Selling the Spine

The marketing of spinal medicine procedures, devices, gadgets and cures is all pervasive.  Dozens of chain stores provide devices for back pain sufferers and most of these remedies have no proven efficacy.  Major medical manufacturers of surgical equipment are advertising directly to the public.  Pharmaceutical companies hawk their wares on television at all hours of the day and night.  Chiropractors have been accused of the most abusive marketing procedures but are not alone.  Many physicians sell their services in ways that are clearly unethical.  By way of example, patients with neck problems are often told that they will become quadriplegic (paralyzed) if they don't have surgery urgently.  This is rarely true and should prompt the intelligent patient to immediately seek an additional opinion.

The following article about chiropractic sales technique is representative of unethical techniques used by many practitioners.  See Dr. Barrett's site ( for information concerning other specialties.

Excerpts from "The Selling of the Spine"

by Stephen Barrett, M.D.

Intensive selling of the spine begins in chiropractic school as instructors convey the scope and philosophy of chiropractic to their students. After graduation, chiropractors can get help from many practice-building consultants who offer seminars and ongoing management advice. This article describes observations I have made over a 30-year period in which I collected practice-building manuals and many other relevant documents.

When confronted with my writings on this subject, most chiropractors respond that my information is outdated and that the unethical practices I have described are not widespread. They also claim that many chiropractors who take practice-building courses don't use the unethical techniques to which they are exposed. I have received many reports from consumers who have encountered inappropriate salesmanship in chiropractic offices. Undercover investigations have also found evidence of their use, but, as far as I know, no profession wide survey has been conducted.

How to Attract Patients

Practice Management Associates (PMA), a Florida-based firm run by Peter Fernandez, D.C., advertised that chiropractors who followed its guidelines would gross an average of $240,000 in their first year of practice and that the average for all of their clients was about $350,000 [6]. The firm touted itself as "the world's largest full-service chiropractic management firm." An ad for one of its 1991 seminars stated: "We use an 'idea' factory approach which teaches a chiropractor every conceivable way that exists to attract new patients, from the most subtle to the most aggressive."

(This excerpt used with permission.  Stephen Barrett, M.D. is Board Chairman, Quackwatch, Inc., and Vice President of the National Council Against Health Fraud. He edits a free weekly electronic newsletter and operates Quackwatch [link] and 15 other consumer-protection Web sites.  For more complete information see


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Last modified: 07/27/08