SaveYourself.ca • Sensible advice for aches, pains & injuries
published 08/15/09, updated 7/19/11
“Modality empire” is my own term1 for a proprietary method of manual therapy — a sub-discipline — championed and promoted by a single entrepreneur who usually suffers from a serious case of healer syndrome. If you have a chronic pain problem, this is an important concept to understand, because so many of the therapies that will be offered to you are the dubious products of modality empires.
While there are many taxonomies of alternative medicines, one thing almost all alternative therapies have in common is they are originally the de novo “discovery” of one lone individual.
Dr. Mark Crislip, “The Marshall Protocol” on Science-Based Medicine
Most modality empires make big promises of healing powers, and usually make their money by selling expensive therapy and workshops. Even if the brand isn’t strong enough to command high fees, they are inevitable if the business succeeds. Professionals are sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is poor and (importantly) completely unregulated.
Modality empires usually revolve around an overly simplistic notion of how the body works and how it might be fixed. In particular, a substantial majority of modality empires are grounded in “structuralism”: the emotionally compelling idea that our problems are caused by being “crooked” in some way, and that all our problems will go away when we are “straightened” by therapy. Unfortunately, there is a great deal of evidence that this view of chronic pain is not fruitful. See Your Back Is Not “Out” and Your Leg Length is Fine.
Some classic examples of modality empires include:
There are many, many more.
Sometimes a modality empire is particularly unoriginal: re-packaging old ideas for a new generation of workshop consumers, like Paul St. John’s take on trigger point therapy (St. John Neuromuscular Therapy™).
A modality empire is as much a business model as a method of helping people, and perhaps much more. There is a great deal of overlap between modality empires and quackery. Please note that “overlap” is not a blanket condemnation: I am not saying that everything about modality empires is wrong, or that every modality empire is equally bad. Many modality emperors are also formidable innovators and experts, and much of value can be found in their methods and teachings. However, as the old lawyer joke goes, “Only 90% of them are making the rest look bad.”
History has shown us time and again that what drives the popularity of a modality empire is not how well it works, but simply how well it is promoted. Once in a while, a well-promoted modality empires hits the big time and become full-fledged profession. Chiropractic is the most obvious example: it began as the modality empire of master marketer DD Palmer, and then his son BJ, and they spent decades pushing it to the status of a regulated profession. The Palmers were certainly entrepreneurial geniuses, but they also promoted many ideas that have been long since been abandoned as useless, even by some chiropractors.2
What puzzles me most about the promotion of modality empires is how effective they are at fooling people who are cynical about other kinds of businesses.
Modality empires actually attract customers who hate The Man, corporate greed, and especially Big Pharma. Yet these “sensitive” consumers, both patients and therapists, turn off their cynicism and give a free pass to most modality empires, even though they are — by definition — corrupted by ego (at least) and by massive profits in some cases. Why the double standard?
It’s just marketing 101. Modality empires are able to successfully cast themselves in the role of the underdog just by emphasizing how they are an alternative to everything the customer is cynical about — the target market is very cynical about “mainstream medicine,” and its very easy for modality empire to make itself look appealing by taking shots at that.
Also, the marketing of most modality empires is usually finely honed by market forces. That is, they primarily exist to give people the health care they want, and not the health care that works — two surprisingly different things. It really is the industry of emotionally appealing treatment ideas. The successful ones are successful precisely because they have found the right psychological buttons to push. Basically all modality empires are sold on the strength of an emotionally appealing idea or theme.
For instance, many of them are based on the idea of “alignment” — that if you are straighter, you will be healthier. This is simplistic and generally false.3 The classic specific example is chiropractic, which, despite all of its pretensions, would never be able to survive as a profession without the simple, emotionally appealing idea that spinal alignment is vital to your general health. Clearly that is false, or every person with scoliosis or a simple spondylolisthesis (a scary-looking but generally asymptomatic condition) would be riddled with disease.
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