Articles by JCS

RWJF

 

 

The War on Chiropractors

The Call for Reform in Spine Care

Submitted by

JC Smith, MA, DC


 

 “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.”[1]

Anthony Rosner, PhD, testimony before The Institute of Medicine


Introduction

“Low back pain has been a 20th century health care disaster. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem...It [back surgery] has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”[2]

Gordon Waddell, DSc, MD, FRCS, orthopedic surgeon, and author of The Back Pain Revolution.

The Robert Wood Johnson Foundation is dedicated to improving health care in America and my proposal will hasten that goal to lower costs and improve outcomes in the field of spine care. The present medical spine care treatments have proven for the majority of back cases to be ineffective, outdated, and terribly expensive. Consequently, the call for reform in spine care grows louder daily amongst researchers, but the public remains deaf to this urgency for reasons discuss in this proposal.

Although back pain may not be as deadly as heart disease, cancer, or medical mistakes[3], it is a pandemic of pain suffered by ~90% of adults that is only getting worse because the primary spine care providers—chiropractors—have been boycotted and stigmatized by the medical profession and the media.

The medical War on Chiropractors has been waged for nearly a century in a classic David vs. Goliath battle. Recognizing its immense power and influence, in 1949 Harper’s Magazine aptly described the AMA as “the most terrifying trade association on earth.”[4] Indeed, to fight the might of the AMA is a battle unlike all others and a war fought by chiropractors alone.

This unique war combines many factors never seen in other social battles. The medical War on Chiropractic is multifaceted and fueled by professional chauvinism, clinical exploitation of patients, economic monopolism by one trade association, academic demagoguery, and a complicit press. It is now a prejudice deeply ingrained into the public.

Although racism and sexism once were deemed politically-correct in the annals of our society, turning points such as the Civil Rights movement and Women’s Suffrage movement began to change the tide of public opinion against these forms of discrimination. The goal of this exposé is to create a similar tipping point by showing the American public the undeniable misdeeds of this medical war that have been suppressed for decades by a complicit media.

This continuing dilemma was evident in a 1984 poll in Oklahoma that revealed one respondent who said, “Chiropractors are seen as being fine for many people in the community, but ‘I wouldn’t want my daughter to marry one.’[5]

This shocking, simple comment is a profound statement that requires serious explanation to understand, which is the goal of this documentary—a socio-political-historical review of the plight of the chiropractic profession.

Indeed, the primary goals of this documentary, the War on Chiropractic, will trigger this tipping point by focusing on three issues:

1) To present the history of the medical war on chiropractors and the damage the AMA did to the reputations of chiropractors whose only crime was competing with the medical profession. This documentary will explain the source of the soiled reputation of chiropractors as a result of the AMA’s campaign to eliminate competition by any means possible. This will be a huge breakthrough to repair the image of the chiropractic profession to its rightful place as the primary spine care providers.

2) To present the new research that vindicates the superiority of chiropractic care over medical care for 85% of the non-specific, mechanical low back pain cases (the other 15% have cancers, fractures, infection, or cauda equina that require medical spine care). It will also teach the public that according to modern research chiropractic is a preferred first avenue of treatment to drugs, shots, and spine surgery for the majority of spine cases.

3) To illustrate the potential cost savings to medical spine care if chiropractors were the primary spine care providers as many experts now suggest.[6] Most importantly, it will save millions of adults from unnecessary spine surgery, addictive narcotics, and a life of disability.

But these goals will not occur until there is a paradigm shift in the conventional wisdom and away from the perceived wisdom formed by the illegal slander from the AMA in its War on Chiropractic. Until this medical prejudice is understood for what it is—medical hate speech—and how it developed, the public will continue to be swayed by unethical MDs profiteering with inferior medical spine treatments. It is time to recognize chiropractors as the primary spine care providers.


The War on Chiropractic

This documentary is very apt today with the growing number of social injustices now dubbed “wars”, such as the initial War on Civil Rights, later the War on Poverty, the War on Women, and the latest outcry over the War on Marriage, the conservative response to President Obama’s support for Gay Rights.

It is past time to add one more injustice to this timeline—the medical War on the Chiropractic profession. Although most people are aware of the animosity between the two professions, they have no idea of the magnitude of historical events, the main characters, or issues involved in this war.

Although the medical profession has declared Wars on Cancer, Obesity, and Heart Disease, unquestionably the AMA has fought its longest and most vicious War on Chiropractic. Few people realize in the first half of the 20th century, over 12,000 chiropractors were arrested for allegedly practicing medicine without a license when, in reality, they never used drugs or surgery. Ironically, their real crime was getting people well without drugs or surgery.[7]

The evidence is mounting that this medical war eventually will be considered on the wrong side of history, but that tipping point has not happened yet due to the lack of public awareness due to a biased and complicit media. Sadly, most Americans are unaware of medical bigotry. The trustworthy Marcus Welby, MD, imagery is very strong in the minds of most people since they have rarely seen the ugly political side of medicine. MDs are constantly portrayed as heroes except for the rare role of villain as seen in The Fugitive with Harrison Ford.

What makes the War on Chiropractic unique is that medical bigotry remains an “acceptable” prejudice that has rarely been exposed or reviled as another form of discrimination. It is also a prejudice that has forced many gullible patients into unnecessary medical treatments by discrediting the main alternative—chiropractic care for the epidemic of back pain.

By today’s standards, the medical propaganda against chiropractors would be considered “hate speech,” which is, by definition, any communication that vilifies a person or a group on the basis of race, color, ethnicity, gender, disability, sexual orientation, nationality, religion, or other characteristics.[8],[9] In this regard, “other characteristics” includes any healthcare method other than drugs and surgery.

In law, hate speech also may incite violence or prejudicial action against or by a protected individual or group. This ploy is exactly what the AMA’s Committee on Quackery had in mind when it announced its goal to destroy the chiropractic profession.

“The ultimate objective of the AMA, theoretically, is the complete elimination of the chiropractic profession.”[10]

To accomplish this genocide, the AMA developed a massive PR campaign led by its Committee on Quackery. Like the Nazis defaming the Jews at every turn, the CoQ’s tactics left the chiropractic profession’s image with a soiled reputation by using epithets such as “quacks,” “unscientific cultists,” “killers,” and “rabid dogs.”[11]  

The judge at the Wilk v. AMA antitrust trial mentioned in her Opinion the damage done by the AMA to libel the image of chiropractors:

“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.” [12]

The judge also commented, The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations.”[13] The AMA was not required to compensate the thousands of chiropractors who went to jail for practicing chiropractic.  The judge also admitted, “Chiropractors suffer current economic injury as a result of the boycott,”[14] but no reparations were given to the thousands of chiropractic stalwarts who suffered from this boycott for nearly a century of conflict. Estimates suggest this medical boycott cost the chiropractic profession nearly $700 million from 1962 to 1976.

It is obvious the AMA still pursues the goal of its defunct Committee on Quackery with such insidious co-conspirators such as the present Institute for Science in Medicine. The overt war ended when the Wilk trial began, but it has now become a covert cold war to have “chiropractic wither on the vine” by restricting chiropractic care in workers’ comp, military health services, DVA, public hospitals, and group health insurance programs.[15]

Until this bias is openly confronted and chiropractic is given the chance to showcase itself in the court of public opinion, people will continue to believe the medical propaganda. After all, the public has been taught for nearly 100 years that “everybody knows that chiropractic is an unscientific cult.”[16] Yet chiropractors have never had the opportunity in the mass media to disprove that contention.

Unfortunately, hate speech was not considered a crime in 1976 when this trial began otherwise the AMA et al. would have been found guilty of far more heinous crimes than only antitrust activities to “contain and eliminative the chiropractic profession.”

This isn’t the first time the AMA has been accused of bigotry. For decades women and black MDs weren’t allowed to join local medical societies or the national AMA. In 2008 before the general presidential election and the great likelihood of our first black president, the AMA’s House of Delegates announced a formal apology for its historical racism toward African American medical doctors.[17] It was admirable that the AMA finally confessed to such professional racism.

However, while black MDs were forced to sit in the back of the medical bus, lest we forget, chiropractors were thrown under the same bus.

When the AMA issued a public apology to its black members for years of discrimination, it was an excellent time also to issue an apology to the chiropractic profession for its illegal persecution.  Alas, no such contrition was forthcoming from the medical profession as if the prejudice against chiropractic never existed, chiropractors were never jailed on spurious charges, and the antitrust trial never happened.  Indeed, there are many skeletons that remain hidden in the medical closet far from the public view and, foremost, is its insatiable desire to destroy chiropractic.

Further proof of the AMA’s antipathy toward chiropractic occurred in 2000 when the AMA snubbed a peace offering by the American Chiropractic Association. According to Howard Wolinsky of the Chicago Sun-Times:

The cold war between the Chicago-based American Medical Association and the American Chiropractic Association is heating up again, nearly a decade after the U.S. Supreme Court ordered the groups to bury the scalpel, the Chicago Sun-Times has learned.

In a Feb. 28 letter to the ACA, AMA Chairman D. Ted Lewers said, "It is our understanding that the ACA desires to meet with the leadership of the AMA in order to `focus on those issues we have in common.' However, the AMA has a different view and no desire for such a meeting." [18]

This snub not to make peace with chiropractic should come as no surprise to anyone familiar with the War on Chiropractic. Even after its defeat in the Wilk v. AMA trial, the medial leadership remained defiant. While Jim Crow remained rebellious after the end of the Civil War, Jim Crow, MD, is just as resolute in his bigoted convictions.

This medical War on Chiropractic documentary will expose a conflict most people vaguely realize but do not fully grasp. Nor do they understand the impact it may have upon their own health since nearly 90% of adults will suffer from an acute low back pain episode and, if given the druthers of organized medicine, these patients will receive the most expensive rather than the most effective treatments.

The goal of this film is to make conscious what is now obscure and confusing to most everyone. It is past time to create a cognitive dissonance in the public’s mind about this War on Chiropractic—to create a rational national discussion between the medical propaganda and the facts of scientific spine care research supporting chiropractic care. Hopefully this conscious friction will begin the return to sanity in spine care.

It is past time to free chiropractors from the injustices from medical prejudice and epithets from medical hate speech. It is past time to give all Americans access to a proven and better form of spine care than drugs, shots, and surgery by removing the taboo image and boycott of chiropractic care by medical propagandists.

Certainly the AMA does not want such a film to be made just as it has resisted all other attempts to reform the current medical system. Since the inception of our nation, the AMA has anointed itself as the unelected fourth branch of government and has ingrained itself into every aspect of our society as the sole gatekeeper to health.

This monopolistic control was foreseen over two hundred years ago by Dr. Benjamin Rush, considered one of our Founding Fathers as a signer of the Declaration of Independence, the Father of American Psychiatry, and a surgeon in the Continental Army, who spoke of medical liberty when he warned of the rise of a medical monopoly. “Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship.” [19]

Undeniably, the AMA has fulfilled Dr. Rush’s premonition as “an undercover dictatorship” fighting against “medical freedoms” considering it has virtually eliminated all competition such as homeopaths and naturopaths as well as marginalized traditional osteopaths (who capitulated to the medical model in order to be included in the original Medicare legislation) and, most of all, fought the chiropractic profession that was to bear the brunt of the medical war alone over the past century.

Let me be frank: the medical profession did not ascend to supremacy by virtue of offering the best mousetrap in the marketplace. The AMA gained dominance by political and economic skullduggery, which began with an alliance in 1930 with the tobacco companies. The tobacco companies became the largest advertiser in JAMA and in various local medical society publications. The AMA allowed the image of physicians in public ads as well.

Though it was a cash cow for the AMA to fund its war chest, it ultimately revealed the AMA’s true intentions—to make money by exploiting the image of the medical profession as “guardians of health” at the expense of patients and the truth.

Apparently the ploy of “public safety” was only a smokescreen to attack other health professionals since the AMA obviously had no real concern for public safety by endorsing the tobacco industry. Indeed, as Harper’s Magazine described in 1949, it was tobacco money that initially transformed the AMA from a “panty waist” organization that promoted education and research into “the most terrifying trade association on earth.”[20]

Although television and the print media have given a voice to many historically oppressed groups, regrettably, no one in the media has revealed the sordid political nature of the AMA’s rise to power nor has the media championed the chiropractic profession’s subjugation to medical bigotry, hence the need for this documentary to tell this intriguing yet untold story from persecution to vindication to acceptance.

 

Paradigm Shift in Spine Diagnosis

This story is not only about chiropractors being victimized. It is also the story of an unsuspecting public being exploited by an unscrupulous medical society subjecting many spine care patients to treatments most of which have been proven to be ineffective, such as addictive opioid drugs, unnecessary epidural steroid injections, and costly and dangerous spine surgeries that are based on a disproved disc theory—all revelations kept from the public.

Ironically, after a century of libeling chiropractic as an “unscientific cult,” research now vindicates chiropractic treatments over medical care for the majority of back pain cases. However, the medically-biased media has failed to inform the public of this revolution in spine care.

The changing paradigm in spine care began nearly twenty-two years ago when MRI research at Emory University revealed the basic medical premise of back pain—the abnormal disc theory—was shown to be invalid. This renaissance in spine diagnosis began in 1990 when research by Scott Boden et al.[21] followed in 1994 by a supportive study by Maureen Jensen et al.[22] found no clear correlation between disc abnormalities and back pain. 

Medical researchers now refer to abnormal discs as “trivial, harmless, and irrelevant,” to the point of labeling them “incidentalomas” since MRI studies have shown many people without back pain have abnormal discs, too. [23]

In fact, 85% of back pain patients do not have a definitive pathoanatomical cause readily identified on imaging.[24] The focus on how the spine looks on imaging is generally shifting towards a more pathophysiological approach, i.e., how the spine functions and bears weight, which includes issues like structure, alignment, compression, movement, gait, core strength, and muscle imbalances.

The key difference in this diagnosis between MDs and DCs is the role of spinal joints. Most MDs fail to understand the role of joint function; instead they focus on discs and anatomical abnormalities. Counting all the vertebral joints, sacroiliac joints, rib heads, and the pubic symphysis, new research now suggest the total is 313, a fact that is lost to most physicians. This total includes all synovial, symphysis, and syndesmosis joints according to Gregory D. Cramer, DC, PhD, Dean of Research at National University of Health Sciences.[25]

This documentary will reveal this paradigm shift in spine care diagnosis, an issue the medical spine field would prefer left unsaid. It would also do wonders to reduce the outrageous and unsustainable costs of spine care in America when the public realizes back pain stems primarily from “slipped joints” instead of “slipped discs.”

Complicit Press

It cannot be overstated the role the media has played to discredit the chiropractic profession, in effect acting as the voice of the AMA. Today, this biased reporting continues considering much of the media in health care matters is controlled by MD reporters, hence the lack of chiropractic information is astounding and very slanted even today considering chiropractic is the third-largest physician-level health profession in the nation.

Until chiropractors gain equal access to the media to present its case, the perceived wisdom in the public will continue to reflect the stigma fostered by the Committee on Quackery and disseminated by a complicit press.

This documentary will reveal for the first time how the AMA did irreparable harm to the image of chiropractors. Just as the Nazis kept their Death Camps a secret, so did the AMA’s Committee on Quackery use clandestine efforts “behind the scenes” to “destroy” the chiropractic profession literally and figuratively, allthewhile paying reporters for writing supposedly third-party articles critical of chiropractic care.

This prejudice in the media is not by chance, either. The Committee on Quackery fully understood the power of the press to spread misinformation about its chiropractic rivals and created “Quack Packs” that included defamatory articles written by hired hands that were given to the public, press, politicians, and high school educators as proof of the evils of chiropractic from supposedly objective third-parties. As the Wilk trial proved, this was a total ruse, but the public to this day still has no idea of the COQ’s clandestine propaganda.

Court records from Wilk revealed the AMA even colluded with syndicated columnist Ann Landers to write anti-chiropractic articles. Perhaps her most ignoble comment was about a patient who was cured by chiropractic care, “The truth is, he’d probably have been cured if he had fanned himself with goofus feathers.”[26]


Conclusion

 Judge Susan Getzendanner described the AMA’s conspiracy as “systematic, long-term wrongdoing, and the long-term intent to destroy a licensed profession.”[27] Yet the media never mentioned these significant findings to the public.

The judge also mentioned in her Opinion the damage done by the AMA to libel the image of chiropractors:

“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.”[28]

        It is past time to stop the medical trash talking and the discrimination against chiropractors. Only a film documentary made by chiropractors will tell the truth of this medical war against chiropractors. If the RJWF believes in free speech and fair play, it will help produce this enlightening documentary with proper funding.

 



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

[2] Gordon Waddell and OB Allan, “A Historical Perspective On Low Back Pain And Disability, “Acta Orthop Scand 60 (suppl 234), 1989.

[3] Gary Null, PhD; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD, Death by Medicine, October 2003

[4] M Mayer, “The Rise and Fall of Dr. Fishbein,” Harper’s Magazine, 199/1194 (Nov. 1949): p. 76.

[5] “Attitudes toward chiropractic health care in Oklahoma,” Welling & Company and Oklahoma Chiropractic Research Foundation in cooperation with the Chiropractic Association of Oklahoma (1984)

[6] 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

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

[8] Definitions for "hate speech", Dictionary.com, accessed 25 June 2011

[9] Nockleby, John T. (2000), “Hate Speech,” in Encyclopedia of the American Constitution, ed. Leonard W. Levy and Kenneth L. Karst, vol. 3. (2nd ed.), Detroit: Macmillan Reference US, pp. 1277-1279. Cited in "Library 2.0 and the Problem of Hate Speech," by Margaret Brown-Sica and Jeffrey Beall, Electronic Journal of Academic and Special Librarianship, vol. 9 no. 2 (Summer 2008).

[10] Memo from Robert Youngerman to Robert Throckmorton, 24 September 1963, PX 173, Wilk v. AMA.

[11] Minutes from the “Chiropractic Workshop,” Michigan State Medical Society, held in Lansing on 10 May 1973, exhibit 1283, Wilk.

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

[13]   Wilk et al v AMA et al., US District Court Northern District of Illinois, No.  76C3777, Susan Getzendanner, presiding judge; Judgment dated August 27, 1987: 10

[14] Wilk et al v AMA et al., US District Court Northern District of Illinois, No.  76C3777, Susan Getzendanner, presiding judge; Judgment dated August 27, 1987.

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

[16] W Trever, “in the Public Interest,” Scriptures Unlimited, Los Angeles, Calif., (1972):11

[17]Lindsey Tanner, “AMA apologizes to black doctors for past racism,” AP Medical Writer, July 10, 2008

[18]  Howard Wolinsky,  “AMA snubs overture from chiropractors,” Chicago Sun-Times, March 24, 2000

[19] ER Booth, History of Osteopathy and Twentieth Century Medical Practice, Cincinnati: Caxton Press, 1905 (1924): 312.

[20] Mayer, ibid.  p. 78.

[21] 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.

[22] MC Jensen, MN Brant-Zawadzki, N Obuchowski, MT Modic, D Malkasian, JS Ross, “Magnetic Resonance Imaging Of The Lumbar Spine In People Without Back Pain,” N Engl J Med. 331 (1994):69–73.

[23] Richard Deyo, MD, MPH and Donald Patrick, PhD, MSPH, Hope or Hype, The obsession with medical advances and the high costs of false promises. 2005 AMACOM books.

[24] Gwendolen Jull, PhD , et al. Whiplash, Headache, and Neck Pain, (Churchill Livingstone, 2008).

[25] G Cramer,  Dean of Research, National University of Health Sciences, via personal communication with JC Smith (April 29, 2009)

[26] Ask Ann Landers, “Chiropractors Eyed,” January 28, 1971, The Times-Picayune, New Orleans, LA.

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

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

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