FTC Drops Chiropractic Investigation
Stephen Barrett, M.D.
The FTC appears to have abandoned its effort to limit claims made by Koren Publications, a Philadelphia-based firm that sells subluxation-based pamphlets and other practice-building aids. The FTC itself has made no public statement, but fundraising appeals from company president Tedd Koren, D.C., and articles in chiropractic publications describe a six-year investigation that ended in June 2001 [1-3].
According to Koren, his case has led to formation of the Foundation for Health Choice, which will focus on health choice and privacy, "beginning with alerting the public to the significant dangers that accompany routine vaccination and what to do about them."  Its first priority will be defending parents and practitioners who resist mandatory vaccination.
Tedd Koren is a 1977 graduate of Sherman College of Chiropractic, the "straightest" of the chiropractic colleges. His Web site states that he was valedictorian of his class and editor of the student newspaper. His company's brochures suggest that spinal manipulative care can help nearly the entire gamut of health problems. His publications have included more 60 pamphlets, the titles of which include: "Allergies," "Are You Popping Pills?" "Asthma & Emphysema," " Blood Pressure," "Ear Infections," "Healthier Children with Chiropractic," "Infants & Babies," "Strengthen Your Immune System," and "Why Should I Return If I am Feeling Fine." His "Healthier Children" brochure lists fever, croup, sore throat, bronchitis, bedwetting, eye problems, frequent colds, and 25 other conditions for which "spinal checkups are vital."  A 1998 flyer for Koren's 12-hour seminar on "The Natural Superiority of Chiropractic" stated that a total of 24 million of Koren's brochures had been distributed worldwide. Koren also markets audiotapes and a dozen books that advise against vaccination.
A report in Dynamic Chiropractic (a chiropractic newspaper) stated that (a) in January 1995, an FTC attorney sent Koren a letter expressing concern about 21 statements or "representations" made in several of his brochures; (b) In 1997, Koren signed an agreement to modify some of his brochures; (c) the Federal Trade Commission rejected the agreement; and (d) the original FTC attorney retired and was replaced by another attorney who proposed a broader agreement that would prohibit Koren from making any unsubstantiated claim that chiropractic:
- improves human immunocompetence
- reduces the incidence in children of ear infection, allergies, or tonsillitis
- administered to children is effective in the treatment or amelioration of asthma, anxiety, low-mental stamina, inability to concentrate, hyperactivity, discipline problems, low grades, or low IQ
- is comparable or superior in effectiveness to vaccinations as a means of preventing common childhood diseases, including measles, mumps, German measles, and chicken pox
- administered to children increases their resistance to common childhood diseases, including measles, mumps, German measles, and chicken pox .
The Dynamic Chiropractic article stated that the proposed agreement would also have prohibited any unsubstantiated representation "about the health benefits, performance, or efficacy of chiropractic, or any substantially similar treatment."  An account in Reason Magazine stated that the FTC commissioners wanted to require Koren to send every chiropractor who had ever bought one of his pamphlets a copy of the consent order and a letter saying, "The FTC has advised that if you disseminate advertising or promotional materials containing [false claims], you could be subject to an enforcement action." 
Koren's Appeals for Help
In 1998, Tedd Koren began appealing for help through e-mail messages, advertisements, and generating news articles in chiropractic publications. Koren portrayed the alleged FTC action as a threat to the entire chiropractic profession. One of his ads, for example, stated:
A great hammer is about to fall on a small profession—OURS! I am only the first D.C. to be attacked in this battle. As you know I have a publishing company—I'm mostly known for producing patient education pamphlets, telling the chiropractic story just as I learned it in chiropractic school . . . .
Four years ago, the Federal Trade Commission came after me and their proposed standards will affect the entire profession. . . .
If we lose, we face the gravest threat to chiropractic ever. .
In a 1998 catalog, Koren stated:
The FTC claims that chiropractors can only tell patients that chiropractic care can be beneficial for low back pain. Nothing else, not subluxations, wellness, headaches, sciatica, allergies, children's health, ear infections, whiplash, etc. Although Koren Publications' literature states that chiropractic is not the treatment of diseases but the correction of vertebral subluxations, the FTC doesn't like the "impression" we're giving the public and patients. We've offered to write disclaimers on each of our brochures. The FTC says that disclaimers are no good enough .
In a 1998 letter, Koren asserted:
All I've done in my writings is put in a reader-friendly fashion, with references, what chiropractors have observed, schools have taught and patients have noticed for over 100 years. My brochures are successful because they pretty much tell the chiropractic story the way chiropractors have traditionally told it to their patients, friends, and relatives since the days of D.D. and B.J. Palmer
Now comes the FTC, which said, "You can only tell about chiropractic if it agrees with our standards of what is scientific research . . . . If you do mention anything else, you'll be destroyed. ($10,000 per day per brochure or ad fines are, in my opinion akin to destruction.)." 
In a December 30, 1998, fundraising message distributed by e-mail, Koren attributed the FTC's action to "a faction in the FTC Known chiropractic haters" who "know if they can take Koren materials down, with its high scientific and literary standards, everyone else will be a pushover." This message also stated that Koren's legal fees were $5,000 per week. Koren's defense was headed by attorneys James Turner and Charles D. Brown of the National Institute for Science Law, and Public Policy.
Terry A. Rondberg, D.C., president of the World Chiropractic Alliance, considered the FTC's alleged position "a real threat to all D.C.s who wish to spread the chiropractic message."  In October 1998, he filed a lawsuit intended to stop the FTC action against Koren and other like-minded providers. Asserting that Koren's publications (and therefore his own) should be protected by the Constitutional right to free speech, the suit papers stated that a proposed consent agreement would basically prohibit Koren from making any public claims about the benefits of chiropractic unless the claims are supported by scientific studies which the FTC believes to be authoritative or valid. On November 16, 1999, a federal judge granted an FTC motion to dismiss Rondberg's suit.
Not all chiropractors regard the FTC investigation as unwarranted. John Triano, D.C., Ph.D., one of chiropractic's most respected researchers, described certain of Koren's claims as "afflicted by absence of scientific merit." In the 1998 Dynamic Chiropractic article he said, "Perhaps those who are calling for donations to Dr. Koren's legal defense would be better served to invest in donations to chiropractic research so that we may produce effective evidence for what we do." 
I agree with Dr. Triano. I also believe that a consent agreement as broad as the one described above would have had greater significance than any other health-related settlement in the FTC's history.
When criticized, chiropractors typically invent "persecutors" as part of their technique to rally their troops. Dynamic Chiropractic has stated that "all indications are that the case was generated by the National Council Against Health Fraud"—and me . However, I haven't the slightest idea how or why the agency began its investigation. I was not involved; and, because the FTC does not discuss cases under investigation, the only information I have comes from the chiropractic sources cited in this article. I suspect that the case was dropped because the FTC concluded that the brochures were "patient-education" materials rather than advertising and thus were immune to federal regulation. Koren has notified me that my "conjecture" was incorrect , but he refused three requests from me to state what he believes is correct.
In 2009, the British Advertising Standards Authority (ASA) upheld a complaint against the Koren Publications brochure called "Infants & Babies." The brochure stated:
There seems to be no limit to the conditions which can respond to chiropractic care: colic, difficult breast-feeding, Erbs palsy (an arm is limp and undeveloped), torticollis (twisted neck), unbalanced face and skull development, foot inversion, nervousness, ear, nose and throat infections, allergies and sleep disorders, and projectile vomiting. . . .
Babies are very top-heavy. Mild to moderate shaking of a child can result in serious neurological damage since their neck muscles are undeveloped. This damage has been known to occur after playfully throwing the child up in the air and catching him/her. The damage caused is called Shaken Baby Syndrome. In addition to being shaken or thrown, being spanked can also cause spinal or neurological damage to a child. Any child who has been subjected to this rough behavior desperately needs a chiropractic checkup to prevent possible nerve damage.
The ASA stated that the brochure must not appear again in its current form .
- FTC questions Koren's claims. Is Koren Publications Just the Beginning? Dynamic Chiropractic, Sept 21, 1998, pp 1,17,42,49.
- FTC fight: The muzzling and gagging of chiropractic. Chiropractic Wellness: The Practice Building Journal from Koren Publications. Volume 1, 1998-1999, back cover. Distributed October 1998.
- Feds drop Dr. Koren's case: First amendment rights of health care professionals were at stake. Dynamic Chiropractic, Aug 2001.
- Healthier children with chiropractic. Pamphlet. Philadelphia, Koren Publications, 1995.
- Doherty B. Masters of manipulation. Reason, March 1998.
- Koren T. What I've learned fighting the FTC could save chiropractic—Maybe. Ad in Today's Chiropractic, Nov/Dec 1998, page 21.
- Koren T. Which standards are best? Today's Chiropractic 27(6):14-16, 1998.
- Rondberg T. WARNING! You may be in violation of FTC regulations. Undated flyer distributed in November 1998.
- Rondberg vs. Federal Trade Commission, US District Court, District of Arizona, Case No 2:98cv-01890, filed Oct 28, 1998, dismissed Nov 16, 1999.
- Koren T. E-mail message to Dr Stephen Barrett, September 13, 2001.
- ASA Adjudication on Koren Publications, Oct 21, 2009.
This article was revised on January 17, 2010.