous system to help restore proper function. The uses of most drugs are based on detailed knowledge of how the body works in health and disease. Chiropractic adjustments do not "reduce interferences to the controlling impulses of your nervous system to help restore proper function." At best, they merely stretch tight muscles and/or increase mobility of spinal joints.
Your body is the perfect drugstore. Directed by your nervous system, it supplies the correct dosage of antibodies, enzymes, stomach acid and other compounds precisely when needed. If not, your nervous system may not be working right. We can help. The nervous system does not control the production of antibodies or enzymes and only partially influences the amount of stomach acid produced. Chiropractic spinal manipulation does not influence any of these functions. The statement also falsely implies that spinal adjustments can influence the course of virtually all diseases and does this better than any medication. This claim is preposterous.
Your body correctly perceives this foreign substance as a threat. Removing it from your system can tax the liver or cause kidney failure. This falsely implies that the use of drugs is fundamentally irrational and dangerous. The message is also inaccurate because drug detoxification and clearance rarely burden the liver or kidneys.
Adverse effects of prescription drugs are the 4th leading cause of death in the United States. This statement has no factual basis and is based on faulty extrapolation of data from a published report about medical errors.
This is why prescription drugs require a prescription. They can be dangerous! This falsely suggests that prescription drugs are generally dangerous. To gain FDA approval, manufacturers must persuade the agency that the expected benefits are significantly greater than the probable risks.
One of the side effects of many drugs is the very problem they supposedly treat. This statement is ridiculous. A tiny percentage of drugs can produce symptoms (side effects) similar to side effects of conditions that they are used to treat. However, the number of drugs that cause a disease they are used to treat is close to zero. Moreover, the fact that drugs can have side effects does not make them useless. In most cases the probability of helping is much greater than the probability of harming, and most side effects are minor and resolve when the drug is stopped.
Why the small print? The small-print information is not written for consumers and includes adverse effects that are very rare as well as those that are common. Physicians are much better equipped than consumers to judge what it means, but the FDA requires it whenever a prescription drug is advertised by name.

Messages of this type are consistent with "straight" chiropractic philosophy, which alleges that spinal "misalignments ("subluxations") are the primary or underlying cause of disease and that "adjusting" the spine prevents disease and promotes healing. However, other chiropractors may like the fact that the messages disparage medical treatment.

Chiropractic schools teach their students almost nothing about how drugs work and when it is appropriate to use them. Furthermore, the vast majority of health problems are outside the scope of chiropractic care. Situations do exist where drugs are prescribed inappropriately or unnecessarily. However, the willingness of chiropractors to advise patients about drugs strikes me as presumptuous and potentially dangerous.

The Bottom Line

Chiropractors who deploy anti-drug messages typically embrace concepts of health and disease that do not correspond with current scientific knowledge. They also tend to offer care that is neither rational nor necessary. If you encounter anti-drug messages in a chiropractic office, head for the exit and don't come back.

References

  1. Esteb WB. Prologue to A Patient's Point of View: Observations of a Chiropractic Advocate. Colorado Springs, CO: Orion Associates, 1992, p 15.
  2. Barrett S. Chiropractic's elusive "subluxation." Chirobase Web site, Revised Dec 25, 2001.
  3. Patient Media 2000 catalog.

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This article was posted on August 21, 2002.