CHIROPRACTIC’S STRUGGLE WITH ALLOPATHIC MEDICINE
Powerful events in the
past inspire the future
Chiropractic had a humble
start in
Economist Paul Zane Pilzer
notes in The Wellness Revolution (Wiley, 2002), “When I began the research for
this book, I thought the existing items in the wellness industry — fitness
clubs, vitamins and the like — might already total a few billion dollars in
U.S. sales. I was very surprised to find that sales have already reached approximately
$200 billion — including $70 billion for vitamins … and yet only a small
percentage of the population even know about wellness. Imagine what will happen
as more people understand the potential that wellness can add to the quality
and longevity of their lives!”
Pilzer’s research and analysis
strongly suggest that chiropractic is a key player in the wellness revolution.
Becoming part of this
revolution has not occurred overnight. During its first 50-some years — from
its start in 1895 to the mid-1950s — chiropractic struggled to win acceptance
in the United States as a recognized alternative healthcare profession.
Chiropractic was finally legalized in New York in 1963 and in Louisiana, the
last holdout, in 1974.
But the profession still had
other challenges to tackle — and overcome. As we celebrate 100 years of
chiropractic, it is appropriate to examine a number of significant battles and
victories.
The power of these events lies
not only in what they accomplished, but also in how they inspire. Chiropractic’s
future lies in its past.
Victory in the Empire
State
Chiropractors in New York
endured five decades of persecution orchestrated by the state medical
association before they won the right to be licensed and practice in the Empire
State. The battle began in 1912 and finally ended in 1963, when Gov. Nelson
Rockefeller signed chiropractic into law.
The crusade for recognition
included some significant moments:
• First bill
introduced in 1913. In 1912, New York
chiropractors organized their first membership society and sought legislation
to license their profession. The first bill to create a chiropractic statute
was introduced in the legislature in 1913.
• Mass
arrests. In the 1920s and 1930s
chiropractors endured mass arrests by state troopers, especially in the
downstate metropolitan area where many were concentrated and massive sweeps
were easy for the police. This persecution occurred despite repeated annual
efforts to persuade lawmakers in Albany of the justice of their cause and the
injustice of allopathic condemnation. A licensing bill passed both houses of
the legislature in the 1920s, but was vetoed by Governor Al Smith.
• MDs
against ‘fakers.’ New York
chiropractic patriots included Wolf Adler, DO, DC; Louis Blackmer, DC; J. Lewis
Fenner, DC; Benjamin Gilman, DC; Sol Goldschmidt, DC; Benjamin A. Sauer, DC;
William Werner, DC; and the ever present, ever witty Lyndon E. Lee, DC.
At one well-remembered
legislative hearing at the state capitol a spokesman for the medical camp
“pointed his finger straight at Lee and raged, ‘Yes, we are against you. We are
against chiropractic and all other fakers. If this legislature will give us
this bill, we will drive you and your ilk out of the state! What do you think
about that?’ Irrepressibly, with the best wit he could muster, Lee replied,
‘first, sir, I’d like to see your driver’s license.’”
• Patients’
advocacy group established. Dr.
William Werner’s response to the repression from allopathic medicine involved
forming the American Bureau of Chiropractic (ABC), a patients’ advocacy group.
In the late 1920s and 1930s,
the ABC organized thousands of chiropractic proponents and their doctors in
mass rallies. One such event, held in Madison Square Garden in New York City,
brought together some 16,000 people and was noted in newspapers across the
country.
• Right to
learn upheld. Because of the
unique structure of educational authority in New York, the state’s education
department routinely denied chiropractic schools the privilege of operating as
“colleges.” Consequently, chiropractors were trained at the Columbia Institute
of Chiropractic (today’s NYCC), the Eastern Chiropractic Institute, the
Atlantic States Chiropractic Institute and others.
When the National Chiropractic
Association’s director of education, John J. Nugent, DC, arranged for the
merger of several of the smaller, proprietary schools into the larger,
nonprofit Chiropractic Institute of New York (CINY, now defunct) in 1944, the
medical establishment sought to shut the school down as an unlicensed medical
college. For once the courts found in favor of the DCs, ruling that the right
to teach and learn chiropractic was protected by the First Amendment.
• Post-WWII
onslaught. But this small
victory did little to staunch the allopathic onslaught in the post-World War II
era. Chiropractors Matt and Kitty Scallon were arrested, tried and convicted
for unlicensed medical practice. Kitty Scallon served time in the Women’s House
of Detention in New York City in 1949.
Dr. Kitty’s soulful jailhouse
letter to friends captured some of the spirit of the times: “Being here is sometimes like a bad dream,
when you think of it being for nothing but doing good … I felt down-hearted
when the news came that Mabel [Palmer] died, but I would always perk up when I
thought of chiropractic and the many people it had helped ... and then I’d
throw my shoulders back and be ready and willing to make any sacrifice to help
free our beloved science…”
• Victory at
last. With the election of
Nelson Rockefeller as governor of New York, chiropractors finally had a friend
they could rely upon. Rockefeller signed a bill authorizing the licensing of
DCs in April 1963. It was a less than perfect law, since it restricted the
chiropractors’ use of x-ray and stated that only those who had previously
practiced in the state could sit for the licensing examination.
Not until the National College
of Chiropractic was accredited by New York’s education department in 1971 were
new applicants accepted. Nonetheless, there was joy and relief in the “great
backward state” as Mahlon Blake, DC, a graduate of the Logan Basic College of
Chiropractic, was sworn in as the first president of the New York Board of
Chiropractic Examiners. New York was the 47th American state to
license chiropractors.
Louisiana: the final
struggle for licensure
Chiropractors endured decades
of persecution from the allopathic political machine in Louisiana, where the
practice of chiropractic was considered the practice of medicine before the
state finally legalized the profession in 1974.
The state medical society had
succeeded in passing statutes that required an individual to graduate from a
school recognized by the American Medical Association (AMA) in order to
practice chiropractic. When chiropractors ignored these laws, they practiced at
their peril, never knowing when a knock at the door might signal an arrest and
incarceration.
In the late 1950s, Palmer
graduate Jerry England, DC, (president of the Louisiana Chiropractors
Association and chairman of the Louisiana Veterans Affairs Committee for the
ICA) and several others engaged Lafayette attorney J. Minos Simon to bring suit
against the board of medical examiners in an effort to break the stranglehold
on licensure and practice.
The case wound in and out of
various state and federal courts, but final judicial relief was later sought in
federal district court. When the magistrate granted an injunction barring
further prosecutions of chiropractors until the legal issues were decided,
doctors of chiropractic could breathe a sigh of relief, at least temporarily.
Chronicled in Chiropractic Economics, the ICA Review, ACA Journal of Chiropractic and
numerous state and college journals, the “England Case” became a favored cause
for chiropractors throughout the nation.
By 1965 the scene of action
was a federal courtroom, where chiropractic college presidents William D.
Harper, DC, MA, of the Texas Chiropractic College and Joseph Janse, DC, ND, of
the National College of Chiropractic, offered testimony in defense of their
healing art.
Chiropractors sought to place
the best spin possible on the proceedings, noting the dramatic and
authoritative testimony provided by each of these chiro-scholars. The truth was
somewhat less cheery. The two men were “raked over the coals” by counsel for the
medical establishment, who hammered away at the lack of federal recognition for
chiropractic education.
Janse reportedly left
Louisiana determined to establish accreditation for National College “or leave
the profession.”
‘Louisiana’s shame’
Meanwhile, chiropractors in Louisiana found their injunction gone and
prosecutions for unlicensed practice recommenced. Leading the persecution
against the chiropractors was AMA official and former Louisiana State Medical
Society president Joseph A. Sabatier, MD, who would become well known to
chiropractors for his chairmanship of AMA’s Committee on Quackery.
To meet the renewed
harassment, several chiropractors sought and won seats in the state
legislature. The state association mounted a massive publicity campaign:
Visitors to Louisiana were greeted by road signs declaring “Louisiana’s Shame:
the Only State That Has Failed to License Chiropractors.”
Their persistence paid off in
1974, when Gov. Edwin Edwards signed the state’s first chiropractic statute
into law. Louisiana was the 50th and final state to license DCs.
In a final irony to the
seven-decade struggle for licensure by chiropractors, two chiropractors in
Caddo Parish were incarcerated after the chiropractic bill was passed. Like
generations of chiropractors before them, after their arrest and release on
bail, they returned to their clinics and continued to serve their patients.
Drs. B.D. Mooring and E.J.
Nosser angered Judge Jack Fant so much that he ordered their re-arrest, placed
them behind bars and fined them for their defiance. However, as though to
reenact the decades old pattern of chiropractic resistance, they were freed
after the sheriff’s office was inundated with outraged patients who jammed the
switchboard with calls complaining of the jailing and seeking justice for their
doctors. With their release, the profession’s long ordeal was finally over.
The Struggle with Allopathic Medicine:
The struggle between allopathic medicine and chiropractors is
ancient. It dates at least to the public feuding in 1899 between chiropractic’s
founder, D.D. Palmer and a local allopathic physician in Davenport, Iowa,
Heinrich Matthey, MD. And it continued
throughout the 20th century.
Perhaps fueled by the threat of economic competition, the
American Medical Association (AMA) and various state medical societies
campaigned throughout the 20th century to squash the chiropractic
profession and all other alternative (that is, non-allopathic) healthcare
providers. The experience of the early osteopaths, naturopaths and various
other alternative doctors was similar to that of DCs, but chiropractors seem to
have endured a special sort of ferocity from AMA and its allies.
Allopathic medicine’s strategies varied throughout the first
century of chiropractic, but never its purpose. These early strategies included
sweeping arrests for “practicing without a medical license;” thwarted
legislative attempts; and strict basic science laws.
Around the mid-1920s, the AMA adopted a policy that
“chiropractic must die.” The organization’s efforts to eradicate chiropractic
came into full steam in 1963, when it convened its Committee on Quackery (CoQ),
whose avowed intention was “first the containment of chiropractic and,
ultimately, the elimination of chiropractic.” The CoQ was formed in
approximately the same time period when chiropractors began seeking federal
accreditation for their schools through the U.S. Office of Education.
Not only did the AMA form the CoQ, but it also orchestrated a
conspiracy to accomplish its goal and enlisted a number of other medical
organizations, including the American Hospital Association, the Joint
Commission on Accreditation of Hospitals, the American College of Radiology and
the American Osteopathic Association. These organizations threatened their members
with severe penalties (such as the forfeiture of hospital privileges) if they
consorted with chiropractors.
Consequently, MDs were unable to refer patients or take x-rays for
chiropractors and chiropractors were unable to have x-rays taken at nearby
hospitals.
The CoQ simultaneously conducted an extensive anti-chiropractic
publicity campaign and actively sought to block federal recognition of
chiropractic education by the USOE. It succeeded in deterring passage of a
chiropractic benefit in Medicare and delayed the licensing of chiropractors in
Mississippi and Louisiana until 1973 and 1974 respectively.
Dewey Anderson, PhD, director of education for the American
Chiropractic Association’s Council on Education, sounded an alarm to
chiropractors about the AMA threat in the March/April 1964 issue of the
Chiropractic Economics. He noted that the AMA “has a definite program to
destroy chiropractic, root and branch, by 1970.” But chiropractors remained
relatively oblivious or unconcerned.
In 1972, the situation with the AMA came to public eye in the
book In the Public Interest, which reprinted a number of AMA internal
memoranda that showed the extent of the scathing attack on Chiropractic. These
memos showed the determination of the AMA to destroy chiropractic. Finally, in 1976, chiropractic went
head-to-head with allopathic medicine, when Chester Wilk took the AMA and its
co-conspirators to court in an antitrust suit. The lawsuit took 14 years. But
finally, in 1990, chiropractic was victorious and a permanent injunction was
filed against the AMA, stopping it from defaming chiropractic.
Chiropractic’s showdown
The battle with the AMA took a significant legal turn on October
12, 1976. That was the date on which Chester A. Wilk, DC, and four
co-plaintiffs brought suit in U.S. district court in Chicago against the
medical association. The basis of the suit: violation of the Sherman Anti-Trust
Act, a federal statute that prohibited unfair competition in commerce. The suit
would take the next 14 years to win. The
plaintiffs were Chester A. Wilk, DC, of Illinois; Patricia B. Arthur, DC, of
Ohio; James W. Bryden, DC, of Missouri; Steven G. Lumsden, DC, of Washington;
and Michael D. Pedigo, DC, of California.
Speaking for the chiropractors was attorney George McAndrews,
whose father had graduated from the Palmer School of Chiropractic in 1933.
Brother Jerome F. McAndrews, DC, was then working as an ICA officer, and would
later serve as president of Palmer College.
Providing a significant information backdrop to the Wilk case
was the 1972 publication of a book, whose contents had been secretly copied
from the AMA’s files in Chicago by an unnamed MD distraught by the unholy
practices of the AMA. In the Public Interest revealed that the core of
AMA’s anti-chiropractic activities had been centered since 1963 in the
society’s Committee on Quackery (CoQ).
Although chiropractors had been warned in the March/April 1964 issue of
Chiropractic Economics about AMA’s plan to “destroy chiropractic, root and
branch, by 1970,” this heads up from Dewey Anderson, PhD, director of education
for the ACA, went largely unheeded.
The now famous Wilk trial began in 1976, but it would take the
next 14 years to culminate in a victory ruling by Judge Susan Getzendanner. The
machinations and revelations that emerged from the confrontation with
allopathic doctors may be more important in the long term than the settlement
the DCs reached with their abusers.
Some of these revelations included:
A pattern of disregard for patients. One cardiologist testified that he would
never accept a referral from a chiropractor, even if the patient’s life
depended on it.
Suppressed scientific truth. The AMA suppressed credible
scientific information on the value of spinal manipulation in order to avoid
any acknowledgment of the clinical value of chiropractic services. However, the
economist who testified on AMA’s behalf prepared his report based on the
assumption that chiropractic care was effective, at least for musculoskeletal
problems.
Lack of medical training in musculoskeletal disorders. John
Mennell, MD, testified that the typical medical school graduate received no
more than four to five hours of instruction on the musculoskeletal system
during four years of medical school.
Threat of ostracism. Medical doctors who sought to collaborate
professionally with chiropractors, an activity banned by AMA’s ethics
committee, were threatened with ostracism and loss of hospital privileges. A
few brave and conscientious MDs reported that they had continued to work with chiropractors
in the best interest of their mutual patients but had been forced to do so
surreptitiously, so as to avoid the wrath of the AMA and its allies. Exemplary was a pediatrician who secretly
provided care to handicapped children at Kentuckiana Children’s Center in
Louisville.
CoQ damage. The AMA’s Committee on Quackery (CoQ) had enlisted
the support of various national and state medical societies to brand
chiropractors as “rabid dogs” and “killers” in the eyes of the public
and among the rank and file of medical practitioners.
This committee’s work delayed the licensing of chiropractors in
the final two states Mississippi and Louisiana, prompted a bogus investigation
of chiropractic by the U.S. Public Health Service and delayed chiropractors’
inclusion in the federal government’s Medicare program for senior citizens. The
AMA sought to block the recognition of National College of Chiropractic by the
New York State education department and worked strenuously to deny recognition
to the Council on Chiropractic Education by the U.S. Office of Education.
The judge’s final ruling
In her ruling at the conclusion of the second trial, federal
district Judge Getzendanner of the U.S. Supreme Court, spoke of the lives and
reputations that had been ruined by AMA’s illegal boycott. She noted that
although several defendants had settled out of court with the
chiropractor-plaintiffs, the AMA had never acknowledged any wrong-doing in its
efforts to contain and eliminate the chiropractic profession.
Accordingly, she mandated that her ruling and injunction against
any continuing barriers to cooperative action among MDs and DCs be published in
the trade association’s periodical, the Journal of the American Medical
Association. A monetary award was also required (amount undisclosed), much of
which was distributed among the chiropractic colleges.
Her ruling was appealed to the U.S.
Court of Appeals where the decision upheld the lower court’s ruling that the
AMA was guilty of conspiracy.
ACA fights to end monetary
discrimination
The Wilk vs. AMA lawsuit was a
landmark decision for chiropractic. But, the battle for professional equality
and recognition is not over. Professional livelihood is now at stake.
“After the injunction [against
the AMA to stop boycotting chiropractors], the battle turned to money,” said
George McAndrews, the attorney who led the fight in the Wilk litigation. “They
[the medical community] all claim that [chiropractic is] part of the core of
the universal practice of medicine. And physical therapists, who have never
been trained like doctors of chiropractic, are now asserting the right to
manually correct subluxations. Even osteopaths, who have never used
subluxation, claim to be chiropractors at heart. Everyone wants a piece of the
action.”
Trying to get that “piece of
the action” led the American Chiropractic Association to sue the federal
government (in 1998) and later Trigon/Blue Cross (in 2000). Money is at the
heart of both lawsuits.
In 1994 the Health Care
Financing Administration (HCFA), part of the Department of Health and Human
Services (HHS), issued a policy letter stating that physical therapists and
medical physicians and osteopaths were authorized to deliver chiropractic
service to correct subluxation.
According to McAndrews, the
policy letter was illegal because it was issued without notice and without
hearing and included physical therapists, who are not physicians under Medicare
regulations. The ACA filed the Medicare lawsuit in 1998 to protect patients’
rights to receive chiropractic care.
The HCFA (Medicare) lawsuit is
important, according to McAndrews, because most managed-care organizations
follow Medicare guidelines.
The Trigon/Blue Cross lawsuit
is about discriminatory payment schedules. This Virginia insurance company had
a policy to pay chiropractors 40 percent less than it paid medical physicians
for the same services, placed a $500 cap on manual manipulations of the spine
and encouraged the utilization of physical therapists in place of
chiropractors.
Neither lawsuit is over, yet.
The federal lawsuit is still pending. And after a three-judge panel of the U.S.
Fourth Circuit Court of Appeals ruled against the ACA on the conspiracy case
and later denied a full-panel hearing, the ACA decided to petition the U.S.
Supreme Court to hear the lawsuit.
Trickle-down effects
Despite the setbacks in the Trigon case and a slow pace in the federal lawsuit,
the ACA identifies a number of changes in the insurance arena, because of the
litigation. They include:
• Greater access. Millions more Americans now have greater access to
chiropractic care and hundreds of millions of additional dollars are being
reimbursed for chiropractic care because of the cooperative dialogue taking
place between the ACA and Blue Cross Blue Shield (BCBS).
• Chiropractic care for
federal employees. The legal action
stimulated the inclusion of a chiropractic benefit in the Federal Employee
Health Benefits plan, which is administered by BCBS.
• Blue CCHiP program. A liaison program (Blues/Chiropractic Clinical Health
plan Program) now allows chiropractors to become integrated into local BCBS
medical policymaking committees across the country.
• Change in CMS policy. As a result of the federal lawsuit, HHS issued a new
policy directive that, under Medicare, physical therapists cannot provide
manual manipulation of the spine to correct a subluxation.
• Medicare access. CMS issued a policy directive that “manual manipulation
of the spine to correct a subluxation” must be made available to Medicare
beneficiaries in all Medicare managed-care organizations and Medicare+Choice
plans.