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Pharma’s 6 Billion Dollars


Our Superior Results

While chiropractors have enjoyed a recent surge of research supporting spinal manipulation over pharmaceutical options, not all medical physicians have heard that news – in no small part because big pharma’s collective marketing voice is far louder than ours. A January 2019 JAMA study detailed pharmaceutical spending trends:


  • “From 1997 to 2016, medical marketing expenditures nearly doubled to 30 billion dollars.”
  • “Direct-to-consumer prescription drug advertising increased from $1.3 billion in 1997 (79,000 ads) to $6 billion (4.6 million ads [including 663,000 TV commercials]) in 2016”
  • “Marketing to health care professionals by pharmaceutical companies accounted for most promotional spending and increased from $15.6 billion to $20.3 billion, including $5.6 billion for prescriber detailing*, $13.5 billion for free samples, $979 million for direct physician payments (i.e. speaking fees, meals) related to specific drugs.” (1)

*Prescriber Detailing– a vendor purchases prescription data from large pharmacies then re-associates the prescribers name with the DEA numbers. They analyze specific physician prescription patterns and sell provider-specific data to pharmaceutical companies. Drug reps then perform evidence-informed, direct-to-physician advertising to influence prescribing behaviors.

Check out the following video of 3 simple steps to help level the playing field.


The Recommendations Are Clear

In the past two years, we have seen numerous published medical studies endorsing spinal manipulation over pharmaceutical alternatives. Evidence-based chiropractors are delighted by the recognition from so many trusted medical establishments including the FDA (2), CDC (3), Joint Commission (4,5), JAMA (6), Annals of Internal Medicine/ The American College of Physicians (7), and The Lancet (8). This certainly means that we have all seen a dramatic escalation of medical referrals – right?

Why No Change?

Medical providers prescribing patterns are influenced by several factors including financial and managed care considerations, pharmaceutical representatives and drug samples, direct-to-consumer advertising, and peer influence. (9)

Unfortunately, medical referral patterns are shaped and changed more slowly – primarily by personal experience.  To break through, chiropractors must provide overwhelming evidence that we are indeed the best option for a given diagnosis. Check out the following short video from a prior blog that outlines three things that you can implement right now to help change medical attitudes and referral patterns.



Click here for samples of the MD Initial Report and Release Report.

Moving Forward

Regardless of our professional degree, MD’s and DC’s all have failed cases mixed into our many clinical successes. Unfortunately, since the successes don’t need to seek additional care, we primarily see each other’s failures. We must not lose sight of each other’s proven value. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, our professions will help more patients than either working alone.

Consistently sending quality communication is one simple way to cultivate better relationships with our medical peers. If you’re looking for a way to automate that process, look no further because ChiroUp does it for you. Visit ChiroUp.com to learn more about ChiroUp’s MD marketing program, and how you can generate better relationships and patient referrals from other medical providers in your community, today!

ChiroUp Empowers



  1. Schwartz LM, Woloshin S. Medical Marketing in the United States, 1997-2016. JAMA. 2019;321(1):80–96. doi:10.1001/jama.2018.19320
  2. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
  3. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
  4. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in 2018 Comprehensive Accreditation Manual for Hospitals.
  5. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
  6. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
  7. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
  8. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Volume 0, Issue 0. Accessed online 4/10/18: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/abstract
  9. Gallan, Andrew. (2011). Factors That Influence Physicians’ Prescribing of Pharmaceuticals: A Literature Review. Journal of Pharmaceutical Marketing & Management. 16. 3-46. 10.1300/J058v16n04_02.

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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