Articles by JCS

Fore, Ladies!

Can Chiropractors Play, Too?

 

Fore, Ladies!

By

JCS

 

For the first time in its 80-year history, Augusta National Golf Club has female members.

The home of the Masters, under increasing criticism the past decade because of its all-male membership, invited former Secretary of State Condoleezza Rice and South Carolina financier Darla Moore to become the first women in green jackets when the club opens for a new season in October. Both women accepted.

"This is a joyous occasion," Augusta National chairman Billy Payne said Monday.[1]

        Undoubtedly the appearance of women at the sanctified Augusta National Golf Club will “tee off” some staid members, not unlike James Carville at a Tea Party meeting, Ted Nugent at a Gay Rights rally, or Rep. Todd Akin (R-MO) at Planned Parenthood. Indeed, women members at Augusta, who would have thunk?

This ten-year war of words first gained national attention in 2002 when Martha Burk of the National Council of Women's Organizations urged the club to include women while former club chairman Hootie Johnson dug in his heels, just like Gov. George Wallace stood defiantly in the doorway when the first African-American students entered the University of Alabama in June, 1962.

Times have changed since that glimpse of a bygone era, but Augusta National still considers itself “socially conservative,” which euphemistically describes a club that also didn’t allow black members until 1990 and required that all caddies be black.[2]

Recall a young man named Tiger helped soften Augusta’s attitude toward black golfers. Obviously winning has its privileges, even to Jim Crow. In the early 1970s Bama coach Bear Bryant introduced the first black footballers who helped to change the South’s segregationist attitude. Imagine the SEC without black players today!

Of course, we all should applaud Billy Payne’s courage to address an obvious discriminatory policy in the full view of the nation, but I doubt the women’s inclusion will be of great social significance as, for example, the full integration of chiropractors into the American healthcare delivery system.

The Medical Bastille

Golf privileges for a few rich ladies would be pale in comparison to hospital privileges for chiropractors in every public hospital. However, it will be more difficult to get a chiropractor into the local hospital since the all-powerful American Medical Monopoly Association stands just as defiant as Gov. Wallace in the doorway of most hospitals to ban chiropractors.

There is one huge difference worth mentioning between Augusta National and public hospitals. Augusta National is a private club that legally is allowed to include or exclude anyone it wants. In regards to public hospitals, one would assume any professional with a state license could practice per patient request. After all, it is a public facility, not private, and informed consent is a law, not an option, nowadays.

Indeed, it is shocking that one trade association can take over a public facility to the exclusion of all competitors. This issue, of course, was addressed at the Wilk v. AMA antitrust trial that litigated the boycott of DCs in hospitals. Ironically, it was a shallow victory because the medical staff alone at every public hospital still decides who is invited on staff.

That’s equivalent to the South losing the Civil War, but the Confederates stayed in power and slavery remained in tact.

This unabridged power is one reason why the AMA was once described as “the most terrifying trade association on earth,” which it remains today.[3] Until public hospital staffs are filled according to merit, we will continue to have autocratic medical staffs devoid of diversity.

Jim Crow, MD

The history of the AMA’s prejudice is not immune to racial controversy, either.  If Augusta National is considered “socially conservative,” the AMA makes the Tea Party seem like a bunch of Berkeley radicals.

Few people understand the AMA’s intransigence to social change is painfully similar to Augusta considering its historical racism when even African-American medical doctors weren’t allowed to join local medical societies or the national AMA.  However, in 2008 with the impending election of our nation’s first black president, the AMA hastily issued a public apology to its black members after years of discrimination. [4]  

While black MDs were forced to sit in the back of the medical bus for decades, lest we forget chiropractors were thrown under the same bus when over 12,000 American chiropractors were prosecuted over 15,000 times, and some 3,300 were sent to jail for practicing without a license in the first half of the 20th century. [5]

When the AMA apologized to black MDs, it would have been an excellent opportunity to issue an apology to the chiropractic profession for its illegal persecution.  Alas, no such contrition was forthcoming from the medical profession whose Committee on Quackery’s stated goal was “to contain and eliminate the chiropractic profession.”[6]  

Throughout the Wilk trial testimonies, the AMA’s witnesses were unrepentant despite the incriminating evidence. After the verdict, the AMA offered no tabula rasa to reconstruct the damaged chiropractic image and no public mea culpa to apologize for its past transgressions like the medical hate speech and trash-talking that chiropractors and patients still hear today.

Judge Susan Getzendanner noted in her Opinion that “Labeling all chiropractors unscientific cultists and depriving chiropractors of association with medical physicians, injury to reputation was assured by the AMA’s name-calling practice.”[7] She also admitted that “The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”[8] 

Again, it resembles the Civil War when slavery ended, but racism continued with Jim Crow laws and segregation.

Dr. Michael Pedigo , one of the Wilk chiropractic-plaintiffs, said he and other chiropractors wanted “to be allowed to compete freely in the marketplace.”[9] Sadly, his hope remains unfulfilled with chiropractors in the medical ghetto considering only six percent of chiropractors in 2009 had hospital privileges according to the American Chiropractic Association.[10]

Considering chiropractors now constitute the third-largest physician-level health profession in the country battling a pandemic of back pain, the continued boycott of chiropractic should resonate loudly to a suffering humanity and to a bankrupt healthcare system. It also bears witness to the corruption in our public hospitals when chiropractors are not on staff everywhere.

In fact, few people realize the number of back pain patients and the staggering costs. Musculoskeletal disorders (MSDs) alone currently cost our society an estimated $267.2 billion every year[11], and when combined with all persons with MSDs in addition to other medical conditions, the cost of treatment in the 2002-2004 time period was estimated to be $849 billion per year.[12]

Although not deadly like heart disease or cancer, back pain will strike most of the 250 million American adults sometime in their lifetime.[13] Chronic low back pain is huge with a daily prevalence in the general adult population estimated at 37%, which equates to 92.5 million people; the annual prevalence is 76%, which equates to 190 million; and the lifetime prevalence is 85% or 212.5 million adults.[14]

In this era of evidence-based healthcare, the proof is positive and research studies cannot be clearer that chiropractic stands at the top of spinal treatments as Anthony Rosner, PhD, testified before The Institute of Medicine: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[15]

Chiropractors to the Rescue of MDs

Not only do chiropractors help millions of patients already, as luck would have it, now they stand to help the beleaguered medical practitioners when Obamacare introduces millions of patients into the system that will require 100,000 more primary care physicians.[16]

Considering the millions of patients with back pain, the inclusion of 80,000 chiropractors as America’s primary spine care providers is a logical solution to this dilemma, a concept now encouraged by many spine experts.[17]

This tsunami of 30+ million more patients will exacerbate an already burdened medical profession. The Mayo Clinic now reports nearly 1 in 2 (45.8%) of the nation's doctors already suffer a symptom of burnout.[18] Apparently being a monopoly has unintended consequences.

Not only are half of MDs burned out and in need of help, research has shown the medical primary care physicians are among the least educated to diagnose musculoskeletal problems.[19]  New studies have confirmed that most (82%) medical primary care physicians are inept in their training on musculoskeletal disorders,[20] more likely to ignore recent guidelines[21], and more likely to suggest spine surgery than surgeons themselves.[22]

Scott Boden, MD, currently director of the Emory Orthopaedic and Spine Center in Atlanta, admits that  “Many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”[23]

       As well, many physicians also suffer from “professional amnesia” when they inexcusably forget to inform patients that chiropractic care is a recommended option to the often ineffective and expensive medical methods consisting of narcotics, epidural steroid injections, and spine surgery based on an outdated disc theory.[24]

Time to End Medical Bigotry

If Augusta National can break its tradition of racism and sexism, it’s past time for the medical profession to end its own brand of bigotry toward chiropractors.

The covert embargo of chiropractors has not only hurt the image and incomes of thousands of DCs, it has also harmed the health of millions of Americans who suffer from back pain and the subsequent billions of dollars that could be drastically reduced if DCs were fully emerged as primary spine care providers in public hospitals, workers’ comp, and all health programs as they are legally entitled to do.

Indeed, after a century fighting in the medical war, chiropractors have been imposed unfair handicaps—they’ve had to tee off from the furthest back tees, forced to play through an unyielding medical opposition trying to slow them down, to shoot from the fairway’s deepest bunkers and the highest rough with one hand tied behind their backs, and yet they continue to score birdies of successful cases and even the occasional hole in one.

Just give chiropractors an equal opportunity to prove their effectiveness in match play on a level field, and then the entire American gallery will see the benefits of chiropractic care. Indeed, it’s past time for chiropractors to play, too.



[1] ESPN.com news services Monday, August 20, 2012

[2] Susan Barnett, Behind the Stories: Public Radio's 51%, Feminist.com

[3] MS Mayer, “The Rise and Fall of Dr. Fishbein,” Harper’s Magazine (Nov. 1949): 78.

[4] AMA apologizes to black doctors for past racism, by Lindsey Tanner, AP Medical Writer Thu July 10.

[5] Russell W Gibbons, “Go to Jail for Chiro,” Journal of Chiropractic Humanities 4 (1994): 61–71.

[6] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987):PX-172 November 11, 1962.

[7] Associated Press, “U.S. Judge Finds Medical Group Conspired Against Chiropractors,” New York Times, (August 29, 1987) 140.

[7] S Getzendanner, ibid.

[8]Chester A. Wilk, James W. Bryden, Patricia A. Arthur, Michael D. Pedigo v. American Medical Association, Joint Commission on Accreditation of Hospitals, American College of Physicians, American Academy of Orthopaedic Surgeons, United States District Court Northern District of Illinois, No. 76C3777, Susan Getzendanner, Judge, Judgment dated August 27, 1987.:10  

[9] G McAndrews, closing arguments, Wilk v. AMA, (June 26, 1987):3093-97.

[10] N Schetchikova, “For the Good of the Patient: The Integrative Chiropractor,” ACA News 5/3 (March 2009):12-15.

[11] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 21.

[12] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 195.

[13] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 21.

[14] Scott Haldeman DC, MD, PhD, FRCP(C) and Simon Dagenais DC, PhD. A supermarket approach to the evidence-informed management of chronic low back pain. The Spine Journal, vol. 8, Issue 1, January-February 2008, Pages 1-7.

[15] Testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.

[16] Ashley Halsey III, Primary-Care Doctor Shortage May Undermine Health Reform Efforts, Washington Post, June 20, 2009

[17] Donald R Murphy et al.,  “The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States,” Chiropractic & Manual Therapies 2011, 19:17 doi:10.1186/2045-709X-19-17

[18] Janice Lloyd, Doctor burnout: Nearly half of physicians report symptoms, 8/21/2012, USA TODAY

[19] AD Woolf, B Pfleger, “Burden of Major Musculoskeletal Conditions,” Bull World Health Organ 81/09 (2003):646-656.

[20] EA Joy, S Van Hala, “Musculoskeletal Curricula in Medical Education-- Filling In the Missing Pieces, The Physician And Sports Medicine,” 32/11 (November 2004).

[21] PB Bishop et al., “The C.H.I.R.O. (Chiropractic Hospital-Based Interventions Research Outcomes) part I: A Randomized Controlled Trial On The Effectiveness Of Clinical Practice Guidelines In The Medical And Chiropractic Management Of Patients With Acute Mechanical Low Back Pain,” presented at the annual meeting of the International Society for the Study of the Lumbar Spine Hong Kong, 2007; presented at the annual meeting of the North American Spine Society, Austin, Texas, 2007; Spine, in press.

[22] SS Bederman, NN Mahomed, HJ Kreder, et al. In the Eye of the Beholder: Preferences Of Patients, Family Physicians, And Surgeons For Lumbar Spinal Surgery,” Spine 135/1 (2010):108-115.

[23] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28 (2003):524-525.

[24] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.

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