Articles by JCS

Scientists & Scalawags

 

Early Chiropractic

Scientists & Scalawags

 

While most DCs principally work with musculo-skeletal disorders (MSDs), some may treat patients suffering from dysautonomia, there also exists the vitalistic part of chiropractic practice that deals with the immaterial rather than the material. This aspect of chiropractic is the most controversial although it certainly can’t be dismissed as nonsense.

The Founder of Chiropractic, DD Palmer, attempted to explain the mechanism of chiropractic when he published in 1910 his 984-page book, “The Science, Art and Philosophy of Chiropractic.” D.D. Palmer's effort to find the cause for disease led him to write:

“A subluxated vertebra… is the cause of 95 percent of all diseases. …The other five percent is caused by displaced joints other than those of the vertebral column.”[1]

Obviously his cure-all belief conflicted with the allopaths who believe in the germ theory as the primary cause of infectious diseases. Science was unaware of the role of stress upon the nerve system to cause health problems, so the battle line was drawn.

Since these early chiropractors at the time couldn’t explain in convincing scientific terms, they turned to a metaphysical explanation of chiropractic that was difficult for scientific practitioners to swallow. This “one cause-one cure-one correction” attitude created the “cure-all” belief that so irritated the medical profession, and rightfully so. Sadly, without medical freedom protected as religious freedom, the argument turned violent with a bunker mentality on both sides with chiropractors in a survival mode and the AMA with its mindset to eliminate them.

This is the source of the strongest criticism of chiropractors: “They go too far when they claim chiropractic care can cure everything.”

Of course, most DCs flinch at this idea today for fear of arousing the medical wrath, condemnation, and the skepticism of the public. This has been the bane of rational chiropractors who deal with MSDs who must apologize for this banter.

But to “straight” conservative chiropractors, this is their raison de'tattheir prime philosophy of practice—not to help with back pain, but to liberate the nerve energy that carries the life force to every cell in the human body.

Élan Vital and Chiropractic

I daresay every DC or MD can attest to some rather remarkable healing that transcends the explainable. The problem is it’s hard to base an entire profession on the unexplainable, which has led to strong criticism by medical professionals who are opposed to anything that appears faith-based healthcare.

Apparently the public has an easier time accepting vitalism in chiropractic care. For example, in 1984, the Chiropractic Association of Oklahoma surveyed 400 households seeking their “attitudes toward chiropractic health care in Oklahoma.”[2] The results were interesting to say the least and provoking in what they revealed. Most interesting was that the more controversial aspects of chiropractic treatment and philosophy—the affect upon organic function and the concept of vitalism—was also very well received by the public.

“Some of the axioms around which chiropractic is structured are firmly believed in, and these are the ones which should be promoted more stringently since they will reach a higher degree of sympathetic belief. A particularly high number (over eight out of ten) agree that:

1. Once nerves are involved, almost anything can go wrong.

2. Bones in the spine can pinch or get out of alignment and affect    functions.

“Additionally, a very high number (71% to 75%) also agree that:

1. The spine can easily get out of alignment and affect functions

2. Nerves more than anything regulate function.

3. There is an unseen life force that cannot function unless all is in harmony.”

Even though most DCs do not make such “medical-politically incorrect” claims, the few who believe in the power of the body to heal itself via the proper functioning of the nerve system have created an image that is both hard to support and hard to deny.

In this vitalistic perspective, a spinal adjustment may reduce back pain, but it may hopefully reduce interference to the healing force of the nerve system. While science hasn’t proven this metaphysical concept, some anecdotal evidence in the field has shown some patient who have been helped with organic disorders.  Since vitalism stands opposed by medical mechanistic concepts, let me define and explain the chiropractic Big Idea.

Vitalism explicitly invokes a vital principle, that element is often referred to as the "vital spark," "energy" or "élan vital," which some equate as “vital force.” Eastern traditions like acupuncture posited similar forces such as “qi” and “prana.”

The most basic example is the energy that distinguishes living from non-living matter. Indeed, what is missing in a dead body? Every physical attribute is still there—the brain and nerves, the heart and blood, the bones, organs and muscles. Nothing is missing in a dead body except for the vital force that animates the living.

It’s next to impossible to speak of this metaphysical power to people who cherish the scientific principles—they want proof, measurements, and the ability to duplicate it in the laboratory. Case studies, anecdotal evidence, philosophy or folklore is not enough to convince these hard core scientists, even when the evidence is obvious.

NM Hadler, MD, author of “The Last Well Person,” scoffs at the vitalism found in some chiropractic enclaves. Hadler also may lack an understanding of the role of the Autonomic Nerve System in one’s health. While he certainly understands the ANS and PNS systems, his medical education never taught him the concept of dysautonomia due to vertebral subluxations—the basis of those damn chiropractors.

 “What is less defined, somewhat contentious within the chiropractic, and very contentious for mainstream medicine is the purview of the chiropractic. Is it solely the regional musculoskeletal disorders? That is not the stance of many chiropractors or many schools of chiropractic. These advocates and practitioners are willing to ‘reduce subluxations’ for a range of ailments from headaches to asthma.”

“Subluxations are the chiropractic diagnosis that implies spinal malalignment. They are imaginary; no such specific skeletal changes correlate with symptoms…how anyone can imagine that such an event can salve asthma or diabetes or the like is a testimony to the tenacity of vitalistic theories.”

What Dr. Hadler suggests typifies the Fundamental Flaw of medicine—the ingrained dislike of any vitalistic concept, whether it’s by chiropractors or Traditional Chinese Medicine, or anyone who speaks of the vital energy within the body—that immaterial intelligence that animates the physical—including religious leaders who speak of the mind, faith, and soul in healing.

Oddly, the original Medical Mussolini, Morris Fishbein, reportedly spoke of God in the healing process. “Never must the physician say, ‘the disease is incurable.’ By that admission he denies God, our Creator; he doubts Nature with her profuseness of hidden powers and mysteries.”[3] Apparently Fishbein, like many MDs, may believe in God, but will not profess the same “hidden powers” are important in the healing process (at least not mention it publicly).

Joseph C. Keating, Jr., PhD, noted chiropractic historian, discusses vitalism's past and present roles in chiropractic and calls vitalism "a form of bio-theology" that he views vitalism as incompatible with scientific thinking:

“Chiropractors are not unique in recognizing a tendency and capacity for self-repair and auto-regulation of human physiology. But we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the 'One cause, one cure' rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers’ Innate should be rejected.” [4]

This is the conflict between science-based vs. faith-based practitioners is not just a chiropractic dilemma. George Lundberg, MD, Medscape Editor in Chief, former editor-in-chief of JAMA from 1982 to 1999, spoke of this faith-based phenomenon in medicine in his webcast editorial.[5]

 “Recognizing that not all interventions have been properly studied but that physicians must make clinical decisions anyway, David Sackett is credited with having defined EBM as the ‘integration of best research evidence with clinical expertise and patient values.’

“I consider the near opposite of pure EBM to be pure FBM -- faith-based medicine. St. Paul defined faith as ‘the substance of things hoped for, the evidence of things unseen. This was OK for medicine in the first century AD, but in 2004, when there is evidence, I choose it as the basis for my care.”

Apparently many medical experts remain critical of “things hoped for but unseen” in CAM treatments, but the lack of evidence for many medical treatments consisting of drugs, shots, and spine surgery for disc abnormalities has not stopped.

Dr. Rick Deyo agrees.

“I’m not sure we’ve made much real progress in the effectiveness of clinical care. We seem stuck in conventional models—involving biomechanics, ergonomics, and drug receptors—that haven’t worked very well so are. I think we’re going to have to create more holistic models that are truly biopsychosocial before we make substantial progress clinically.”[6]

Many evidence-based DCs are also torn with this dilemma, myself included, because the evidence points in both directions.

I’ve seen patients with apparently healthy, structurally sound spines who are experiencing great pain while some patients with ugly, unhealthy, and badly misaligned spines are nearly pain free. Some patients respond to the slightest touch while others don’t. Our science certainly is not exact; in other words, 1 + 1 does not always equal 2.

While I mainly treat musculoskeletal problems, on occasion patients will tell me of improvement with other health issues that were unexpected indicating the neurological aspects, such as getting pregnant! In fact, I’ve had seven women get pregnant after receiving spinal manipulation for LBP (that’s a special adjustment), but none of them came to me asking for treatment of their infertility. Other patients have told me of improvement with their blood pressure, asthma, bowel movements and some have told me their psyche or well-being is better by feeling less stressful.

Recently I had a patient who told me I “saved” his life. He told me he felt like he was dying before he started chiropractic care. What can you say to this remark? There’s no physical explanation, but certainly a meta-physical one that cannot be substantiated.

While I cannot explain why this myriad of problems are improved other than to think of the immaterial healing force inherent to the nerve system—the “subtle substance of the soul” as BJ Palmer wrote—I do not bank of this treatment since in other cases the same conditions are not affected. There are too many co-factors in the healing process: the neurological, nutritional/bio-chemical, psychological, hormonal, physical, toxins/elimination issues, to name just a few of the many processes that control your overall health and homeostasis.

Chiropractic Cures All

The developer of chiropractic, BJ Palmer, and many of his disciples have even made a pseudo-religion—chirovangelism—of this vitalism and this has been a source of controversy for over 110 years now. For example, the past president of Life Chiropractic College, Dr. Sid E. Williams, was quoted, “The only thing chiropractic can’t cure is rigor mortis.”

After DD Palmer’s death in 1913, BJ became the developer and defender of chiropractic during the early 20th century when chiropractors were being prosecuted for practicing medicine without a license. Rather than the messiah he envisioned himself, perhaps a more realistic comparison is to Fredrick Douglas, the freed slave who became a journalist and promoter for civil rights before and after the Civil War. Until his death in 1961, BJ led the profession with his “rule or ruin” mindset that demonstrated his megalomania to his rivals within chiropractic and the medical opponents.

The Palmers created their metaphysical explanation because DD, BJ and their followers couldn’t explain the mechanisms of their art in scientific terms; plus this became a legal ploy to avoid being accused of practicing medicine or osteopathy.

Indeed, only recently has research given a clearer understanding of the effect of back pain and stress upon the homeostasis of the body as Hans Seyle, MD, has popularized.

Recent medical researchers have shown the deleterious affects of spinal injury/back pain upon neurotransmitters causing loss of neocortical gray matter (Apkarian et al.), fibromyalgia, chronic fatigue, post-traumatic stress disorder, and depression (Schweinhardt et al., Baliki et al.) As future researchers delve into the damage done to the nerve system from abnormal neurotransmitters reacting to spinal injury, other degenerative disorders may finally be explained, such as Parkinson’s, Alzheimer’s, to mention a few of the dementias that have nothing to do with germs or genetics, but may have much to do with neurotransmitters gone amok.

Indeed, it doesn’t take a rocket scientist to understand intuitively that a damage spine may injure nerves that control function and tone of tissues as well as affecting the neurotransmitters that regulate homeostasis and overall health. Obviously that is a sophisticated concept of disease that has slowly emerged today but remains sketchy as it certainly was 100 years ago.

Without question, the biggest objection by MDs toward chiropractors stems from the notion that chiropractic care helps patients in many situations, not just for neck/back pain and headaches—the common ailments patients seek help from DCs. Experienced DCs often see anecdotal cases of organic dysfunction improve in their offices, but science was unable to explain the how and why. 

Perhaps now research by A. Vania Apkarian, P. Schweinhardt, Acerra, Moseley, and Anil Kuchinad is finally catching up to explaining the why and how spinal manipulation to remove back pain also may affect nerve system function and overall homeostasis.

Part of the problem with MDs is their limited perspective of health. Being the supposed “scientific” profession that uses only mechanistic, physical science to explain itself, health has become a description of MRI scans, blood analysis and other quantifiable tests. Indeed, most folks are fully aware of their blood counts such as cholesterol levels, triglycerides, and sugar levels, but they often miss seeing the forest through the trees.

What’s been lost today in medical science are the intangible elements that focuses on the patient’s overall health. Terms such as vim, vigor and vitality are lost in today’s scientific arena since they cannot be measured, but they remain expressions of good health. Too many patients may have perfect blood profiles, but they lack the vitality associated with vibrant health. If it’s not “bad blood”, what else could it be?

Even the medical analysis of an MRI or x-ray scan of the spine fails to see the overall alignment, strength, flexibility and weight-bearing capacity of the spine, instead searching for pathological lesions, such as disc abnormalities, fractures or infections. While MDs focus on these minutiae, chiropractors also look at the forest through these trees of abnormalities.

Chiropractic Scalawags

Not only does chiropractic suffer from a medically-biased press, but some members of our profession seem intent on shooting our profession in the foot. Most of the bad press concerning cultism in chiropractic stems from chiropractors who subscribe to the demagoguery espoused by BJ Palmer, the son of the founding chiropractor, DD Palmer. BJ’s metaphysical, vitalistic explanation of chiropractic was difficult for scientific practitioners to swallow, but his “rule or ruin” attitude to control the entire chiropractic profession caused a split within the profession itself.

Most people are unaware that there are two schools of thought within the chiropractic profession—the original Palmer “straight” philosophical beliefs versus the broad, holistic beliefs of the National College founder, Dr. John F. Howard, and his successors, Drs. William Schultz and Joseph Janse, who emphasized a scientific rather than metaphysical approach to chiropractic. These two branches still exist today within chiropractic education and practice.

While the holistic branch predominates in the profession today with most DCs practicing a broad range of treatments as well as differential diagnosis and examinations, the Palmer branch continues to practice more narrow “detect and correct subluxations” only method. They eschew diagnostics, exams, and focus solely on spinal adjustments.

They espouse the importance of an innate intelligence in the body to heal and believe “vertebral subluxations” interfere with the flow of “life energy” and “mental impulses” that may cause disease. “Above-down, inside-out” was the Palmer mantra to depict the innate intelligence in the body that came from the universal intelligence above.

I believe the Palmers created their metaphysical explanation because BJ and his followers couldn’t explain the mechanisms of their art in scientific terms. Indeed, only recently has research given a clearer understanding of the effect of back pain upon the homeostasis of the body. The Founder of Chiropractic, DD Palmer, attempted to explain the mechanism of chiropractic care when he published in 1910 his 984-page book, “The Science, Art and Philosophy of Chiropractic.”

But BJ Palmer, his son and self-described Developer of Chiropractic, was far less scientific and used metaphysical explanations that led down a slippery slope of charismatic demagoguery that has encouraged other less-than-scientific charismatics to follow in his footsteps. BJ Palmer was a huge fan of PT Barnum and spent time in Florida at his circus training site. BJ later used similar theatrical circus tent venues to promote his brand of chiropractic among his college graduates.

Rather than scientific-oriented, evidence-based like the National College lineage, the BJ Palmer lineage has included vendor-driven entrepreneurs like Jimmy Parker, Reggie Gold, and the most infamous, Sid E. Williams, the founder of Life Chiropractic College who all used the circus tent environment at their seminars to promote their brand of chirovangelism.

These men along with their many sycophants have caused the cultish image of chiropractic. They boast of curing anything via the innate intelligence of the body and even downplayed the importance of spinal care for helping back pain as if it were insignificant compared to their higher mission to cure the body of whatever ails it. Sid Williams often said, “The only thing chiropracTIC can’t help is rigor mortis.”

With a fervor likened best to religious missionaries, their followers were taught to “love for the sake of loving, give for the sake of giving, and serve for the sake of serving.” Even the name of Williams’ college, “Life,” is symbolic of his cultism when he pronounced, “Nothing is bigger than life.”

Another chirovangelist from Williams’ generation was Reggie Gold who began a short-lived venture called the Church of the Divine Spine where he mixed chiropractic Palmer philosophy with adjusting methods, rejecting science, diagnostics, or examinations. His goal was to bypass the chiropractic requirements for education and licensing by creating a new religion.

The argument against chiropractic is confusing since the clinical results of manual manipulation for MSDs is clouded by the vitalism espoused by the founders, DD and BJ Palmer, nearly 100 years ago. Today, medical critics still hark on the old image of “chirovangelism” to criticize the entire profession although the majority of DCs today while aware of the vitalistic philosophy, generally practice conservative spinal care.

 

Chiropractic’s Own Critics

This dilemma to eliminate the zombie science in chiropractic remains a topic of many leading chiropractors. Attorney George McAndrews dealt with the medical criticism of chiropractic’s claim to help organic disorders during the Wilk v. AMA antitrust trial and later commented:

“Again, I believe that research can result in an explosion of need for the services of chiropractors. I believe that certain headaches, ulcers, respiratory problems, allergies, etc. may prove to be singularly responsive to correction of the so-called subluxation complex. It will be a real shame if the fringe elements and the demagogues in the profession destroy any hope of survivability by putting chiropractic in a death grip while the American Chiropractic Association and other research oriented bodies [NCMIC, FCER] attempt to deal with the real problems of the 1990’s--research and active representation before government and third party payers.”

"Make no doubt about it, no one is running from the subluxation complex.  Society and the political and economic worlds in which we exist have simply put the theory under a microscope: either prove it exists and that real health problems are affected by it or surrender all right to be compensated for taking care of the phenomena. Argument will no longer suffice--data, results, costs are the order of the day.[7]

George’s late brother, Jerry McAndrews, DC, former Palmer Chiropractic College president and ACA spokesman, also commented on the need for a scientific future for the profession.

“Thank heavens we have an increasingly emerging group which collectively says, ‘we’ve had enough.’ This group supports new journals, reads them, begins to reject the smoke of the past, begins to demand that the language be accurate. Eventually, the misuse of ‘chiropractic philosophy’ will disappear and we will find the ‘philosophy of the science of chiropractic’ in its place. It already sounds stimulating.”

Scott Haldeman, DC, MD, PhD, and leading researcher, also admonished those within the chiropractic profession who are prone to hyperbole:

 “What must be avoided at this stage of understanding of the neurologic effects of the adjustment is the unreasonable extrapolation of current knowledge into speculation and presentation of theory as fact…justification for scientific ignorance or poor practice methods on philosophical grounds will never be accepted.”[8]

David Seaman, MS, DC, DACBN, Palmer-Florida instructor, ACA Academician of the Year, 2006, mentions the dichotomy among chiropractors as DD Palmer noted years ago in his seminal text book. “The zealots do not consistently represent BJ or DD. In particular, if you read some of DD’s 1910 text, one can only be impressed by his command of science. DD even stated the following (p. 334-335):

“There are two classes of chiropractors:

  • those who desire to know all they can of physiology, pathology, neurology and anatomy, and
  • those who have an aversion for intelligence, do not want to take effect into consideration, depending upon an examination of the spinous processes.”

Regrettably, the presumed zombie science of chiropractic has shrouded its proven effectiveness with MSDs and kept alive the medical chauvinism that impedes the integration of chiropractic care into the mainstream healthcare delivery system. But faith-based medicine also presents a problem in evidence-based healthcare. Faith in unproven, ineffective treatments cloaked in the appearance of science remains the problem with zombie spine care as Bruce Charlton indicated.

Most people are unaware that there are two schools of thought within the chiropractic profession—the original Palmer “straight” philosophical beliefs versus the broad, holistic beliefs of the National College founder, Dr. John F. Howard, and his successors, Drs. William Schultz and Joseph Janse, who emphasized a scientific rather than metaphysical approach to chiropractic. These two branches still exist today within chiropractic education and practice.

While the holistic branch predominates in the profession today with most DCs practicing a broad range of treatments as well as differential diagnosis and examinations, the vitalistic, “philosophical” branch continues to practice by the more narrow “detect and correct subluxations” only method. They eschew diagnostics and adjunct therapies, and focus solely on spinal adjustments. They espouse the importance of an innate intelligence in the body to heal and believe “vertebral subluxations” interfere with the flow of “life energy” and “mental impulses” that may cause disease.

BJ Palmer was far less scientific and resorted to metaphysical explanations that led down a slippery slope of charismatic leadership that has encouraged other less-than-scientific charismatics to follow in his footsteps, while the more scientific chiropractors followed another path less traveled.

BJ Palmer was a huge fan of PT Barnum and spent time in Florida at his training circus. BJ used similar theatrical circus tent venues to promote his brand of chiropractic among his college graduates. Rather than scientific-oriented, evidence-based like the National College lineage, the BJ Palmer lineage has included men like vendors and entrepreneurs like Jimmy Parker, Reggie Gold, and the most infamous, Sid E. Williams, the founder of Life Chiropractic College who all used the charismatic environment at their seminars to promote their brand of chirovangelism.

These men along with their many sycophants have caused the cultish image of chiropractic. They boast of curing anything via the innate intelligence of the body and even downplayed the importance of spinal care for helping back pain as if it were insignificant compared to their higher mission to cure the body of whatever ails it. Sid Williams often said, “The only thing chiropracTIC can’t cure is rigor mortis.”

With a fervor likened best to religious missionaries, their followers were taught to “love for the sake of loving, give for the sake of giving, and serve for the sake of serving.” Even the name of Williams’ college, “Life”, is symbolic of his cultism when he proclaimed, “Nothing is bigger than life.”

Although I attended Berkeley during the late 1960s when the anti-Vietnam war movement and the Free Speech Movements were still strong, the students at Berkeley were pale in comparison to some of the offbeat students at Life, including the president himself. He is best described as a cross between Don King, Jimmy Swaggart, and Saddam Hussein; some liken him to Jim Jones of chiropractic with hundreds of followers ready to drink the purple Kool Aid.

This charismatic megalomaniac ran a diploma mill unlike anything I’d ever experienced. The students were taught chiropractic demagoguery to vilify anything medical like medications, immunizations, and all surgery; they demonized all MDs as barbarians, and they were controlled by devilish charismatic rhetoric unlike anything I had ever heard before in my life.

Hidden beneath this “chirovangelism” was a strong motivation of greed illustrated by a chant created by Dr. Williams—the infamous "Money Hum"!

“Start imagining yourself ultra, ultra, ultra wealthy. Just see bales and piles of money, just everywhere. Gold or diamonds or whatever it is turns you on… Start down at the bottom and get you a handful of it. In your mind’s eye, say Mmmmmmooonnneeeyyy!!!”

It’s unimaginable that any college president would stoop to such unethical, greedy motivating chants, but it was par for the course at Life College. Sadly, students didn’t fall far from the tree when they entered the field causing scores of insurance fraud and student loan defaults.

Undoubtedly one huge concern by the accrediting bodies, the federal Council on Chiropractic Education, the regional Southern Association of Colleges and Schools, was the combined salaries of Life’s executive staff (in the range of $2.7 million) in a supposedly non-profit organization that at its height brought in over $78 million annually, as noted by the editors of the Atlanta Journal-Constitution. To say Life was a cash cow for Williams is an understatement considering he was paid more than the president of both Harvard and Yale.[9]

“Among other things, the accreditation panels criticized the school's financial management: The Williams dynasty draws massive salaries by any university's standards. In 1997 (the latest figures for Life's salaries from the Chronicle of Higher Education), Williams' salary was more than $900,000; his wife's was nearly $500,000; his sister-in-law, assistant vice president Mildred Kimbrough, more than $323,000; and his longtime friend, Vice President Durie Humber, $625,870.

“By comparison, Harvard's president earned $380,000 in 2000 and Yale's president, $552,000. While her salary is not available [allegedly in the $400,000 range], Williams' daughter, Kim, is also employed in the administration.”

It’s hard to imagine that Sid Williams’ salary alone was nearly equivalent to the salaries of the presidents of Harvard and Yale combined! Indeed, Life College was a gold mine for the Williams clan of academic imposters until the bubble finally burst and Life lost its accreditation and the board replaced them all. Today Life University is back on track as an accredited college, albeit still committed to a vitalistic foundation.

Sadly, while the mainstream chiropractic colleges were upgrading their curriculums to meet the higher standards, Life made a mockery of them suggesting that the standards were too “medical” and a chiropractic college shouldn’t have to meet medical standards. Even after Life had lost its accreditation, Williams remained in denial of his shoddy educational program despite the obvious facts.

"I do not think the academics of this university are deficient. The program at Life University is far beyond many of the accredited universities. Students get a superior education."--Sid Williams[10]

While Williams espoused his delusional beliefs, the fact is the scores on the national board exams proved differently.

“A report submitted in May to the Council on Chiropractic Education shows Life students trailed behind the national average in each section of the National Board Part I exam administered in spring 2001…In the anatomy portion of the exam, 83 percent of Life students passed on a first attempt, 7 percent below the national mean. Students also trailed behind their peers in the physiology, chemistry, pathology and public health portions, the report shows.” --Editors of the Atlanta Journal Constitution[11]

Certainly this mess was a stake in the heart to chiropractic’s reputation in Georgia and nationally. While every other chiropractic college strove to improve, Life had become a diploma mill with academic imposters at the helm. And it certainly didn’t help when the press revealed the obnoxious salaries of the Williams’ clan, the low academic rates, and high student loan default rates.

In the January 17-18, 1996, editions of the Atlanta Constitution newspaper appeared a two part series about "The 'Life' and Times of Sid Williams"[12] as well as a revealing follow-up article, "Student DEBT", about Life College leading all professional colleges in student loan defaults to the tune of $28.2 million.

The Associated Press picked up this story and distributed another embarrassing article entitled, "Life College Students Top Federal-loan Default List."[13] Dr. Williams' ineloquent response was just as embarrassing: "My students are not skunks or scalawags. They got trapped in something they can't help." I'm not certain if he meant they were trapped in Life College or in a poorly administered loan program, both of which may be true!

The impact upon the image of chiropractic in Georgia was tarnished badly due to this fiasco and may take three generations to overcome. Rather than a blessing for the southeast, his college became an embarrassment that set back the acceptance of chiropractic badly.

Also in the news has been the arrest of DCs operating "runners" scams and insurance fraud in Georgia and throughout the southeast. Combined with the endless stream of "Free Spinal Exams" and "Free Chicken Dinners" offered by "Spines 'R Us" practitioners, the public's image of chiropractic is soiled even more by these negative promotions. It seems most of the news about chiropractic are either distortions of the facts, embellishments of anecdotal cases, or outright embarrassments by DCs themselves.

Chiropractic’s Own Critics

Unfortunately, ethical and hard-working DCs are tarnished from both sides - or as they say down South, "caught between a rock and a hard place." If it's not the medical media bashing chiropractic, other DCs find ways to embarrass our profession on their own volition. The public's awareness about our profession is not formed by the good work done daily by mainstream DCs for millions of Americans; instead our public image is mainly formed by these outrageous examples.

The need for reform within chiropractic is not new. In 1992 Mr. George McAndrews, the ACA's legal counsel, wrote in the ACA Journal his opinion of chiropractic's image:

"I believe this is the era of image. It is time for the 'dewierdization' of the profession... An aura of 'weirdness' is the necessary consequence of some chiropractic literature, advertisements... a sampling of yellow page ads makes one wonder if chiropractors are financial advisors or health care professionals... it is time to isolate the rascals."[14]

Before the ACA House of Delegates on May 13, 1992, Mr. Mark Goodin, the ACA's legislative consultant, was even harsher in his opinion of chiropractic's dilemma:

"That enemy, of course, is this profession itself - and those elements within it that are unwilling to deal forthrightly with the charlatans, hucksters, profiteers, and wild-eyed 'philosophers' who put their own selfish interest ahead of science and the ethical and professional demands that every true healer must shoulder.

"You know who they are. They exist in virtually every community in which you practice. Their garish yellow page advertisements hawk free exams and x-rays - tests that, lo and behold, discover a variety of subluxation-related ailments which, if not treated immediately, threaten the life of the unwitting patient. They intentionally promote and practice the over-utilization of chiropractic.

"...They pass themselves off as 'educators,' but cut corners and counsel their students with messianic appeals on ego and self-promotion. They spend their out-of-practice careers in a cause to stop legitimate reform. They bring nothing of value to the future of this profession - but will resist, oppose, reject, undercut, and nitpick any effort to lift it up through higher accreditation, more comprehensive education, real standards of care and more ethical practice requirements.

"They are the small, but vocal class of professional nay-sayers who continue to enrich themselves, all the while dragging down an entire profession which now stands at the very brink of long-term success or instant failure and continued ignominy... The question that vexes me most is why? Why does this profession continue to tolerate their excesses?"[15]

Indeed, chiropractic is the mystery science profession that remains in between a rock and a hard place for a variety of reasons. Honest DCs will continue to be perceived as second-class professionals who are cut out of the loop by political medicine and who suffer a poor public image from a medically-minded press as well as from dumb behavior by "scalawag" DCs.

The argument against chiropractic is confusing since the clinical results of manual manipulation for musculoskeletal disorders is clouded by the vitalism espoused by the founders, DD and BJ Palmer, nearly 100 years ago. Today, medical critics still hark on the old image of “chirovangelism” to criticize the entire profession although the majority of DCs today while aware of the vitalistic philosophy, generally practice conservative spinal care.

In fact, many chiropractors today are employed as primary care physicians, nutritionists, pediatricians, public health officials, some work alongside MDs in the VA and military health services, and many in the growing field of sports medicine. Indeed, this isn’t your granddaddy’s chiropractic any more.

Chiropractic’s Own Critics

This dilemma to eliminate the zombie science in chiropractic remains a topic of many leading chiropractors. Attorney George McAndrews dealt with the medical criticism of chiropractic’s claim to help organic disorders during the Wilk v. AMA antitrust trial and later commented:

“Make no doubt about it, no one is running from the subluxation complex.  Society and the political and economic worlds in which we exist have simply put the theory under a microscope: either prove it exists and that real health problems are affected by it or surrender all right to be compensated for taking care of the phenomena. Argument will no longer suffice--data, results, costs are the order of the day.[16]

 

George’s late brother, Jerry McAndrews, DC, former Palmer Chiropractic College president and ACA spokesman, also commented on the need for a scientific future for the profession.

 “Thank heavens we have an increasingly emerging group which collectively says, ‘we’ve had enough.’ This group supports new journals, reads them, begins to reject the smoke of the past, begins to demand that the language be accurate. Eventually, the misuse of ‘chiropractic philosophy’ will disappear and we will find the ‘philosophy of the science of chiropractic’ in its place. It already sounds stimulating.”

Scott Haldeman, DC, MD, PhD, and leading researcher, also admonished those within the chiropractic profession who are prone to hyperbole:

 “What must be avoided at this stage of understanding of the neurologic effects of the adjustment is the unreasonable extrapolation of current knowledge into speculation and presentation of theory as fact…justification for scientific ignorance or poor practice methods on philosophical grounds will never be accepted.”[17]

Despite the trend to evidence-based education and practice in chiropractic, admittedly there remain a few enclaves that still promote the chirovangelism of yesteryear to the chagrin of Charles Lantz, DC, PhD, former Director of Research, Life Chiropractic College.

“Even in the most evidence-based institutions the resistance to scientific methodology and critical assessment is rampant.  It only takes one 'The Power that Made the Body Heals the Body' sermon to undo several semesters of efforts to teach critical thinking and an appreciation of the 'rigueur de science'. 

“Who wants the rigors of critical thinking when they can zone out on the intoxicating siren song of Innatism, or the giddy ecstasy attained from chanting the mantra S-U-B-L-U-X-A-T-I-O-N?”

Regrettably, the presumed zombie science of chiropractic has shrouded its proven effectiveness with musculoskeletal disorders and kept alive the medical chauvinism that impedes the integration of chiropractic care into the mainstream healthcare delivery system. But faith-based medicine also presents a problem in evidence-based healthcare. Faith in unproven, ineffective treatments cloaked in the appearance of science remains the problem that occurs in some quarters in medicine too.

Faith-based or New Paradigms?

George Lundberg, MD, Medscape Editor in Chief, former editor-in-chief of JAMA from 1982 to 1999, spoke of this faith-based phenomenon in medicine in his webcast editorial[18]

 “Recognizing that not all interventions have been properly studied but that physicians must make clinical decisions anyway, David Sackett is credited with having defined EBM as the ‘integration of best research evidence with clinical expertise and patient values.’

“I consider the near opposite of pure EBM to be pure FBM -- faith-based medicine. St. Paul defined faith as ‘the substance of things hoped for, the evidence of things unseen. This was OK for medicine in the first century AD, but in 2004, when there is evidence, I choose it as the basis for my care.”

 

Apparently many medical experts remain critical of “things hoped for but unseen” in CAM treatments, but the lack of evidence for the zombie medical treatments of drugs, shots, and spine surgery for disc abnormalities has not stopped them.

Consumer Beware

As a patient and practitioner alike, I weep knowing that millions of patients are wasted on drugs, shots, and surgery by MDs using ineffective treatments who by now should know chiropractic spinal care ranks amongst the best treatment for most neck/back pain cases, but they’re willing to sacrifice their patients’ health in order to appease their gods of power and money.  I cringed at the realization of the millions of unnecessary back surgeries, addictive pain medications, expensive epidural shots, and worthless muscle relaxers that mostly impair rather than help as the latest research now reveals.

Sadly, the only time the public is informed about the chiropractic profession seems to be when something terrible occurs. A few years ago allegations that manipulative therapy caused strokes surfaced in the press when a lawsuit in Canada was filed. Although researchers proved it was virtually impossible for this to happen, and the chiropractor was found innocent at trial, in the court of public opinion, the medically-biased press had all but convicted chiropractors of murder.[19]

To this day, I still have the occasional patient who is scared to death of being manipulated after getting what I call the voodoo diagnosis from their MD: “If you’re stupid enough to go to a chiropractor, don’t come crawling back to me when you’re paralyzed.” If I had a nickel for every time I’ve heard this, I’d be rich.

Fortunately, the facts belie this falsehood. As I tell these frightened souls, the malpractice insurance companies know who’s hurting who. While rates vary by location, brain surgeons in Brooklyn currently pay $267,000 annually for malpractice insurance, while general surgeons in Manhattan pay $123,120 and obstetricians in Queens pay $180,490.

Last year I paid only $1,600 for malpractice insurance. In 30 years I’ve never been sued because spinal manipulation is incredibly safe in skilled hands. While adverse effects like soreness might occur, in general manipulation is safe and effective. Obviously the malpractice insurance companies know who’s hurting who, and we chiropractors are remarkably safe. Plus, a good spinal adjustment is the second-best feeling there is!

Clinical iatrogenesis for chiropractors usually consists of broken ribs, occasional strokes or supposed disc aggravation, to name but a few. Of course, the rate of accidents is 1-2 per million for all SMT and, excluding the 40% of problems caused by the 6% of non-DCs who do manipulation, this rate actually drops to 1 in 3 million for neck manipulation. Considering the rate for cervical surgery is 15,600 accidents per million, I can live with our very low rates.

Despite the evidence of the efficacy of conservative, chiropractic treatment of disc herniation, many MDs still do not generally include referral to DCs for manipulation. One reason may be the presumed lack of safety and fear that joint manipulation may cause further injury to an already weakened disc. Yet published medical experts in manipulation such as Bourdillon and Day in Canada,[20] Lewit in the Czech Republic,[21] and Maigne in France,[22] agree with the chiropractic and osteopathic professions that skilled manipulation is safe and appropriate for the great majority of patients with disc herniation and should be considered a first option for conservative care.

In a comprehensive literature review in 1992, assessing all the studies internationally in English, French and German that reported adverse effects of lumbar spinal manipulation, Terrett and Kleynhans found a total of 65 cases in which disc-related complications were alleged.[23] Nearly half (44%) were medical manipulation under anesthesia. Oliphant provides a best estimate of the risk of spinal manipulation causing a clinically worsened disc herniation of “less than one in 3.7 million treatments.”[24]

A generation ago some researchers, such as Farfan, suggested that rotational stress (torsion) for manipulation might cause disc failure.24 However, Cassidy et al. conclude that in general “it is hard to comprehend how the small amount of rotation introduced during side-posture manipulation could damage or irritate a healthy or herniated disc.”[25]

More recently other extensive studies have concluded that spinal manipulation is as effective if not more so than anything the medical world has to offer. The Decade of Bone and Joint Disorders studied chronic low back pain treatments consisting over 200+ different types and also suggested SMT is as effective as anything in the medical arsenal. It also suggested there were too many drugs, shots and surgery, just like the AHCPR study concluded in 1994.

Indeed, the public wants improvement in the American healthcare delivery system. People understand by now that no one health care profession holds the key to every aspect of health care in this epidemic of back pain with escalating surgical costs and disability, and with the emerging evidence-based research and international guidelines now showing the efficacy of manual manipulation for both acute and chronic low back pain, people are clamoring for options to medical care.

Imagine the validity chiropractors could gain if the press and public knew  multidisciplinary groups of MDs now work alongside DCs, such as the Texas Back Institute, the Rehab Institute of Chicago, the Rhode Island Spine Center at Brown University, to name but a few in the private sector and, in the military health services, the Department of Veterans Affairs Medical Centers now has 30 clinics with MDs and DCs working cooperatively, as well as the  DoD that has multidisciplinary services in more than 50 clinics throughout the US including the Bethesda Naval Hospital.

Rather than outcasts as chiropractors are now perceived by many, instead DCs should be seen as overlooked heroes who brought a new non-drug, non-surgical vision of health along with effective tools to help this epidemic of neck/back pain.

I often liken chiropractors to the black aviator heroes of the Tuskegee Airmen during the Second World War that led to changes in the American military policy of racial separation. Fifty years after the war ended and racism abated in the military, these unsung heroes finally were honored for their bravery.

More recently, the AMA passed a resolution that announced a formal apology for its historical racism toward African American medical doctors. [26] While black MDs were forced to sit in the back of the medical bus for too long, chiropractors were thrown under the same bus. Few people realize that chiropractors were jailed over 15,000 times in the first half of the last century for allegedly practicing medicine without a license when, in fact, the real crime was practicing health care without drugs and surgery.

While this may be well known by most DCs, it is not common knowledge among the press or public. To this day, while many realize the medical profession has a bad attitude about chiropractic, they have no idea of its origins or its ugliness. As far as public perception goes, the Wilk antitrust trial never existed and the damage done to the chiropractic profession was never explained.

In one sense, it’s as if the chiropractic holocaust never existed and continues unabated despite the legal victory.  That’s why I thought when the AMA issued a public apology to its black members for years of discrimination, it would be an excellent time also to seek an apology to the chiropractic profession for its persecution.  Alas, no such contrition is forthcoming from the medical profession.

Apparently the AMA is willing to apologize to its own black members who suffered from prejudice within its own ranks, but to apologize for its documented genocidal program against chiropractors is asking too much, illustrating the demagoguery, bias, and prejudice that still exist within the medical profession.

I can only  imagine the public’s reaction if it were aware of the AMA’s Committee on Quackery established by its Board of Trustees for the sole purpose "to study the chiropractic problem and whose prime mission was to be, first, the containment of Chiropractic and, ultimately, the elimination of Chiropractic.

In this day of public condemnation of all things sexist or racist, imagine the public’s anger when told the AMA referred to chiropractors as “killers and rabid dogs,” and conspired with the ARA, AHA, and other medical groups to eventually “see them wither on the vine.” If this wouldn’t spark reactions among the public, what would?

Little does the public remember that even ethical MDs who referred to DCs were threatened with the loss of licensure and ostracized from the medical fraternity for consulting with “cultists and quacks.” MDs couldn’t even join the same social club for fear of being branded as unethical by their own medical society.

Nor does the public realize the many medical researchers who now admit that the medical management of this epidemic has added to the problem with unnecessary drugs and ineffective back surgery, and admit that chiropractic spinal manipulation may be the best solution for the majority of these LBP problems.

Sadly, this honesty is not well known by most people and what most people know about chiropractic care is just foolishness learned from medical bigots. I’m not suggesting that every MD is prejudiced against chiropractors, but most are adamantly biased, not unlike a white person growing up in the Old South. The history of this sordid situation is well documented but remains unknown by nearly everyone.

As any type of prejudice slowly erodes as the light of truth shines upon it, many Americans today now realize they have been the victims of this medical racism, if you will, from ineffective and unnecessary drugs, shots, and surgery. Back treatments like pain pills, muscle relaxers, epidural steroid injections and spine surgeries are now considered by worldwide research as mostly unnecessary, ineffective, costly, and based on a failed disc theory.  This message has not reached the public although chiropractors have been the torchbearers of this caution for over 110 years now but, for the most part, getting short shrift by the media that is strongly influenced by the medical profession.

Hopefully soon public opinion of back surgeries will join the ranks of once considered routine but now regarded as unnecessary surgeries like appendectomies, tonsillectomies, pacemaker implants, coronary bypass surgery, hysterectomies, Caesarean section, prostate surgery, radical mastectomy, laparoscopy, or surgery for sleep apnea and jaw pain.[27]

Many experts believe up to 60% of all surgeries are unnecessary, and some suggest 50% to 90% of back surgeries are deemed the same. Most Americans don’t know that the rate of back surgery in the United States is at least 40% higher than any other country and was more than 5 times those in England and Scotland. [28]

Imagine the impact of this information upon the impending healthcare reform effort if the legislators knew that chiropractic care could eliminate upwards of 90% of all back surgeries. The financial savings, the decrease in disability costs and human suffering would do wonders to improve the epidemic of back pain, productivity of the work force, and the general health of our entire society.

 



[1] Palmer D.D., The Science, Art and Philosophy of Chiropractic. Portland, Oregon: Portland Printing House Company, 1910.

[2] Welling & Company and the Oklahoma chiropractic research foundation in cooperation with the chiropractic association of Oklahoma in 1984 that surveyed the “attitudes toward chiropractic health care in Oklahoma”

[3] http://thinkexist.com/quotes/morris_fishbein/

[4] "The Meanings of Innate," Joseph C. Keating, Jr., PhD, J Can Chiropr Assoc 2002; 46(1)

[5] Evidence-Based Medicine or Faith-Based Medicine? Posted 12/10/2004.

[6] The BACK Letter, vol. 23, No. 5, 2008, pp. 58.

 

[7] McAndrews, George. Private communication. March 24, 1992

[8] Philosophy and the future of chiropractic. J Chiro 1990 Jul; 27(7):23-28.

[9] AJC editorial, 6-14-02.

[10] AJC, 6-14-02

[11] AJC, 6-15-02

[12] Harrison, Bette, "The 'Life' and Times of Sid Williams", The Atlanta Constitution, Jan. 17, 1995.

[13] McKenna, M.A.J., Hardie, Ann, "Student DEBT", The Atlanta Constitution, Jan. 18, 1995

[14]McAndrews, George, Journal of the American Chiropractic Association, 1992.

[15] Goodin, Mark, Journal of the American Chiropractic Association, 1992.

[16] McAndrews, George. Private communication. March 24, 1992

[17] Philosophy and the future of chiropractic. J Chiro 1990 Jul; 27(7):23-28.

[18] Evidence-Based Medicine or Faith-Based Medicine? Posted 12/10/2004.

[19]Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine. 2008 Feb 15;33(4 Suppl):S176-83.

[20] Bourdillon JF, Day EA (1987) Spinal manipulation, 4th edition, William Heineman medical books, London, 216-217.

[21] Lewit K (1985) Manipulative therapy and rehabilitation of the locomotor system; Butterworths, London and Boston, 178.

[22] Maigne R (1972) Orthopedic medicine: A new approach to vertebral manipulations trans and ed by Liberson WT, 300.

[23]Terrett AJ, Kleynhans AM (1992) Complications from manipulation of the low back, Chiropr J Aust 27:129-140

[24] Oliphant D (2004) Safety of spinal manipulation in the treatment of lumbar disk herniations: A systematic review and risk assessment, J Manipulative Physiol Ther 27:197-210

24 Farfan HF, Cossette JW et al. (1970) The effects of torsion on the lumbar intervertebral joints: The role of torsion in the production of disc degeneration, J Bone Joint Surg, 52A:468-497.

[25] Cassidy JC, Thiel HW, Kirkaldy-Willis KW (1993) Side posture manipulation for lumbar intervertebral disk herniation, J Manipulative Physiol Ther 16(2):96-103.

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

[27]Unnecessary Surgery by James Barron; Published: April 16, 1989, NY Times.

[28] Cherkin DC, Deyo RA, An international comparison of back surgery rates et al. Spine. 1994 Jun 1;19(11):1201-6.

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