Articles by JCS

Tear down this wall

Chiropractors to AMA:

 

“Tear down this wall”

By

JCS

The ACA has a serendipitous opportunity that comes on the heels of the AMA’s House of Delegates that recently announced a formal apology for its historical racism toward African American medical doctors. (“AMA apologizes to black doctors for past racism,” by Lindsey Tanner, AP Medical Writer Thu July 10).

Indeed, if the black MDs were forced to sit in the back of the medical bus, we DCs were thrown under the same bus. If we are to seek atonement from our medical foes, now is the time to petition our grievances publicly.

We chiropractors deserve the same apology from the AMA. Certainly we have not suffered physically or emotionally as badly as our black brethren, but we have suffered greatly as a professional minority. For too long we’ve suffered in silence; now we need to speak up for ourselves as other minorities have done.

Recently the House of Representatives in Congress also voted to apologize to black Americans for the wrongs committed against them and their ancestors who suffered under slavery and Jim Crow segregation laws. Congress has issued other apologies to Japanese Americans for their internment during WW II and to native Hawaiians for the overthrow of the Hawaiian kingdom in 1893.

The tension between our professions resembles the Cold War between the USA and Soviet Union. In the 1950s, Khrushchev predicted: "We will bury you." In the 1960s, the AMA tried to do the same thing with its Committee on Quackery to see us “wither on the vine.” For the most part, the public remains unaware of the AMA’s tactics whose “prime mission to be the first containment of Chiropractic and ultimately the elimination of Chiropractic.” Few Americans realize the sentiments of the AMA paralleled those of the Nazis with similar hate verbiage and goals to eliminate an innocent group of people.

The AMA’s brutal boycott referred to chiropractors as “killers and rabid dogs” as attorney George McAndrews revealed in court, and 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.” Perhaps Mr. McAndrews needs to remind all of us of the dastardly means the AMA took to sabotage our profession, many of which remain covertly in force today despite a permanent injunction ordered by the court in 1987.

Coincidentally, 1987 was the same year that President Ronald Reagan gave his famous speech in Berlin where he said, “Mr. Gorbachev, tear down this wall!”

Nearly 21 years later, our profession must say to the new president of the AMA, Nancy H. Nielsen MD, PhD: “Tear down this wall that stops us from working together to help needy patients.

President Reagan saw one glimmer of hope in Mikhail Gorbachev, the new leader of the Communist Party, despite the old guard of internal resistance within Moscow.

“General Secretary Gorbachev, if you seek peace, if you seek prosperity for the Soviet Union and Eastern Europe, if you seek liberalization: Come here to this gate! Mr. Gorbachev, open this gate! Today thus represents a moment of hope. We in the West stand ready to cooperate with the East to promote true openness, to break down barriers that separate people, to create a safe, freer world.”

 

The AMA’s act of contrition toward its black members can be seen as a glimmer of hope for us chiropractors. While the AMA is handing out apologies, we chiropractors should press their intent:

“If you seek to promote the art and science of medicine for the betterment of the public health as your mission statement says, and if you now offer an apology to your black members for decades of racism, then tear down the wall of your boycott of the chiropractic profession.

“Despite the century of opposition and despite the wall that separates our two professions, we chiropractors stand ready to cooperate with physicians, to promote openness, to break down barriers that separate our members, and to create a safer, healthier world. But it starts with an open gate—an apology from you—and a tabula rasa by all of us to work cooperatively to help suffering people. Is this too much to ask considering our contentious rivalry?”

President Reagan said in his speech, “I invite Mr. Gorbachev: Let us work to bring the Eastern and Western parts of the city closer together, so that all the inhabitants of all Berlin can enjoy the benefits that come with life in one of the great cities of the world.”

We in the ACA must say the same: Let us work together as we now see in small pockets across America like the Texas Back Institute, the Rehab Institute of Chicago, the Rhode Island Spine Center at the Warren Alpert Medical School of Brown University, Jordan Hospital in Plymouth MA, Brigham and Women's Hospital, Boston, the ChiroMedical Group in San Francisco, Lehigh Valley Hospital and Health Network, Allantown, PA, to name but a few MD/DC clinics in the private sector.

As well, the military gates have recently opened in the Department of Veterans Affairs Medical Centers with 30 clinics now has DCs working alongside MDs.  DoD is also multidisciplinary with more than 50 clinics throughout the US such as the Bethesda Naval Hospital. Cooperation is happening, but at a very slow rate to help the millions of patients suffering from spine problems.

In this era of evidence-based healthcare, the long-awaited international research and guidelines now endorse our brand of conservative spinal care—AHCPR and the Decade of Bone and Joint Disorders showed manual medicine is appropriate for both acute and chronic low back pain. It may have taken over 100 years, but science finally proves our art.  In this era of informed decision making, ethically we must work side-by-side with MDs to give patients the best of both worlds as it should be. The suffering patients need it and the public clamors for cooperation.

Indeed, now is the time to win this battle in the court of public opinion just as the Wilk trial won in the legal court. But this window of opportunity won’t remain open indefinitely, so let’s not procrastinate. Some delegates have already told me the likelihood is small that the AMA will cooperate, some think the AMA may be offended, and some of our own ACA delegates suggest my Resolution is too extreme or unprofessional.

Coincidentally, similar reservations were told to President Reagan before his Berlin speech. In May of 1987, President Reagan met with Chief of Staff Howard Baker and Deputy National Security Advisor Colin Powell who both objected to the phrase, “Tear down this wall,” saying it sounded “extreme” and “unpresidential.” Nevertheless, Reagan liked the passage saying, "I think we'll leave it in." The rest is history.

Let us be bold today and take the same leap of courage that President Reagan took. Let us give suffering patients hope, just as Reagan gave hope to Berliners and the entire world.

“Today thus represents a moment of hope. We in the West stand ready to cooperate with the East to promote true openness, to break down barriers that separate people, to create a safe, freer world.”

 

“As I looked out a moment ago from the Reichstag, that embodiment of German unity, I noticed words crudely spray-painted upon the wall, perhaps by a young Berliner: "This wall will fall. Beliefs become reality." Yes, across Europe, this wall will fall. For it cannot withstand faith; it cannot withstand truth. The wall cannot withstand freedom.”

With our success in research, in education, in legislation, and in the clinic, this is a golden opportunity to improve our public image, polish our tarnished professional identity, and prove our effectiveness within the mainstream healthcare system. We have faith in our methods of manual medicine, we now have the truth in recent research, and all we need now is the freedom to practice alongside our medical counterparts for the betterment of patients. Now should be heralded as the era of cooperation between medicine and chiropractic.

We chiropractors are on the brink of a new era. We have evolved into a highly educated, evidence-based health care profession on the leading edge of spinal care. Tony Rosner, PhD, formerly Director of Research at FCER, spoke of this proof in 2003 concerning the evolution of the research supporting chiropractic care in his testimony before The Institute of Medicine: Committee on Use of CAM by the American Public:

 “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.”

If the AMA faces the challenge to admit its discriminatory policy toward chiropractors, we chiropractors face a similar challenge to overcome our own stumbling blocks—our unscientific image and clinical exaggerations due to our vitalistic philosophy.

 

George Lundberg, MD, Medscape Editor in Chief, editor-in-chief of JAMA from 1982 to 1999, offered a challenge to our profession that needs to be accepted by the ACA:

“If some influential individual or group in chiropractic would follow your thesis, and would loudly and openly embrace EBM, let the chips fall where they may, and, if I may push further, openly repudiate the ‘vertebral subluxation and resulting nerve pressure is the root of all diseases’ (presumably the Palmer belief structure), then I and many other physicians could openly and without fear and derision look at what 2005 EBM chiropractors actually do and go forward together.” (Private communication, Nov. 2, 2005)

Methinks Dr. Lundberg’s challenge mirrors the same trepidations of the AMA’s HOD.

I’m certain we can admit that some of our woes were brought on by our own, not just by political medicine. Just as the AMA’s slate is not clean, nor is ours. If we challenge the AMA to look at itself, shouldn’t we do the same?

Let’s be very clear: we are not our grandfathers’ chiropractic, so let’s not act like it. Let’s not feel compelled to defend our past mistakes. Rather than acting as quacks with unfounded, exaggerated claims and cultists who refuse to work with our medical counterparts because of “philosophical” differences, we can show the public that we are among the best qualified doctors to treat this epidemic of back pain.

Indeed, are we ready to accept his challenge? Can we let the chips fall where they may and put the chirovangelism aside and stand on our clinical success and research studies with our brand of non-drug and non-surgical care for neuromusculoskeletal problems?

 

Or will we steadfastly stand by a Big Idea that has never been proven—the cure-all that has made skeptics of many of our own colleagues? Just as the Communists lived and died by a failed ideology, are we willing to fall on our sword?

Let us approach the end of the Medical Cold War with a give-and-take attitude that may lead to a peaceful coexistence for the first time in our history. For the sake of our suffering patients, it’s time for both the medical and chiropractic professions to beat their swords into plowshares.

 

 

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