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April 1, 2003

How-to lessons
Posted by Teresa at 06:09 PM *

This is journalist Ralph Lee Smith’s fascinating account of attending a 1969 seminar in “practice building” for chiropractors. It’s taught by a born salesman and storyteller, James W. Parker, who appears to have had one of those oversize Texas personalities. After making a fortune as a chiropractor and creating a chain of eighteen clinics, Parker wrote a textbook and turned his hand to running six three-day seminars a year in which he told his fellow chiropractors the real tricks of the trade.

“At these sessions,” he said, “I intend to teach you all the gimmicks, gadgets, and gizmos that can be used to get new patients. … Thinking, feeling, acting determine the amount of money you will take to the bank. … Remember, enthusiasm is the yeast that raises the dough.”

The afternoon and evening sessions were devoted to “Success Philosophy.” It turned out that, when it comes to love, the hippies have nothing on Jim Parker. In order to succeed, the Textbook says, the chiropractor must “LLL: Lather Love Lavishly!!” “When you meet a new patient,” Parker explained, “you can push a button. You can push the LLL button, the love button. It’s like a light bulb that you switch on. When you meet a new patient, LLL him in. When you do this, you disarm a patient who has developed sales resistance.” However, like the hippies, Parker finds some people more lovable than others. An unlovable type from the chiropractor’s point of view is a person with an acute illness. The course, says the Textbook, “is designed to make you a ‘D.C.’ — ‘Doctor of Chronics’ rather than a Doctor of Acutes.’ “You’ll make a lot more money,” Parker explained.

But what if the patient comes in with acute, rather than chronic, symptoms? The chiropractor’s task, Parker said, is to try to discover that the symptoms are “an acute flareup of a chronic condition,” and to convince the patient that this is so.
The patient has now been drawn into the chiropractor’s office for a “free initial consultation”—the purpose of which, as Parker’s textbook explicitly states, is to get the caller into the office so you can make a complete selling pitch in person:
Now come the most important steps. First, the “Yet Disease.” “If the patient has a pain in his left shoulder Dr. Parker said, “ask, “Has the pain started in your right shoulder yet?” “Use it when you must instill a sufficient amount of fear to get the patient to take chiropractic.” The next step is to “dig for chronicity.” The doctor puts an elaborate series of questions to the patient that suggest or imply that the condition is chronic. “How long has it been since you really felt good?” the doctor murmurs gently. (“I make $10,000 a year on that one, easy,” a chiropractor sitting next to me whispered in my ear.) With the verbal digging completed and chronicity unearthed, the chiropractor moves on to “Connect up affected parts (pain) with the area of treatment (spine)”that is, to tell the patient that his condition stems from spinal subluxations. Having done this, the chiropractor is then to “restate information (or acquire additional information) which may prove useful later on to explain limited results, or to excuse you from getting results expected.” As a final step he releases some more lather to “establish LLL principle in patient’s mind.” At this point says the Textbook, “most patients are ready to proceed.”
The patient has now been examined—and charged in cash for the examination. Turns out the consultation is free, but the examination isn’t. At this point the Textbook…
…adds some comments intended for the chiropractor’s eyes only. “You might suggest only as many adjustments as the patient can pay for,” it says. “…One adjustment for each year of age of the average chronic patient over twenty years of age is a rough thumbnail guide of what people will willingly accept and pay for.” However, the book observes, there is no reason for the chiropractor to he unduly modest in his expectations: “Chiropractors should keep in mind that many truck drivers, carpenters, electricians, steel workers, and radio repairmen earn more than $12,000 annually.”
Now that the patient’s in treatment, the “patient management” phase begins. The emphasis is on getting the patient to believe he’s getting better, and getting him to say so. Very important part, apparently, this business of getting the patient to explicitly say he’s getting better. Parker has suggestions for how to do it. He also has suggestions for how to pump the patient for the names of family members and friends who might be susceptible to the lure of chiropractic treatment. Summing up at the end, the journalist says:
Throughout the procedure the chiropractor tries to wean the patient away from established medical treatment—permanently, if possible. “A true chiropractic patient,” says the Textbook, ” is one whose convictions with regard to health have been diverted from the muddy road of medicine to the superhighway of chiropractic by a series of correlated mental concepts, positively implanted in proper order.”
The episode at the seminar is one chapter of an entire book, At Your Own Risk: The Case Against Chiropractic by Ralph Lee Smith, published by Pocket Books in 1969. It’s long out of print, so the author has put the whole thing up on the web. It’s got some interesting episodes. In Chapter 3, Smith presents himself as a patient at the National College of Chiropractic in Lombard, Illinois:
When I arrived for my appointment I was met by a young chiropractor—we’ll call him Dr. John May. At National College, I found, the clinic work is done by recently graduated students, who work at the clinic for fifteen to eighteen weeks before beginning their practice. … [T]heir work is supervised by chiropractors on the college faculty and on the staff of the clinic. For about a year, I said, I had been having dull, cramplike pains in my chest. I had them sometimes two or three times a day, sometimes only once a week. They tended to come when I had been exerting myself heavily, or when I was angry or under strong emotional stress. The pains, I continued, would cause me to breathe deeply. They lasted for periods of time ranging from a few seconds to a few minutes. When they came, I said, they would go away if I simply stopped what I was doing, if they came when I was angry, they would go away if I just took it easy, sat back, and relaxed. I added that these pains would sometimes go up from my chest into my left shoulder and arm.
That is, he’s claiming to have a set of symptoms so obvious that even television network execs can spot them.
Dr. May asked me no questions about my symptoms, and showed not the slightest sign of recognizing their possible significance. He took a brief medical history. As he finished it, Dr. Eugene V. Hoffmann, Jr., a chiropractor who is an assistant director of the clinic, came in. Dr. May told him that I had “dull chest pains, going up into his left shoulder and arm.” Dr. Hoffmann was apparently as impervious to the possible meaning of the symptoms as Dr. May. He asked me no questions.
You know how it comes out, right? Both Dr. May, the graduate student, and Dr. Hoffman, the assistant director and faculty member, conclude that what Smith needs is to have his spine adjusted.

I know this is going to sound weird, but I’m finding it sort of comforting to remember that blatantly irresponsible fraud wasn’t invented this decade.

Comments on How-to lessons:
#1 ::: Stefan Jones ::: (view all by) ::: April 01, 2003, 07:37 PM:

Hogwash, cons, quacks and charlatanry go way back, and the techniques and tropes of a century ago sound darn familiar to today's ears.

Take in Lewis's _Elmer Gantry_ some time.

* * *

The chiropractor I saw last week after my orthopedist told me to wait out my condition (bulging disk, pinched sciatic nerve) must be lazy, or honest.

I was weirded out enough by some of the stuff he said that I'm certainly not giving up on Real Medicine, but he *did* note some weak butt and thigh muscles (palpably flabby on the effected side) that nicely explains why *sitting* hurts like hell. When I tense up those muscles the pain becomes tolerable.

He said there was nothing wrong that wouldn't go away with time, but gave me a couple of exercise routines to build up my thigh and told me to check back in a couple of weeks.

Of course, if he offers to clear up my allergies with Adjustments I'm running like hell.

#2 ::: Derryl Murphy ::: (view all by) ::: April 01, 2003, 07:43 PM:

My ex-wife took her daughter to a licenced chiropractor and naturopath when Zoe was 4, because she was acting up (my input about the divorce and remarriage didn't take). This quack had Zoe remove her shirt and then put four sugar cubes on her stomach, from this discovering that she had a sugar allergy. The word cam down: no more wheat products, actual sugar, juices, some other foods, and of course, more sessions. Never again.

#3 ::: Vic ::: (view all by) ::: April 01, 2003, 08:23 PM:

Hi all,

You might already be familiar with it, but if you want to read more about chiropractic bad practice, go to www.chirobase.org and its associated www.quackwatch.com.

#4 ::: Vic ::: (view all by) ::: April 01, 2003, 08:26 PM:

Typo in the URL for Chirobase above. Here it is again www.chirobase.org

#5 ::: Mary Kay ::: (view all by) ::: April 01, 2003, 08:57 PM:

I find chiropractic very useful for some things: like some kinds of back, shoulder, and neck pain. Also occasionally helps my bad knee and ankle. But I am a firm believer in better living through chemistry and my medical doctor for medical complaints. If the chiropractor starts to give my quackery I explain what I will and won't do. If they abide by that, we're fine; if not I find another one. You just have to take control of your own treatment as you have to try to do in any medical situation. It's your damn body after all. What I have against chiropractors is that they're all so damn cheery and chipper all the time. Makes me dour for hours afterward in response.

#6 ::: Laurie Mann ::: (view all by) ::: April 01, 2003, 10:09 PM:

If nothing else, they do give good massages.

I have chronic low back trouble (bad posture and
being fat don't help that) but, every once in a while, get really severe pain in the upper back
(to the point that all I can do is sit in a chair - luckily, it goes away in about a day).

I did go see a chiropractor about it, got a few weeks of massage, some neck adjustments, and the recommendation to rearrange my desk at work (not keeping your hands lower than your elbows when you type can cause upper back trouble).

The main thing to me that seemed pointless was
having a brief massage with a little device that
bounced sonor into my muscles. I can't say
that did anything for me.

But when I said I felt fine, that was fine. No problem.

#7 ::: Robert L ::: (view all by) ::: April 02, 2003, 02:09 AM:

My father was a neurologist before he switched to psychiatry (which many, not without justification, would regard as another form of quackery, but that's outside the scope of this discussion). He was also a pillar of the medical establishment. He warned me sternly when i was a lad that the basis of chiropractic was quackery. And yet, he said, some chiropractors knew what they were doing, and were beneficial. "The trouble is, you never know what you're getting." It was thus with deep cynicism that I approached a visit to a chiropractor who a friend urged me to see. To my surprise, what he told me made perfect sense, and I believe that his treatment relieved what was--no doubt about it--a chronic case of lower back pain. If I would criticize his treatment, it would be that he didn't advise me to strengthen my lower back muscles through exercise, which I did subsequent to the treatment. While one can criticize chiropractors, the fact is that the conventional medical establishment doesn't have a very good record as far as treating lower back pain either.

#8 ::: crazysoph ::: (view all by) ::: April 02, 2003, 02:59 AM:

I cringed reading this post at first: I just started treatments with a chiropractor. But I'm happy to report that none of these "techniques" for spinning money out of my wallet were used, so far.

My own motive for going was to experience a new (for me) body-work technique, and to get some minor back grumbles attended to. At the initial consultation, he said "a few treatments" and he's stuck to that.

The wall of the waiting room displays some "principles" authored by L. Ron Hubbard (run away!!), but the individual practitioner is sound enough. To affirm Mary Kay Kare's position, I went in with a clear idea, on what basis I was allowing this treatment.

And yeah, Laurie Mann, brilliant massages!

Crazy(but tries to be civil when anonymous)Soph

#9 ::: janeyolen ::: (view all by) ::: April 02, 2003, 07:05 AM:

Ralph Lee Smith is an old friend from our days in the Village in the 60s. He was then (don't know about now) a thorough-going, honest, hardworking journalist. No frills, but straight-ahead stuff.

As to chiropractery--there's good, bad, and chicanery. And as someone up above noted, it's hard to know which is which until somewhere along in treatment.

But isn't that the same with doctors? Who hand out Lipitor (still) for cholesterol problems as if it's candy. And ghu knows how many folks have horror stories attached to that drug.

Jane

#10 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 02, 2003, 02:32 PM:

Jane, why am I not surprised to find out that you know the author?

Vic, if you'll run your pointer over the link I posted, you'll find that it's part of the www.chirobase.org site.

All: I have no doubt that chiropractors do some good. Many people in my family suffer from something-or-other that causes our backs to get out of whack. One or two applications of gentle pressure, your back makes a noise like popcorn popping, and suddenly Everything Feels Much Better. This is totally alien stuff to Patrick, but he's gotten pretty good at doing it for me.

These days the worst quacks tend to be working other lines (viz., selling colloidal silver as a cure-all via high-pressure MLM plans). What fascinated me about that chapter wasn't what it said about chiropractic practice, but rather the broadly applicable general principles of quackery. The "Yet disease" gambit is a work of art. So is "How long has it been since you really felt good?"

I'd love to get a look at Parker's textbook.

#11 ::: Jane Yolen ::: (view all by) ::: April 02, 2003, 03:07 PM:

Ralph Lee Smith is one of those undersung non fiction writers who never won a major prize, but still managed to coin phrases like "information highway" and write the most important and comprehensive book on the dulcimer which is still (I believe) in print. He looks like superman before he steps into the phone booth. Not the Reeves Clark Kent, but the unassuming nerdy guy who no one suspects. . .

My brother went to Lafyette and was head of the student group that arranged for music acts to perform at the college, way back in the early 60s. And Ralph--as a minor folk singer--was one of those invitees. Posters went up all over the campus trumpeting, "RALPH LEE JONES here Saturday night." I have never let my brother forget that one!

Jane

#12 ::: Stefan Jones ::: (view all by) ::: April 02, 2003, 03:48 PM:

Jane wrote:

"Ralph Lee Smith is an old friend from our days in the Village in the 60s."

I have to ask . . . ever hear of a place called Fugazzi's?

#13 ::: CrazySoph ::: (view all by) ::: April 02, 2003, 04:30 PM:

Point taken, Teresa, about the general application of those tactics - will stop feeling defensive, and be on the lookout for "Yet". I consider myself at least somewhat better armed against LLL, having sorta recognized it on my own (the inbuilt BS detector going *ping!*). I'll be on the lookout for good rejoinders to the "yet" tactic, or any of the others, really....

Crazy(yes, would love a look at that textbook, too!)Soph

#14 ::: Deborah J. Ross ::: (view all by) ::: April 02, 2003, 05:09 PM:

An amen to much of the above from a former chiropractor. That Parker stuff is for real, at least when I graduated (1978) and for all I know, is still being taught in weekend seminars. However, the profession has made a serious effort to become more scientific, not to mention more responsible, since then, so I don't think it's any more valid to judge today's graduates by the practice-management seminars of 40 years ago than to judge modern medicine by the phlogisthon theory.

That said, I believe that spinal manipulation can be a valuable therapeutic modality, that no one does it as well as chiropractors, and that we know very little about the best ways to apply it to musculoskeletal ailments. The problem, as I see it, is that DCs (Doctors of Chiropractic) work as =primary care providers= without the clinical skills to do it properly. As an example, in my last year of practice, I had 2 patients with kidney infections and one with metastasized ovarian cancer, all of whom presented with back pain. I diagnosed the infections and referred them to medical care, and the woman with the cancer was already in medical workup, but later died. After some time out living abroad, I realized that I could not ethically continue to assume responsibility as a "portal of entry" primary care provider without the necessary knowledge. I had plenty of book learning, but no internship or residency to put that learning into action. I know some DCs who have close professional relationships with MDs, and I think that's the best situation.

As for all the incredible woo-woo --- if I put it in a science fiction story, no one would believe it!!

#15 ::: James D. Macdonald ::: (view all by) ::: April 02, 2003, 05:26 PM:

IF YOU THINK YOU'RE HAVING A HEART ATTACK, CALL 9-1-1 OR YOUR EMERGENCY MEDICAL SYSTEM IMMEDIATELY.

Some heart attacks are sudden and intense -- the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort.

Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.

If you or someone you're with has chest discomfort, especially with one or more of the other signs, don't wait longer than a few minutes (no more than 5) before calling for help. Call 9-1-1... Get to a hospital right away.

#16 ::: Janet Croft ::: (view all by) ::: April 02, 2003, 06:07 PM:

Funny -- they DO still seem to be doing the same seminars! I recently attended a small library conference at a hotel in Oklahoma City, and the room next to ours was being used by a group "trying to help chiropractors build their practices." I wasn't quite nosy enough to go in, but the literature I saw on the table looked a bit like the stuff Smith mentions. They seemed to mostly be the type of person who, when confronted by the concept of a room full of librarians, were dumbfounded and said "I never read a book in my life." My mom used to be very skeptical of chiropractic but now swears that having her spine manuipulated has cured her knees, and I'm sure I'll get to that point myself sometime.

(Hi to the several familiar names from MythSoc!)

Janet

#17 ::: Jane Yolen ::: (view all by) ::: April 02, 2003, 07:26 PM:

"I have to ask . . . ever hear of a place called Fugazzi's"

No, but I was in the White Horse crowd. And that was 40 years ago and I have Fuzzy Memory Syndrome.

Jane

#18 ::: Stefan Jones ::: (view all by) ::: April 02, 2003, 07:57 PM:

TNX. 40 years ago would be the right timeframe. It's mentioned in _Howl_, and my grandparents ran it.

#19 ::: Laurie Mann ::: (view all by) ::: April 02, 2003, 08:53 PM:

Jim M: Right you are. So the very first time I
had severe upper quadrant pain on the left side
that came out of no where, I did go to the hospital.
That turned out to be the first episode of the
periodic upper back problem I described earlier.
I was extremely embarassed that it turned out to
be just muscle strain, but at least it wasn't
anything any worse than that.

#20 ::: Bruce Arthurs ::: (view all by) ::: April 02, 2003, 09:04 PM:

When I was having severe back pain two years ago, after a couple of months of traditional care with little result (perhaps I should call that "care" since it was a workplace injury and I ended up at the Postal Service's contract clinic, the only place where I've had a doctor literally SNEER at me and make it plain that she thought I was a liar and faker), I finally decided to seek chiropractic care.

I talked to three chiropractors before I found one I felt comfortable with. The first talk was with a clinic that wouldn't treat me unless Workmans Comp would authorize the change to chiropractic care. (WC wouldn't.)

The second was with a small office that left me feeling very uncomfortable. They were of the persuasion that chiropractic would cure EVERYTHING. I raised some questions about the claim on a wall poster that chiro would be effective for acne. They responded by quoting... GRAY'S ANATOMY (a very general passage about the importance of the spinal cord) as a conclusive authority on the efficiacy of chiropractic. They also showed a video of a guy effusing about chiro, but the guy did it in so slimey a manner that I ended up thinking "This guy oozes snake oil." And they also wanted me to sign up for a minimum of a year's treatments.

The third chiropractor I talked to had over twenty years experience, didn't preach the gospel of chiro at me, and just said he thought he could help me with the back pain. After two weeks treatment, I'd improved significantly, and was able to go back to carrying mail in a month.

This discussion has made me remember the time, many years ago, when a smart, charming and lovely young lady at a party offered to "pop" my neck.

She was a smart, charming and lovely young lady. So OF COURSE I let her "pop" my neck.

To no ill effect. But looking back on that now, from the perspective of a 50-year old whitebeard, I'm aghast that I would have let an untrained amateur do that sort of twisting and jerking on my neck.

(I wonder if Teresa remembers that party?)

#21 ::: Robert L ::: (view all by) ::: April 03, 2003, 09:59 AM:

Bruce Arthurs--I've experienced the USPS's "doctors" (it really does belong in quotes) and their attitude toward lower back pain. I feel for you. In my experience, those guys would say you were malingering if you were decapitated...My doctor neighbor says that the reason HMO doctors are so bad is because they are "not patient advocates." This applies a fortiori to USPS doctors, who care only about minimizing any trouble for the outfit, and culling the weak...

#22 ::: LauraJMixon ::: (view all by) ::: April 03, 2003, 10:16 PM:

I was fortunate that the chiro I went to was reputable -- also trained as a Dr. of Chinese medicine, and very not in the mode of the sleaze style. But I've seen the quacks and sleaze, too. I agree with those who have said you have to choose carefully.

#23 ::: madeleine Robins ::: (view all by) ::: April 10, 2003, 11:44 PM:

Our first chiropractor was all of the dreadful things Smith mentions in the article. He was also a pretty good technical chiropractor. If you discounted most of the anti-medical stuff and just took him for what he could do, he was good. When we stopped being able to put up with him, we found someone else who was pretty good too. I will say that chiropractic care during both pregnancies did me a world of good. It does not cure the common cold, at least in my experience.

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