Articles by JCS

One-Drop Rule

One-Drop Rule

The tragedy in Charlottesville brought new attention to bigotry and white supremacy in a most unusual manner from a testimonial by a graduate of the University of Virginia medical school.

On August 14, 2017, Dr. Jennifer Adaeze Okwerekwu, wrote a heartfelt editorial in STAT about her experiences as an African-American female doctor enduring racist patients, “I went to medical school in Charlottesville. I know white anger well.”

“The response to the violence in Charlottesville has had its fair share of denial — people saying, this is not the city I know, the protesters came from elsewhere, this is not the America I know.

“Such statements are infuriating.

In Charlottesville, this was exactly the America I knew. This was the Virginia I knew. This was the medicine I knew… a few weeks ago, an angry patient kept referring to me as ‘that woman.’ Another patient refused to look at me, a black doctor, as she believed black people, ‘are more prone to violence.’

“This is the America I know, the medicine I know. Bigotry in a hospital gown — it’s a risk I face every day when I go into work.”

Welcome to the world of medicine, Dr. Okwerekwu, because this is the “bad medicine” every chiropractor knows too well. Indeed, you are not alone; you’re among good company as a minority in a white male medical monopoly.


I under
stand your moral outrage, Dr. Okwerekwu, since the “bigotry in a hospital gown” you experience because your roots go back to Africa is an issue chiropractors still deal with because our roots go back to Davenport.

Dr. Okwerekwu, we chiropractors feel your pain and humiliation as the object of scorn and bigotry. While some racist patients and physicians may call you the “N-word” behind your back, few will ever call you to your face a “quack, rabid dog or dangerous killer.”

 Little does Dr. Okwerekwu realize in the first half of the 20th century over 12,000 chiropractors were arrested over 15,000 times and 3,300 spent considerable jail time for allegedly practicing medicine without a license when, in fact, chiropractors never prescribed medicine.[1]

Their real crime was getting patients well without drugs and competing with MDs who prefer a monopoly over free enterprise on a level playing field.

Jim Crow, MD

Just as Jim Crow laws prevailed to keep black people oppressed and segregated, so were Jim Crow, MD, medical policies to exclude minority practitioners and chiropractors from public hospitals.

Take heart, Dr. Okwerekwu, at least the AMA offered an apology to black physicians in 2008 for its "past history of racial inequality towards African-American physicians."

"The AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine," said AMA Immediate Past President Ron Davis, MD, in a commentary published in the July 16 Journal of the American Medical Association.

We know his apology is disingenuous occurring only after Barack Obama was elected president in order to show contrition by the “noble profession” of medical supremacists; otherwise this fauxpology would never have happened.

Not only should the AMA apologize for suppressing African American physicians, it should also apologize to chiropractors for the defamation committed to advance the AMA’s stated goal to “contain and eliminate the chiropractic profession.”

As well, the AMA ought to apologize to the public for dissuading MD referrals to chiropractors that has led to the biggest drug crisis of addiction and deaths this nation as ever experienced.

A case can be made the current epidemic of opioid abuse can be traced to an illegal decades-long defamation campaign against chiropractors by the AMA that has led to millions of opioid addictions and unnecessary back surgeries considering the majority of legal narcotic painkillers are prescribed for LBP[2] that DCs can help without drugs or surgery.

Indeed, the AMA has a lot of explaining “across the span of a century” for its discrimination and harm done to many people.

One-Drop Rule

This medical supremacist attitude reflects a recent newspaper editorial by columnist Cal Thomas, “Tragedy in Charlottesville”:

In the South during the Jim Crow era, the “one-drop rule,” codified into law, asserted that if a person had just one drop of African-American blood, they were considered “black.”

Apparently this “one-drop rule” exists in medical care: if a practitioner had one drop of chiropractic training, cooperation or sympathy, it disqualified him/her from the same privileges in hospitals and might have led to revocation of his/her medical license.

This became a focal point at the Wilk v. AMA antitrust trial when evidence revealed medical physicians had to comply with “The Principles of Medical Ethics[3] to boycott chiropractors under the threat of losing their licenses or hospital privileges.

Nor were MDs allowed to teach or speak at chiropractic colleges or seminars. In 1962-3, the boycott began in earnest by the AMA’s Committee on Quackery to segregate chiropractors from mainstream medicine and, most of all, to keep them out of public hospitals.

At the heart of these misguided ethics was Principle 3 that stated:

“A physician should practice a method of healing founded on scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle.”[4]

To put pressure on its members who wouldn’t comply, the AMA passed another illegal policy, Principle 4, requiring each member to snitch on his colleagues under the same threat:

“The member should expose without hesitation unethical conduct of fellow members of the profession.”[5]

“Unethical” in this case was not practicing bad medicine but associating with DCs for the good of their patients. At the Wilk v. AMA trial George McAndrews referred to liberal MDs who cooperated with DCs as the “flowers in the desert” – there were a few brave souls, but not many.

To cite an historical analogy, recall the Nazis also used similar laws to persecute Jews and those friendly to them. According to the article, Anti-Jewish Legislation in Prewar Germany, the persecution of Jews represented a central tenet of Nazi ideology:

In their 25-point Party Program, published in 1920, Nazi party members publicly declared their intention to segregate Jews from "Aryan" society and to abrogate Jews' political, legal, and civil rights.

In April 1933, German law restricted the number of Jewish students at German schools and universities. In the same month, further legislation sharply curtailed "Jewish activity" in the medical and legal professions. Subsequent laws and decrees restricted reimbursement of Jewish doctors from public (state) health insurance funds.

Is this not similar to the Committee on Quackery’s goal to contain and eliminate chiropractic?

Bigotry is Bigotry is Bigotry

The parallel between medical supremacy and Nazi supremacy is obvious — discrimination in hospitals against DCs was widespread, credit was never given to DCs despite the emerging evidence of the success of spinal manipulative therapy (SMT), and good MDs were living in fear if their cooperation with DCs was discovered.

The discrimination against chiropractors also applied to medical journals. For example, John “Jay” Triano, DC, MA, PhD, formerly at Canadian Memorial Chiropractic College and the Texas Back Institute, tells the story about his first submission in 1981 to the medical journal Spine when he was notified the editor would not use the DC degree in his byline.

Henry La Rocca, MD, the editor of Spine, felt the discrimination was appropriate when he wrote to Dr. Triano:

“Please be advised that it is the policy of Spine to print only designations indicating University degrees or equivalent… Therefore, we would propose to acknowledge your M.A. degree only.”

 

 

DD Palmer also encountered medical prejudice over a century ago; imagine an innovative health researcher explaining new health concepts such as neurophysiology, structure affecting function, and “tone” to a profession of allopathic germ theorists:

It is a pity that the medical professionals are possessed of arrogance instead of liberality; that instead of encouraging and fostering advanced ideas, they stifle and discourage advancement; that they only adopt advanced ideas when they are compelled to do so by public opinion.”[6]

Methinks the same situation exists today after the release of the updated American College of Physicians (ACP) and JAMA guidelines recommending SMT before medical spine care treatments. It will be interesting to discover how many MDs will now refer back pain patients to chiropractors, but don’t hold your breath — evidence-based guidelines may have no impact to “fostering advanced ideas”, just as the 1964 Civil Rights Act did not end racism or segregation as we witnessed in Charlottesville.

Medical Supremacy: Another Type of Hate Crime

It’s not a long leap today to equate white supremacy with medical supremacy.

In fact, many medical men are quite outspoken about their medical bias, such as the medical trolls at Science Based Medicine.

Just as the KKK members are proud of their racism and supposed white supremacy evident by their public display of white hoods, robes, and burning crosses, so are those wearing white jackets in hospitals.

Nortin M. Hadler, MD, MACP, MACR, FACOEM, Emeritus Professor of Medicine and Microbiology/Immunology at University of North Carolina, is an author of many controversial books on medical issues, including Stabbed in the Back, his foray into the back pain epidemic.

Dr. Hadler’s book was intended as a figurative stab in the back of the chiropractic profession. Not surprisingly, like a proud medical supremacist, he admits to his burning cross:

I admit to chauvinism; I value my profession above all others to the extent that it tests the limits of certainty regarding the validity of its therapeutic offerings… I also write extensively on how its practitioners hear a higher calling.

Medicine has achieved so much in the past fifty years that it merits and commands a perch atop the contemporary pecking order of healers.”[7]

There are many clues in his one paragraph about his supremacy: “…chauvinism…hearing a higher calling…a perch atop the contemporary pecking order of healers…my profession above all others…”

His comments are painfully reminiscent of another chant, “Deutschland über alles,” by white supremacists who believed their Ayrian race was superior to people of color, nationalities, immigrants, and people of other faiths. Hadler could not have been clearer.

Certainly Dr. Hadler suffers the “halo effect”, an “unflinching faith in medicine and a naïve optimism” to forego any critical appraisal.[8]

When the "halo effect" is combined with “chirophobia” – the medical bias against chiropractors, LBP patients are easily persuaded onto the medical gravy train to drugs, shots, and surgery without any detour beforehand to the chiropractor’s office as the new guidelines recommend.

Don’t Look Behind the Curtain

As a rheumatologist who prefers drugs in spine care, no doubt Dr. Hadler was unhinged by the American College of Physicians for treating nonradicular low back pain that do not recommend OTC meds as a first-line approach as it once did in its 2007 guideline before evidence revealed the dangers and ineffectiveness of OTC drugs and prescription painkillers. 

As Donald Teater, MD, of National Safety Council said, “Opioids do not kill pain. They kill people.”[9]

Hadler also might be stunned at the recent reports such as  ibuprofen was associated with a 31% increase in heart attack risk or the study finding Pregabalin (Lyrica) was no help for sciatica. Another recent study at the VA clinic in Minneapolis by Erin Krebs, MD, found opioids were no more effective than Motrin, which also has an arm’s length of side effects.

Ironically, Hadler’s favorite tools have all been shown ineffective and dangerous – his burning cross has flickered out.

Instead of admitting the failure of his preferred drugs, like Don Quixote, Hadler wastes his time fighting chiropractic windmills:

“Subluxations are the chiropractic diagnosis that implies spinal malalignment. They are imaginary; no such specific skeletal changes correlate with symptoms.” [10]

I will refrain from explaining to this medical chauvinist the concepts of neurophysiology, but a quick scan of this website about spinal-visceral reflexes might do quite well to get such allopathic curmudgeons up the learning curve.

Scientific Flip-Flop

Aside from Hadler’s ignorance of neurophysiology and spinal biomechanics, let me illustrate his intellectual conflict of interest as a researcher.

A 1987 study in Spine by the same NM Hadler, Peter Curtis, et al., A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-Back Pain: A Stratified Controlled Trial,” found patients hurting for two to four weeks experienced a 50 percent reduction in score more rapidly with spinal manipulation. Hadler concluded “the ability to abrogate an episode of backache, even by a few days, has major ramifications.”[11]

In this study, SMT was rendered by Peter Curtis, an MD at UNC, not a DC. Apparently patients being helped by an MD (who undoubtedly has inferior training in SMT than a DC) is still better than a lowly chiropractor in the eyes of Hadler.

Surprisingly, when the AHCPR panel in 1994 recommended SMT as a “proven treatment,’ Hadler took another cheap shot at manipulation in his book despite being a Special Consultant to the panel:

“However, at best this is much ado about very little. Certainly, it is little reason to advocate a form of sectarian medicine.” [12]

Doesn’t it seem odd in 1987 when he and Curtis did research on LBP, Hadler concluded SMT to have “major ramifications, but when a prestigious panel of experts at AHCPR in 1994 endorsed SMT as a “proven treatment,”[13] suddenly Hadler flip-flops from touting the “major ramifications” of spinal manipulation to describing the benefits of chiropractic care as “much ado about very little.”

Obviously Hadler may be fearful of having “one-drop of chiropractic blood” on his medical résumé if he supports this “sectarian medicine.” BTW: “sectarian” is medical code for cult – his “N-word” for chiropractors.

Dr. Hadler’s conflicted opinion should be seen as irrational hate speech from a misguided medical supremacist tainted by the “one-drop rule” – in this case, chirophobia.

While professing to be expert on spine problems, Dr. Hadler also reveals his ignorance:

“Acute neck pain following a minor accident is in small part related to the violence of impact. However, biomechanics has little if anything to do with the persistent neck pain or the other manifestations of WAD [whiplash associated disorder].”[14]

Once you stop laughing at his assertion, keep in mind he offers no proof and probably still mistreats WAD patients with his cornucopia of medications.

Despite the growing popularity of chiropractic care and CAM, Hadler continues to mock them as “folk remedies”:

“I have long been fascinated by the staying power of folk remedies such as back cracking. Clearly some, and perhaps nearly all, folk remedies are simply delusional idiosyncrasies of culture. But back cracking is sufficiently distinctive to foster entire schools of sectarian medicine. Are the practitioners self-deluding and their patients seduced by placebo events?”[15]

Once again just look at the number of insults he said in one paragraph:

“…folk remedies…back cracking…delusional idiosyncrasies…sectarian medicine…self-deluding…seduced by placebo events…”

Indeed, his chirophobia knows no bounds. I daresay Hadler probably never learned how to play fair in Kindergarten either.

Apparently in 2009 Hadler realized he was on the wrong side of history with his claim chiropractic care is placebo when he back-tracked after the AHCPR report:

“When it comes to regional back pain, however, the chiropractic has staked out its turf. Two of the stakes are driven quite deeply: first, spinal manipulation as a modality may not always be a placebo; and second, many who avail themselves of the chiropractic perceive themselves better off for the efforts.”[16]

Geez, Dr. Hadler, thanks for the corrections, but let me also correct your bad grammar: it’s not “the chiropractic,” but only “chiropractic.” His continual slurs of our profession again typify his disdain even when the facts fall on our side—it just sticks in his craw to give any praise to chiropractors.

Like Jim Crow, Hadler just cannot accept Jackie Robinson should be in Major League Baseball.

Undoubtedly with the new 2017 guidelines, I wonder what Hadler and Curtis would say now since SMT has been shown to be better than anything the medical world has to offer for chronic LBP such as opioid painkillers, OTC meds, ESI, radiofrequency denervation (RFDN)[17] or disc fusions for chronic back pain patients.

Hadler remains unrelenting in his criticism and continues to show his ignorance: “Furthermore, we still have no earthly idea what causes regional low back pain.”[18]

Ironically, Hadler’s ignorance is obvious as someone who is unlearned about chiropractic but quite willing to condemn chiropractors who do know something about what causes LBP.

Dr. Hadler is not alone in his quandary. Dr. Marc Siegel at FOX News admitted medical primary care providers have only 9 hours of education on “back” and he blamed the opioid epidemic on his own colleagues and pharmacists. “We’re getting a growing awareness of two things: the abuse of back surgery and the abuse of opioids.”[19]  

Hadler’s Hocus-Pocus

Obviously Hadler is clueless and unwilling to understand why chiropractic care works so well. Just as he is ignorant of neurophysiology and spinal-visceral reflexes, he is also clueless about spinal biomechanics and the concept of joint play of the 364 joints in the spinal column as a source of pain and impairment.[20]

To help him up the learning curve, two studies by Drs. Donald Murphy and Eric Hurwitz found joint dysfunction was the cause of neck pain in 69% of cases and the cause of low back pain (lumbar and sacroiliac) in 50% of patients.[21]

Perhaps Hadler should also read Dr. John McMillan Mennell’s book, The Musculoskeletal System, or read his testimony at the Wilk v. AMA antitrust trial:

“Eight out of 10 patients that come out of any doctor’s office complain of a musculoskeletal system problem regardless of from what system the pain is coming…I will say 100% of those complaints, which are, in fact, due to joint dysfunction in the musculoskeletal…If you don’t manipulate to relieve the symptoms from this condition of joint dysfunction, then you are depriving the patient of the one thing that is likely to relieve them of their suffering.”[22]

In a rather strange note, Hadler wrote in Stabbed in the Back about a demonstration of medical manipulation he once witnessed by pioneer Dr. James Cyriax, the Father of Orthopedic Medicine, and his skewed opinion was evident when he said, “To my eye, it was hocus-pocus.”

He further insults Dr. Cyriax with his cynical comment:

“I have never felt comfortable performing manipulation, recommending manipulation, or letting anyone crack my back. But no other modality has even this much scientific support.”[23]

For someone not trained in SMT, his reluctance to perform SMT is understandable and I agree he should never attempt manipulation. As well, his fear to let anyone “crack” his back, suggesting the likelihood of fracture, undoubtedly stems from the AMA’s own propaganda about the dangers of manipulation, not based in fact but upon fear-mongering.

However reluctantly, he did admit “no other modality has even this much scientific support.” I can hear him grinding his teeth in disgust to admit the truth. “Okay, maybe Jackie Robinson can play baseball.”

Haters Will Hate

You can see his pattern—rather than giving credit where it is due, he conjures up outrageous bogus reasons why chiropractic care works so well and then misconstrues the positive evidence with his mumbo-jumbo explanations based on bigotry, not on facts.

Reading his book was frustrating; his grandiloquence confuses rather than clarifies, which was probably his purpose to talk over people’s heads to make himself appear smarter than anyone else — another part of his medical chauvinism and the “halo” effect to be sanctimonious.

I do agree with Dr. Hadler on one comment: “The pen may be mightier than the sword, but it is not mightier than the dollar.[24]

Undoubtedly, the AMA wields many swords on Capitol Hill, led by Sec. Tom Price as their champion, and Big Pharma controls the medical media and public mindset with its incessant TV ads promoting its “pill for every ill.”

The only way to dethrone this medical chauvinist is in a war of words with the new guidelines, not political swords, but that may be a wasted effort trying to convince haters not to hate.



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

[2] Denise Boudreau, PhD, et al. “Trends in De-facto Long-term Opioid Therapy for Chronic Non-Cancer Pain,” Pharmacoepidemiol Drug Saf. 2009 December ; 18(12): 1166–1175.

[3] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987):21.

[4] Ibid.

[5] Ibid.

[6] Pierre-Louis Gaucher-Peslherbe, DC, PhD, “Chiropractic: Early Concepts in Their Historical Setting,” National College of Chiropractic publisher, 1993, pp. 543-49.

[7] Hadler, NM, Stabbed in the Back; confronting back pain in an overtreated society, University of North Carolina Press, 2009, pp. 56

[8] Hoffman TC, Del Mar C, Great expectations: our naïve optimism about medical care, The Conversation: Academic Rigor, Journalistic Flair, December 22, 2014;

[9] Da Hee Han, PharmD, “Survey Finds Most Doctors Prescribe Opioids for Longer Than CDC Advises,” MPR Daily Dose, March 28, 2016

[10] Hadler, NM, ibid. pp. 68

[11] NM Hadler, P Curtis, DB Gillings, S Stinnet, “A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-Back Pain: A Stratified Controlled Trial,” Spine  12/ 7 (1987): 705.

[12] Hadler, ibid. p. 70

[13] AHCPR publication No. 95-0644, Patient Guide, Dec. 1994, p.7

[14] Hadler, ibid. p. 58.

[15] Hadler, ibid. p. 68

[16] Hadler, ibid. p. 68

[17] Ostelo R et al., Effectiveness and cost effectiveness of radiofrequency denervation for chronic low back pain originating from the facet joints, presented at the International Forum for Back and Neck Pain Research in Primary Care, Buxton, UK, 2017.

[18] Hadler, ibid. p. 5

[20] Cramer, G.; Darby, S. 2014 Clinical anatomy of the spine, spinal cord, and ANS. 3rd Edition, Elsevier/Mosby, St. Louis, 559 illustrations, 672pp. Appendix I, pp. 638-642.

[21] Donald R Murphy and Eric L Hurwitz, Application of a diagnosis-based clinical decision guide in patients with neck pain, Chiropractic & Manual Therapies 2011, 19:19 
Donald R Murphy and Eric L Hurwitz, “Application of a diagnosis-based clinical decision guide in patients with low back pain,” Chiropractic & Manual Therapies 2011, 19:26

[22] Transcript of testimony of John McMillan Mennell, MD, Wilk v AMA transcript, pp. 2090-2093.

[23] Hadler, ibid, p.70

[24] Hadler, ibid, p.88

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