Articles by JCS

USA Today


The Medical War

Against Chiropractors

By

JC Smith, MA, DC

History will show the American Medical Association (AMA) has fought its longest and most aggressive war not against any disease, but for over a century it has fought an illicit war against chiropractors.

Most adults are aware of the war between the two professions, but few understand the historical events, the enormity of the present back pain epidemic, or how this conflict may affect them personally as collateral damage in this war. This remains the untold story of chiropractic from persecution to vindication.

Although not deadly like heart disease or cancer, back pain is pandemic that currently costs an estimated $267.2 billion annually and will strike most of the 250 million American adults sometime in their lifetime.[1] Chronic low back pain is huge with a daily prevalence in the general adult population estimated at 37%, which equates to 92.5 million people; the annual prevalence is 76%, which equates to 190 million; and the lifetime prevalence is 85% or 212.5 million adults.[2]

The First Medical War Against Chiropractors: 1906 to 1949

The first skirmish involved the founder of chiropractic, DD Palmer, who was jailed in 1906. His imprisonment was followed by 12,000+ more chiropractors nationally who were arrested in the first half of the 20th century for allegedly practicing medicine without a license although chiropractors never used drugs and surgery. This legal harassment continued until 1975 when the last state, Louisiana, passed legislation to establish the scope of chiropractic care as well as to protect chiropractors and their patients from arrest.[3]

This clash escalated into outright war in 1910 with the appointment of the AMA’s new executive director, Morris Fishbein, MD, who was appropriately dubbed the “Medical Mussolini” by his contemporaries. He was quite open about his tyrannical attitude when he wrote in 1925 that “Scientific medicine absorbs from them that which is good, if there is any good, and then they die.”[4]

Most historians argue that Fishbein was not interested in health in any way as evident when he went to bed in 1930 with the tobacco industry that funneled millions into his coffers to wage war against chiropractors and other competitors such as optometrists, psychologists, osteopaths, and, nowadays, nurse practitioners.[5]

Under his reign, tobacco companies became the largest advertisers in The Journal of the American Medical Association. In exchange, the AMA even allowed the image of physicians in tobacco ads in magazines, newspapers, and later in TV ads featuring doctors endorsing cigarettes.

Harper’s Magazine suggested in 1949 that 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,” which it remains today.[6]

Tobacco advertising money motivated the AMA to lie to the public for 56 years about the dangers of tobacco until 1986 when the weight of scientific evidence was too large to deny any longer. And just as the AMA lied to the public about tobacco being addictive and deadly for over fifty years, it also lied to the public about the benefits of chiropractic care for over a century.

 Above: Morris Fishbein, aka, the Medical Mussolini

The Second Medical War Against Chiropractors: 1962 to 1976

After his forced retirement in 1949, Fishbein’s successors in the AMA created a Committee on Quackery (CoQ) in 1962 that restated his goal to wage war on the chiropractic profession.

The AMA’s campaign was clearly spelled out in its Final Plan, “What Medicine Should Do about the Chiropractic Menace.”[7] Dr. David Stevens , a member of the CoQ, minced no words when he said, “We weren’t out to be fair. We were advocates. Our job was to destroy chiropractic.”[8] This strategy later became the focus of an antitrust trial, Wilk et al. v. AMA et al.[9]

The CoQ’s attorneys created a secretive multi-faceted strategy, including a national anti-chiropractic defamation PR campaign, tactics to deter chiropractic colleges from gaining federal accreditation, underhanded political skullduggery to exclude chiropractic from inclusion in Medicare and insurance programs, and an illegal plan to keep chiropractors out of public hospitals by denying them staff privileges.  No stone was left unturned by the AMA to “contain and eliminate the chiropractic profession.”[10]  

Operation Sore Throat

The Second Medical War Against Chiropractic lasted openly until 1976 when four brave chiropractors led by attorney George P. McAndrews filed suit in federal court in Chicago after a fortuitous event exposed the secretive and illegal plan of the CoQ.

At the height of the medical war in 1972, the chiropractic profession experienced a serendipitous windfall from a most unlikely group that would change the course of the medical war by giving chiropractors the ammunition for its first major counterattack.

This event was dubbed “Operation Sore Throat,” which by today’s events was comparable to a “WikiLeaks” incident. An exposé, In the Public Interest, was sent to leaders in chiropractic that contained actual photocopies directly from the AMA’s files revealing its war against chiropractors and became the evidence needed to pursue legal action.[11]

Allegedly, three members of the Church of Scientology pilfered the secret documents from inside AMA headquarters. The release of this highly sensitive internal information was a treasure trove of evidence that proved the AMA’s campaign to destroy chiropractic. With this insider information, the chiropractors filed in 1976 an antitrust lawsuit against the AMA and litany of thirteen other medical organizations and individuals.[12]

Wilk et al. v. AMA et al.

Not only did In the Public Interest reveal many illegal dirty tricks, it exposed another important battle waged in the court of public opinion by the CoQ promoting its slur that “everybody knows chiropractic is an unscientific cult.” [13]

To accomplish this widespread slander, the CoQ developed a massive PR campaign that left the chiropractic profession’s image with a tarnished reputation by using such name-calling as “quacks,” “unscientific cultists,” and “dangerous” that went unchallenged by a complicit media.[14]

At trial the AMA’s leaders offered no proof for these allegations—they were simply repeating lies from their own propaganda. Nor did the medical attorneys produce one patient who had been injured by any chiropractor during this 11-year trial.

Court records from Wilk revealed the AMA even colluded with famed 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.”[15]

It cannot be overstated the role that some in the media played in this war to discredit the chiropractic profession. The CoQ 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 members of the public, press, politicians, and high school counselors as “proof” of the evils of chiropractic from supposedly objective third-parties.[16]

The Wilk trial proved this to be a gross deception. In her Opinion, Judge Susan Getzendanner mentioned the extensive effort by the CoQ to segregate chiropractors from MDs, to ruin the reputations of chiropractors, and to boycott their services in public hospitals.[17]

 The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations…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.[18]

Despite this landmark trial, the public still has no idea of this clandestine propaganda campaign that continues with yellow journalism emanating from successors of the CoQ known as the Institute for Science in Medicine, a loose association of medical demagogues who continue to cast aspersions upon chiropractors’ reputations with spurious accusations reminiscent of the CoQ.

The Evidence Emerges

After a century of libeling chiropractic as an “unscientific cult,” the present era of evidence-based healthcare has been a blessing to chiropractors. Ironically, many spine experts now suggest chiropractors should be considered America’s primary spine care providers by virtue of their training and effectiveness.[19]

Today there are more random controlled trials on spinal manipulative therapy for low back pain than any other treatment.[20] Researchers now vindicate chiropractic treatments over medical care for the majority of “mechanical” back pain cases that comprise the majority (~85%) of all back pain cases.[21]

This transformation began in 1990 when MRI research rocked the spine world concerning the basic medical premise of back pain—the abnormal disc theory—was proven invalid. This revelation in spine diagnosis began at Emory University when researchers found many people without back pain had herniated or degenerated discs, too. [22]  Spine researchers now refer to abnormal discs as “trivial, harmless, irrelevant,” to the point of calling them “incidentalomas,” equivalent to “finding gray hair” since both are part of the normal aging process.[23]

By the mid-1990s, many spine studies produced clinical evidence for spinal manipulation for low back pain, such as RAND (US, 1991)[24], Manga (Canada, 1993)[25], AHCPR (US, 1994)[26], and the Meade Study (UK, 1990).[27] According to Pran Manga, PhD, Ontario (Canada) health economist: "There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management." [28]

In 2010 the North American Spine Society admitted spine fusion should be a last resort and recommended spinal manipulation should be considered before surgery. [29] In January, 2011, North Carolina Blue Cross/Blue Shield said it would not pay for spinal fusion if the sole indication is disc degeneration or herniation since these are present in asymptomatic patients, too.[30]

Researchers also discovered that the majority of medical primary care physicians were very poorly trained in back pain and musculoskeletal disorders (MSD) as well as found their heavy reliance upon outdated treatments. Inexplicably, it was found that 50% of all medical schools do not require MSD training. Moreover, 82% of MDs flunked a 25-question MSD competency exam.[31]

Most MDs still masquerade as experts in back pain at the same time international guidelines on back pain have abandoned as the initial treatments narcotic opioids, epidural steroid injections, MRIs detecting incidentalomas, and spine surgery except as a last resort in a minority of cases of cancer, fractures, infections or those cases unresponsive to manipulative therapy.

Despite this new evidence, from 1994 to 2007, MRIs increased 307%, spinal fusion surgery increased 204%, spinal injections increased 629%, and opiate use increased 423%.[32] The most complex type of back surgery increased dramatically between 2002 and 2007 with an implausible 15-fold increase despite evidence that abnormal discs are ubiquitous.[33]

In comparison with other countries, the rate of back surgery in the United States was at least 40% higher than any other country and was more than five-times those in Great Britain. Among the various reasons for such large increases include financial incentives involving both surgeons and hospitals.[34] The hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former and $80,888 for the latter.[35]

Back surgery rates increased almost linearly with the per capita supply of orthopedic and neurosurgeons.[36] A shocking 2009 Stanford University study also found the abundance of MRI scans directly leads to unnecessary back surgeries.[37]

Indeed, excessive and expensive medical spine treatments are now a public safety issue and a burden upon escalating healthcare costs. Nearly 600,000 Americans opt for back operations each year, but for many, surgery has been accused of “leaving more tragic human wreckage in its wake than any other operation in history.[38],[39]

The Cost of War

The Dartmouth Institute of Health Policy suggests 30-40% of spinal fusions surgeries are unnecessary.[40] Considering the estimated cost of back pain is $267.2 billion annually, a 40% reduction would be $106 billion.[41] This cost savings would be equivalent to the War in Afghanistan that costs nearly $2 billion weekly or $119.4 billion annually.[42]

After a century of persecution and defamation by a relentless medical society, clinical research now vindicates chiropractic care for the pandemic of back pain that could save millions of patients from unnecessary narcotics, epidural steroid injections, MRIs, and spine surgery as well as potentially offer cost savings of billions of dollars in a strapped healthcare economy.

JC Smith, MA, DC, is a 33-year chiropractic practitioner, author, and founder of www.chiropractorsforfairjournalism.info



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

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

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

[4] Morris Fishbein,  Medical Follies, (New York, Boni & Liveright, 1925): 43.

[5] Dana Ullman, , How the American Medical Association Got Rich, Berkeley:  North Atlantic Books, 2008.

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

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

[8] G McAndrews, “Plaintiffs’ Summary of Proofs as an Aid to the Court,” Civil Action No. 76 C 3777, Wilk, (June 25, 1987): 3055

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

[11] JF McAndrews email to JC Keating dated July 5, 2005, notes on “Wilk et al. vs. AMA et al. and The Century-Long War Between Chiropractic And Allopathic Medicine.”

[12] H Wolinsky and T Brune, The Serpent on the Staff: The Unhealthy Politics of the American Medical Association, Putnam Book, New York, (1994

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

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

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

[16] G McAndrews closing argument, Wilk II (June 26, 1987):3082.

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

[18]   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

[19] 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

[20] Rubinstein SM, Terwee CB, de Boer MR, van Tulder MW. Is the methodological quality of trials on spinal manipulative therapy for low-back pain improving? International Journal of Osteopathic Medicine. 2012;15(2):37-52.

[21] RA Deyo, “Conservative Therapy for Low Back Pain: Distinguishing Useful From Useless Therapy,” Journal of American Medical Association 250 (1983):1057-62.

[22] 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.

[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] PG Shekelle, A Adams, et al. "The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel." RAND Corporation, Santa Monica, California  (1991)

[25] P Manga, D Angus, C Papadopoulos, W Swan, “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain,” (funded by the Ontario Ministry of Health) (August, 1993)

[26] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)

[27] TW Meade, Letter To The Editor, British Medical Journal  319/57 (July 3, 1999).

[28] P Manga, Ph.D., D Angus, M.A., C Papadopoulos, M.H.A., W Swan, “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain,” (funded by the Ontario Ministry of Health) p. 104, August, 1993.

[29] MD Freeman and JM Mayer “NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain,” The Spine Journal 10/10 (October 2010):918-940

[31] Matzkin E, Smith MD, Freccero DC, Richardson AB, Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005, 87-A:310-314

[32] Martin BI, Deyo RA, Mirza SK et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299: 656-64

[33] J Silberner, “Surgery May Not Be The Answer To An Aching Back,”  All Things Considered, NPR (April 6, 2010)

[34] “New Study Demonstrates A Three-Fold Increase in Life-Threatening Complications With Complex Surgery,” The BACKLETTER, 25/6 (June 2010):66

[35] “New Study Demonstrates A Three-Fold Increase in Life-Threatening Complications With Complex Surgery,” The BACKLETTER, 25/6 (June 2010):66

[36] DC Cherkin, RA Deyo, et al. “An International Comparison Of Back Surgery Rates,” Spine, 19/11 (June 2004):1201-1206.

[37]  M Brandt, Stanford University Medical Center, “MRI Abundance May Lead To Excess In Back Surgery,” (Oct. 14, 2009)

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

[39] Linda Carroll, “Back Surgery May Backfire on Patients in Pain,”  MSNBC.COM, Oct. 14, 2010

[40]Elliott Fisher, MD, on the CBS Evening News, “Attacking Rising Health Costs,” June 9, 2006.

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

[42] Estimated War-Related Costs, Iraq and Afghanistan, "The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9/11," Amy Belasco, Congressional Research Service Report for Congress, RL33110, p. CRS9).

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