Scene: Shopping Mall.
Wedged in between the Yogan Frooz (motto: made up Scandinavian words tastën groövi) and the Cell-U-Cessories cart (motto: I’m a bored guy on a stool) one can occasionally spot what is commonly called a chiropractor performing what is commonly called a “spinal screening”. Step right up and you can get your spine checked for problems. No back pain? No problem! These little spine problems are sneaky buggers and have a funny little way of creeping up and kicking your ass. You may not even know you’ve got one until it’s too late. Like appendices that always seem to be removed seconds before they were going to burst (whew, thank God! The size of a grapefruit you say?) these spinal boo-boos can wipe you out! What’s that, Miss? You just had a checkup at your medical doctor’s? Last week? And he didn’t find any spinal problems? Didn’t he? Well, that’s okay – you’ve got to be a chiropractor in order to finds ‘em and fixes ‘em. Here’s my card. We’ll see you at 9:00 am tomorrow. NEXT vict- I mean screening subject!
You might be asked to stand on two modified bathroom scales, one foot on each. Notice how the weight isn’t the same on the two scales? AH HA! Structural imbalance! Or, you might stand against a metal frame with strings going across it and the chiropractor will slide the strings to match up with your shoulders and hips. You step down and AH HA! Those strings aren’t level! Spinal problems! Or perhaps Dr. RightbySears is taking the high tech approach and running a scanning device up and down your spine and them shows you on the computer screen what looks like a bar graph coming out of both sides of your back. Some areas are blue, some yellow and uh oh, you’ve got red ones! You need to come in to my office Monday morning and turn those red things into blue.
Public screenings are an important tool in improving the public health. True, screenings for prostate and breast cancer have taken some hits in the literature but the practices are changing in alignment with the scientific evidence (slowly, but responding). The spinal screenings you see in the mall are not the same as having your blood pressure checked by the volunteer ambulance outside the Stop & Shop. Elevated blood pressure has a clinical correlation with chronic disease and the blood pressure cuff is a proven method of detecting hypertension. The evidence for using two bathroom scales for determining the need for future spine care? Clearly demonstrated in the American Journal of Notsomuch. That fancy scanning thing that produces the sideways colorful bar graphs? Just saw it in last month’s New England Journal of Maybenot. Unproven to be anything other than a marketing gimmicks.
Screening is a public health activity with the aim of detecting disease before symptoms appear. Screening has the potential to save lives and improve quality of life through early diagnosis of serious conditions but can only be ethically used in cases where the screening procedure can actually detect what it proposes to find and the early detection will actually make a difference in the progress of the disease. For example, more than half of seniors have hypertension. One could be accurate half the time waving a magic wand over a group of people over 65 and declaring a diagnosis of high blood pressure in half of them. Accurate? Yes. Ethical? Hardly.
To call these advertising booths ‘screenings’ is a slap in the face to true public health measures. Screenings should identify or prevent a public health concern – not create patients through scare tactics, confusion and deceit.
I have no problem with people marketing their businesses as long as they call it what it is. When I see an ad in the newspaper for a cafe that says it has the world’s best coffee, I’m pretty sure there wasn’t a scientific poll organized to determine it. But it’s different when a doctor does it. It needs to be different.
Setting up a booth in a mall looking for people who will believe what you are selling is not a screening for public service. It’s a store. And if you sell items or services by lying, then not only is it not a screening but it’s a self-serving fleecing. These people should have telemarketers for older brothers so they’d have role models to look up to. Run away. All the way to the Gap if you have to.