is ready to step up to the plate and to let its belief systems be tested scientifically.
Let the chips fall where they may.’’ [1]
John J. Triano, DC, PhD
Doorway Diplomacy
The medical war against chiropractors has been fought on many battlefields, including in the sanctity of our nation’s classrooms and universities. Political medicine realized in order to shape public opinion it had to start early by brainwashing children through their teachers and counselors. The AMA was mortified to learn from its own survey that 70 percent of high school seniors thought that chiropractors were best for neck and back pain.[2] In response, the Committee on Quackery (COQ) under the direction of H. Doyl Taylor produced “The Quack Pack” to disseminate misinformation to high school counselors to give to prospective chiropractic or medical students.[3]
As well, in order to demean chiropractic’s academic legitimacy, the COQ had to smear chiropractic’s image and “contain” its expansion in the ranks of higher education with intimidation and censorship. Indeed, no leaf was left unturned by AMA, Inc. in its effort to “eliminate” its competitors.
The 1963 “Iowa Plan” created by the AMA’s attorney Roger Throckmorton included a strategy for the containment of chiropractic colleges.
“To the extent that [the schools’] financial problems continue to multiply, and to the extent that the schools are unsuccessful in their recruiting programs, the chiropractic menace of the future will be reduced and possibly eliminated.”[4]
The Iowa Plan sought to prevent the government from granting chiropractic student loans and tried to end all government grants for research at chiropractic colleges. While the AMA worked to starve chiropractic education, it also complained loudly that chiropractors did not do enough research to prove scientifically its scope of treatment, illustrating the duplicity of political medicine.
As well, the Committee on Quackery developed a plan to resist any federal recognition and financial assistance to chiropractic education. As long as the education of chiropractors appeared inadequate compared to medical schooling, the AMA could use it as leverage against chiropractors gaining equal status.
This was the tactic used in the late 1950s and early 1960s in the medical war in the state of Louisiana, which was the last state to legislate a separate scope of practice law for chiropractors in 1974. The England case, as it became known, was filed by Dr. Jerry England and other Louisiana chiropractors who sought the right to practice chiropractic without hindrance from the medical establishment. This lengthy legal process that began in 1957 and ended in 1966 was appealed all the way to the US Supreme Court, which in 1964 remanded it back to the District Court.[5]
Similar to the tactics in the first Wilk trial, the shameless and unethical practices of some chiropractors were exposed to the judges. The medical attorney also emphasized the lack of federally-recognized accreditation for chiropractic schools. In 1965 the three-judge tribunal ruled in favor of the medical board. The tribunal ruled that the proper venue for seeking change in the laws governing licensure was not the responsibility of the judiciary but should come from the legislature.[6]
Renowned chiropractic educator Joseph Janse, DC, ND, president of National College of Chiropractic (NCC) in Chicago, was embarrassed as a witness during the England trial when he was forced to admit to the lack of federal accreditation of chiropractic by the U. S. Office of Education (USOE), unlike all other health professions that had this recognition.
According to the historian of National College of Chiropractic, Ronald P. Beideman, DC, ND, “He vowed he ‘would correct this fault … or leave the profession.’”[7] Being a “scrapper” that Janse was known to be all his life, [8] this ridicule motivated him to seek accreditation for NCC, which he accomplished six years later when his college received regional accreditation.
He did not leave the profession and his efforts led to federal recognition in 1974 when the Council on Chiropractic Education (CCE-USA) was finally established by the USOE as the professional accrediting body for chiropractic colleges. As well in the same year, Louisiana chiropractors were finally granted recognized status by statute.
It was not by coincidence that Louisiana was also the home state of Dr. Joseph Sabatier, better known as the chairman of the Committee on Quackery and a co-defendant in the Wilk trial that began in 1976. The Pelican State was the last ditch effort of Sabatier to thwart chiropractic’s legal recognition, and once the tribunal in 1965 had ruled in favor of the medical board, arrests of chiropractors commenced again after the nine-year legal battle. In 1967, Dr. England and his wife left Louisiana in the middle of the night to avoid going to jail, relocating in Alabama for the next 27 years.[9]
Recall this came just two years before the Wilk trial began, and due to the initial failure of the England case, the American Chiropractic Association and many chiropractors were initially hesitant to support Chester Wilk and return to a legal battle in another courtroom with a much stronger opponent.
Both the England and Wilk legal battles had to be fought and, despite initial defeats in the courtroom, the subsequent appeals proved positive. The England case that led to improving educational standards was essential for chiropractic’s survival as well as important in the Wilk trial by removing a legitimate criticism of chiropractic – its lack of federally-recognized educational standards.
Sabatier and the Committee on Quackery (COQ) had no wish to see chiropractic improve on the educational front. Two of the stated goals of the Sabatier’s COQ were the distribution of propaganda to the nation’s teachers and guidance counselors to discourage students from seeking careers in chiropractic and punishing community colleges that offered pre-chiropractic programs. Of course, this extended to the established universities’ medical schools to resist the implementation of any chiropractic academic programs.
The Iowa Plan also addressed the issue to contain the improvement of chiropractic education by prohibiting medical professionals from consulting with chiropractors about patients or teaching. According to attorney George McAndrews in his closing remarks in the Wilk trial, “The plan encompassed keeping them from having adequate teachers in their schools. So then you could turn around and condemn the schools for being inferior.”[10] The Iowa Plan also prohibited for MDs to attend seminar where chiropractors lectured.
Both Morehead College in Kentucky and the College of St. Thomas in Minneapolis attempted to begin a two-year pre-professional course for students seeking to attend chiropractic college. In both instances, the local medical society put pressure on the college president to stop the affiliation or else lose their accreditation.[11]
For example, in 1971, the C.W. Post College, a division of Long Island University in New York State, was asked by Lincoln College of Chiropractic to cooperate to set up a Chair of Chiropractic and to teach the pre-professional basic sciences, and they indicated a desire to have this chiropractic college work with them.[12]
However, this program was scuttled when the college capitulated to the threat of the AMA to cut funds and withdraw accreditation. The NY medical society sent newsletters to its member physicians throughout the state stating “the lights of the Empire State have gone out.” In July, 1972, issue of the Medical Society of the State of New York, an article, “Long Island University says it will not teach pre-chiropractic students,” reported that “the proposal was protested vigorously by the Medical Society…”[13]
Ernest R. Jaffe, Acting Dean of the Albert Einstein College of Medicine of Yeshiva University, sent a letter to Long Island University that said, “I urge you to take all appropriate measures to terminate any relationship with Lincoln College of Chiropractic. It can only bring discredit to your university.” [14]
Roger Throckmorton, legal counsel of the AMA, wrote the guideline to contain chiropractic education in his booklet, “The Menace of Chiropractic.” Since chiropractic colleges were exclusively funded by tuition money and not by federal grants like medical schools, most operated bare bones budgets. Throckmorton wrote:
To the extent that these financial problems continue to multiply and to the extent that the schools are unsuccessful in their recruiting programs, the chiropractic menace to the future will be reduced, and possibly eliminated.[15]
George McAndrews commented on the “objective reasonableness of any men or women of science saying that they are going to benefit patient care by undercutting the educational base of a licensed healthcare profession, and that is what they did, I might say probably to their everlasting shame.”[16]
Henry I. Feinberg, chairman of the Committee on Quackery, reported that the medical staff at C.W. Post had threatened to resign if the chiropractic proposal was implemented:
It is reprehensible that a number of intellectuals of an accredited institution of higher education would even consider participation in this chicanery. Our purpose is to alert everyone engaged in the legitimate practice of medicine to the tremendous danger of setting up a program for those who wish to practice medicine through the back door.[17]
Once again we hear the echoes of Morris Fishbein speaking when he wrote:
It has been said that osteopathy is essentially a method of entering the practice of medicine by the back door. Chiropractic, by contrast, is an attempt to arrive through the cellar. The man who applies at the back door at least makes himself presentable. The one who comes through the cellar is besmirched with dust and grime; he carries a crowbar and he may wear a mask.[18]
George McAndrews summarized the intent of the AMA to thwart chiropractic education was to “have the appearance of lack of education”:
That’s equivalent of book burning. You can’t give a lecture to these people because we want to accuse them of being stupid so we can eliminate them. You can’t teach in their schools because we’re going to maintain the appearance they don’t have any knowledge. And they never know when to send anyone to an MD, so we’re going to make it unethical for them to refer a patient to us. And since all they do well is biomechanical things, we are going to make it unethical for an MD to ever refer a patient to a chiropractor under any circumstances even when the MD intimately knows the chiropractor. They left no room.[19]
Indeed, chiropractic had become a taboo subject for many colleges due to this intimidation. To this day, no major American university has a chiropractic program. Author Gary Null, PhD, summarized this twisted sense of medical ethics that had no bearing to improve patient welfare, but did improve the AMA’s own economic welfare to thwart the progress of a rival profession:
Placing this kind of pressure on academic institutions was central to the strategy of the AMA and the other medical organizations involved. If chiropractors had access to the same university privileges that the medical profession enjoyed—including internships and residencies in university medical school hospitals—it would undercut the medical profession’s arguments that chiropractors lack the education necessary to diagnose or treat human ailments.[20]
The Illinois State Medical Society (ISMS) drew its own line when it published an article, “Snap, Crackle and Pop,” written by Dr. William Lees, MD, Chairman of the ISMS Board of Trustees. This article was immediately sent around the United States by Doyl Taylor.
Among many incriminating statements, Dr. Lees wrote:
Physicians must become fully knowledgeable, must educate their patients, and must help ISMS to concentrate activity to eliminate chiropractic.
It is also recommended that physicians not compete with chiropractic practitioners since this lends status and credence to them and implies a certain equality.[21]
When Lees learned that a chiropractor had been allowed in the door of a tax supported public state university, he wrote to the Illinois College of Medicine:
It might be wise to prohibit any contact of any kind at any time by persons at the medical center with any chiropractor.[22]
One might think the chiropractor had the bubonic plague that might contaminate the college staff. Instead, in the opinion of Lees, he had something worse – a chiropractic degree. Mr. McAndrews addressed this attitude at trial when he said, “This is what you call total absolute ostracism, segregation, isolation, and humiliation.”[23]
Since some medical physicians such as orthopedists and general practitioners were in direct competition with chiropractors in the treatment of back pain, in 1964, Sabatier admitted one financial motive behind the AMA’s genocidal campaign: “It would be well to get across that the doctor of chiropractic is stealing [the young medical physician’s] money.”[24] Indeed, money rather than patient care or academic dispute was the main concern of AMA, Inc.
Throckmorton and his allies in the COQ used the Principles of Medical Ethics of the AMA to bully their own members, even those who knew chiropractic care helped patients with biomechanical problems. Principle 3 stated:
A physician should practice a method of healing founded on scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle.[25]
Not only did Principle 3 intimidate those “flowers in the desert” as McAndrews referred to those ethical MDs who consulted with chiropractors, but Principle 4 of the Medical Code of Ethics was just as bad when it promoted outing those ethical MDs who worked with chiropractors clearly suggesting to reveal these desert flowers who put patient care ahead of the AMA’s political agenda
The member should expose without hesitation unethical conduct of fellow members of the profession.[26]
According to attorney McAndrews,
…the fact of the matter is they [the AMA] threatened the medical physicians across the country with professional disgrace, public humiliation, loss of membership, loss of cross-referrals, loss of consultation, and loss of hospital privileges if they wanted to relate to a chiropractor. And you don’t find many medical physicians that are going to commit professional suicide to consult with or refer patients to or from chiropractors.[27]
McAndrews noted in this closing of Wilk II that by forcing Principle 3 and 4 upon its members, “the AMA has set the chiropractic profession back, has set the healthcare of this country back, and did it deliberately because it confused its trade union responsibilities with its responsibility to healthcare.”[28]
As shocking as this lack of academic freedom may seem to many today, it was typical of the bigoted mindset American experienced before the Civil Rights era began in the early 1960s. Sadly, America would experience another such injustice decades later at Florida State University.
George McAndrews noted this appalling academic situation created by the AMA:
Any medical physician that tried to teach in a chiropractic college was banned. He was anathema. He was unethical… you haven’t had anything like that in modern history except down in the South where they used to say you can’t educate blacks. There aren’t many instances of anything like that in the history of the United States, that you can’t educate someone and you can exercise sufficient power to bully a university system supported by taxpayers into not giving education to someone.[29]
In 1966 at a debate between Dr. J. Joseph Allen, chiropractic author, lecturer and educator, and Dr. Sabatier, then-president-elect of the Louisiana State Medical Society, Dr. Allen questioned the ethics of Sabatier’s persecution:
It is contrary to all the rules of justice and fairness to allow a competitor (the medical profession) to pass on our ability… There is a law that supersedes man-made law and that is the moral law. People are going to chiropractors, millions of them and these millions are getting results. [30]
Despite the medical criticism of the poor standards of chiropractic education, when the USOE began the process to establish a federal accrediting agency to improve chiropractic education, the Council on Chiropractic Education (CCE), the AMA adamantly complained again.
On March 1, 1974, Dr. Ernest B. Howard, Executive Vice-President of the American Medical Association, made a second attempt, following a similar attempt in 1972, to get the U.S. Commissioner of Education to discontinue its consideration of recognition of an accrediting agency for chiropractic education. The thrust of his argument was that chiropractic had no scientific validity or social usefulness. (emphasis added)
In his response to Dr. Howard, U.S. Commissioner of Education, John Ottina, cited a July 19, 1972 memorandum from the Office of General Counsel to HEW on Dr. Howard’s 1972 request in which he stated:
Under the relevant legislation requiring him to list nationally recognized accrediting agencies and associations, it is our view that the Commissioner is not called upon to express his opinion as to the legitimacy or social usefulness of the field of training of the agency seeking listing. That is not to say that where training in the field under question or the practice of such training is patently illegal, or an apparent hoax or fraud, that the Commissioner must recognize and list an accrediting agency for that Subject.[31]
Howard presented no facts or research to prove his allegations. The AMA would not stop in its relentless pursuit to obstruct federal accreditation of chiropractic colleges by the USOE because along with federal accreditation came guaranteed student loans, the lifeblood of any college.
At the May 23-24, 1974 hearing of the USOE Advisory Committee on the CCE Application for Recognition in Washington, D.C., the AMA sent its new chairman of the Committee on Quackery, Boston neurosurgeon, Dr. H. Thomas Ballantine. He made a vicious attack on the chiropractic profession, the CCE, and its Commission on Accreditation. He characterized the chiropractic profession as a cult and stated that “medical authorities agree that chiropractic has no validity… and represents a significant hazard to the public.”[32]
Once again, Ballantine presented no facts or research to prove his allegations. The AMA would do anything to have chiropractic colleges wither on the vine, including lying to the courts. The alibi that chiropractic is an “unscientific cult” was later reiterated at the Wilk trial in 1976 and the New Zealand Inquiry on Chiropractic in 1978 and shown to be an unproven allegation without merit, but that did not stop these medical war generals from stating such ridicule.
Despite the notion of academic freedom in higher education, the AMA and its Committee on Quackery made a mockery of this enclave of learning. Recall it was Sabatier who said “Rabid dogs and chiropractors fit into about the same category…Chiropractors were nice [but] they killed people.”[33] As well, Dr. Stevens testified, “We weren’t out to be fair. We were advocates our job was to destroy chiropractic. We certainly weren’t going to use anything that was favorable to them.”[34]
While the AMA spokesmen were defaming chiropractic as quackery, they ignored the testimony of prominent medical doctors who disagreed, most notably, Dr. John McMillan Mennell, a distinguished orthopedist who has taught at eight medical schools. He also testified at the Wilk trial. In a letter dated October 28, 1968 to the HEW panel on Medicare coverage for chiropractic in which he participated, he mentioned the value of chiropractic care:
Manipulative therapy relieves symptoms of pain arising from mechanical joint dysfunction and restores lost joint function. No other modality or physical treatment can do this as effectively. This is clear from personal experience, from assessing the value of manipulative therapy in my practice, from experiences related by intelligent, well-educated people in all walks of life including other doctors…from the best figures available to me I would suspect that nearly 20 million Americans today could be spared suffering and be returned to normal pain-free life were manipulation therapy as readily available to them as empirical nonspecific drug treatment is. [35] (emphasis added)
The Iowa Plan to undermine chiropractic education illustrated the power of one special interest group to impose self-serving policies on public institutions — scholastic, hospitals, and health programs in general – that affected millions of Americans. In effect, the AMA’s plan to ban chiropractic was an egregious attack on academic freedom and an affront to every civil minded person, and this mindset did not end when the CCE was accredited by the USOE making student loans available for chiropractic students. It may have lost this battle, but the medical war to thwart chiropractic education and research was far from over.
The Perfect Storm in Florida
The thrust to expand chiropractic education from small private colleges operating on shoe-string budgets to a major university level became the goal of the Florida Chiropractic Association that lobbied five years to convince the state legislature and Governor Jeb Bush to implement a chiropractic program at Florida State University (FSU) to access its research capabilities at its Tallahassee campus Medical School.
The fact that not one major public state university offers a chiropractic graduate level program speaks volumes about the influence of the medical profession considering chiropractic is the third-largest physician-level profession in the world. Academia remains a bastion under medical dominance and this warfare became a perfect storm in Florida that blew in like a hurricane to destroy a heroic effort to implement a chiropractic program at FSU.
In 2004, the Florida state legislature, led by Senate President and FSU alum Jim King and Senator Dennis Jones, a chiropractor, gave FSU the authority to offer a chiropractic degree and provided the university $9 million a year for a School of Chiropractic Medicine. This legislation was hugely supported by the legislators. SB 2002 was the first bill sent to Gov. Bush during the 2004 legislative session after being approved 38-1 by the Florida Senate on March 4, and approved by the House unanimously, 113-0, the following day.[36]
“Throughout this long effort, the Florida Chiropractic Association (FCA), its lobby team, and legislative leadership never lost sight of the goal to have a public option for a chiropractic education,” said the FCA’s CEO Deb Brown. “We have a long list of legislators, chiropractic leaders, educators and others to thank for helping to achieve this success.”
“We look forward to sharing the great news with the chiropractic world that this program is funded and that future chiropractic students at last have an option of a public education,” said CEO Emeritus Ed Williams, DC.
A public chiropractic school at FSU was the longtime goal of Senate Majority Leader Dennis Jones, a 1963 graduate of Lincoln College of Chiropractic and former president of the FCA. While serving in the House of Representatives, he argued for decades that Florida had no chiropractic school to call its own, causing hundreds of people who were interested in studying chiropractic to move out of state to obtain a degree.[37]
FSU proposed a joint Masters degree program that would be five years in length, as opposed to the usual four years of study in other chiropractic programs. In addition to the doctor of chiropractic degree, students would be required to obtain a collateral masters degree in microbiology, nutrition, health policy or biomechanics, depending on their course of study.[38]
Dr. Rand S. Swenson, DC, MD, PhD, and Associate Professor of Anatomy and Medicine at Dartmouth Medical School was retained by the Board of Governors as a consultant to review the proposal. Dr. Swenson indicated in his report that the proposed chiropractic program would benefit from its relationship with the integrated master’s programs, and he also suggested that those programs (and others at FSU) might be enhanced by the addition of chiropractic education.
The University also responded to the call both within and external to the profession for more scientific research related to chiropractic health care and a more evidence-based approach to professional practice. [39]
The integrated MS program emphasizes the following themes:
Science-based educational curriculum
Evidence-based care and research
Prevention, health promotion and wellness
Complementary and integrative health care
Health care information and quality improvement
Patient-centered care with focus on special populations
Dr. Swenson indicated in his consultant’s report that a chiropractic program at a public institution may be more effective in attracting minorities because of the decreased cost of attendance.
The FSU program would have been a turning point in chiropractic research and education, according to John J. Triano, DC, PhD, a leading chiropractic researcher, who was instrumental in the development of this program. “The transition is from the stereotypical impression of chiropractic as a bunch of people running around claiming they can treat everything, to a very evidence-based but open-minded practice approach.”[40]
The goal of the evidence-based chiropractic program was to do research at a major university that had the facilities, faculty, and funding to determine the scope of care of chiropractic care, but this noble cause was killed after it was conceived in the legislature when medical demagogues and political subterfuge crushed the proposed chiropractic program before it was implemented.
In a combination of events never seen before in the ranks of American higher education, this became a perfect storm consisting of a power struggle among the state legislature, the Board of Governors, the Board of Trustees, the FSU administration, an objectionable medical faculty, a divided chiropractic camp, and a gullible media that narrated the path of this storm to the public.
According to newspaper reports, the FSU Provost Abele had done a “commendable job” in putting together a chiropractic plan that attempted to bridge the gaps in chiropractic science and establish loftier academic standards. Despite his support, he felt compelled to distance this program from the poor image of chiropractic education emanating from Life Chiropractic College (LCC) in nearby Georgia that was supplying many of the states chiropractic graduates.
Our first commitment is to a rigorous scientific educational program, one that would explicitly reject some current chiropractic activities, such as many of the articles published in the Journal of Vertebral Subluxation Research,” he wrote. The Journal includes such “peer-reviewed science” as the benefits of spinal manipulation to promote fertility in infertile women, or to reverse multiple sclerosis and Parkinson’s disease.[41]
The role of LCC in the FSU proposal was a big factor in this perfect storm. Not only as a direct competitor for students, LCC stirred controversy with its unfounded position on the scope of chiropractic care as noted by the Provost when he referred to the Journal of Vertebral Subluxation Research (JVSR), an upstart chiropractic publication from LCC that had met mixed reviews, some often harsh, from within chiropractic itself for pushing the envelope of questionable case studies about organic disorders being help by chiropractic care.
The original scientific mainstay of chiropractic indexed research journals is the Journal of Manipulative & Physical Therapeutics (JMPT). Indeed, the decision by the provost to reference any articles from the JVSR was unfortunate — the equivalent to quoting the National Enquirer instead of the National Review on political matters.
Chiropractors, who traveled from Canada and New York, acknowledged there were fringe elements that damaged the legitimacy of spinal manipulation. But, they said, with FSU’s help, chiropractic medicine could trim the fringe and become a respected practice.[42]
Nonetheless, the FSU program was to research the scope of chiropractic care, which would in itself be a huge undertaking considering there are different levels of treatments within the chiropractic field as the New Zealand Inquiry noted. Foremost are the musculoskeletal disorders (Type M) like neck/back pain and headaches, the most common reasons why patients seek chiropractic care. These Type M disorders include neuromusculoskeletal disorders (NMS) that include radiating pain like sciatica.
On the other hand, some organic health problems (Type O) have also known to respond to chiropractic care as the New Zealand Inquiry had reported. (Chapter 5) Of course, this was a source of contention despite the emerging, albeit scant, supportive research on the neurophysiologic aspect of spine care. This explains why such research at a well-funded university was important to implement.
Most controversial, and also noted by the New Zealand Inquiry, was the vitalistic component of chiropractic philosophy extolling the body’s ability to heal itself. This philosophical tenet of chiropractic had become the Achilles heel that was attacked by the medical opponents as “pseudoscience.”
Certainly any philosophy is pseudoscience by definition, but medical critics use this to mischaracterize all of chiropractic as such. To many chiropractic proponents, this philosophical issue was nothing more than a red herring issue that became a stumbling block rather than a stepping stone to better understanding the dynamics of the healing process (discussed in the next chapter).
This alluded to the cure-all notion of chiropractic care emanating from the traditional “straight” chiropractic branch — the metaphysical aspect of the Palmer tenets that are faith-based rather than science-based.
This became the trump card for the medical critics who fought to stop the chiropractic program at FSU. Rather than seeing the value of the main goals to explore the clinical scope of chiropractic and conduct research in an academic setting with the staff, facilities, and funding available only at a major university, this vitalistic philosophy of chiropractic became the source of ridicule for the medical opponents at FSU. What should have been an academic debate would take on the fervor of a religious war to keep the heretics out of the medical sanctuary.
Academic Demagogues
The goal of the FSU chiropractic program was supported overwhelmingly by the state legislators by the combined vote of 151-1, but that did not persuade the medical opponents who did not like the idea of any chiropractic presence on campus, no matter the lofty academic goals or research objectives or the popularity in the state legislature. Never before had medical interference with chiropractic education taken on such an open display of academic demagoguery that quickly became another huge factor in this perfect storm in Florida.
Raymond Bellamy, MD, orthopedist and adjunct professor at FSU, became the lightning rod who led an academic revolt against this proposed chiropractic college that would have highlighted the profession’s struggle to move from broad unscientific claims to evidence-based treatment.
In effect, Bellamy’s effort was not a studious argument as much as it quickly digressed into a tirade of pejoratives, exaggerations, and slanderous accusations that reflected the ranting of Morris Fishbein in the 1930s rather than an informed college professor in the 2000s.
Bellamy told the media that he was fearful that establishing a chiropractic school would “devalue his FSU degree, the university’s reputation, and its medical school.” In effect, his argument sounded eerily familiar to “race defilement” as his main reason – to avoid contamination by chiropractors – and not the quest for academic inquiry as one might expect in an institution of higher learning.
“I’m trying to avoid embarrassing FSU or threatening their funding, but it may not be possible,” Bellamy said. “My sense is the only way we have of stopping this chiropractic school is getting the public educated.” He also admitted to “tapping into national experts who work against chiropractic education.” [43]
It was shocking to discover that nearly 30 years after the Wilk trial initially exposed the illegality of the Iowa Plan to undermine chiropractic that the AMA still had “national experts” whose goal was to “contain and eliminate” any presence of chiropractic on any campus as the Iowa Plan called for nearly fifty years ago in 1963.
The following excerpt from the Palm Beach Post, “Question Of Science” by Melanie Yeager clearly illustrated the academic demagoguery espoused by Bellamy.
A frenzy of e-mail exchanges…Conference calls and closed-door meetings, petitions circulating through the Internet…
Criticism against Florida State University’s planned chiropractic program has gained momentum in the last few weeks as Dr. Ray Bellamy, a longtime Tallahassee orthopedic surgeon, has quickly become the loudest naysayer in town.
Calling chiropractic medicine ‘pseudoscience,’ Bellamy is telling all who will listen – FSU administrators, trustees, state officials – that the program needs to be stopped.
“There are quacks. There is no question,” Provost Larry Abele said of the chiropractic profession. “But it’s incorrect to say all chiropractic is non-science and non-evidence based.” And he said FSU wants to bring better scientific practices to a health service used annually by 15 million Americans.
But Bellamy still thinks most chiropractic care is based on “gobbledygook … not one shred of science.” He said it degrades FSU’s entire scientific effort.
“It looks to me like the university’s for sale here,” Bellamy said. Bellamy’s primary beef is academic and personal, not financial. He’s fearful that establishing a chiropractic school would devalue his FSU degree, the university’s reputation and its medical school, where he teaches as an adjunct faculty member.
“I’m trying to avoid embarrassing FSU or threatening their funding, but it may not be possible,” Bellamy said. “My sense is the only way we have of stopping this chiropractic school is getting the public educated.”
“Not one single major scientific contribution has been made by chiropractic in 100 years, about the dangers of high neck manipulation and so on, but all I ask is that the facts be given a chance,” Bellamy said. [44] (emphasis added)
“… all I ask is that the facts be given a chance,” Bellamy pleaded. Too bad he would not give the chiropractic program the same fair chance.
Bellamy’s claim that chiropractic “has not one shred of science” reeks of the same unproven bias heard for years from the medical propagandists: “everyone knows chiropractic is an unscientific cult.”
The fact that Bellamy failed to appeal to the Florida legislature revealed his strategy was not to stage his battle until he had surrounded himself with his medical allies on the FSU campus rather than at the state capital where he would have faced 151 legislative proponents who voted for the chiropractic program.
The avoidance of a confrontation with the legislators on their turf in the capital was reminiscent of the AMA’s battle in the 1960’s when the Illinois State Medical Society executive director, a Mr. White, who was not an MD. When Doyl Taylor of the COQ approached the ISMS to adopt its policy against chiropractors, he wrote a response to Taylor on November 25, 1966.
The current AMA campaign to brand all chiropractors as cultists poses a problem for us in our dealings with the general assembly. Insofar as Illinois is concerned, you should know that many members of the legislature are not convinced that most chiropractors are quacks, many have told me personally that they have been to a chiropractor or some member of their family has been to a chiropractor and they have found relief.[45]
Undoubtedly the Florida legislators felt the same considering they passed the bill by a vote of 151-1. Instead, the medical mob chose to fight its battle on its home turf at FSU and in the media where it could avoid any critical feedback.
Although Bellamy’s accusations were unsubstantiated, the public and press were unaware that his own brand of academic gobbledygook and confounding accusations were derived from historic Fishbein propaganda deeply imbedded into the medical consciousness and not in scientific proof.
In retrospect, it can be seen that Bellamy’s strategy was to make the proposal of a chiropractic program into a propaganda exercise instead of an academic debate by using the classical tactics of demagoguery.
Humorist H. L. Mencken once defined a demagogue as “one who will preach doctrines he knows to be untrue to men he knows to be idiots.” Throughout history many demagogues have followed this doctrine which also aptly describes both Morris Fishbein and Raymond Bellamy in this medical war.
The following characterize the tactics of demagoguery specifically in this FSU fiasco:
to misrepresent chiropractic as a “pseudoscience,” “an unscientific cult,” and “gobbledygook,”
to mischaracterize chiropractic care as “dangerous” with “not one shred of evidence,”
by not allowing any academic or public debate for chiropractors to refute these allegations with known research studies,
predicting a doomsday outcome for the university’s image by suggesting “the university’s for sale here,” and
to stir action among his biased supporters, mainly other medical professors on faculty, by pushing the buttons of passion, fear, and prejudice by suggesting the mere presence on campus of a chiropractic program “devalues the FSU degree.”
Despite his assertion that his concern was not financial, the truth belied his claim since Bellamy had an obvious conflict of interest in this matter as “a longtime Tallahassee orthopedic surgeon” which may explain why he “has quickly become the loudest naysayer in town.”[46]
As Upton Sinclair once said, “It is difficult to get a man to understand something when his salary depends on his not understanding it.”
In the face of his obvious conflict of interest as an orthopedist and his use of blatant demagoguery, still no one in the media challenged Bellamy’s lack of objectivity. Nor did any reporter do any homework that would have revealed the many research studies and guidelines that supported chiropractic and refute his claims of gobbledygook.
Indeed, the media seem content to quote his exaggerations and pejoratives; it appeared the more sensational he became, the more copy the newspapers gave Bellamy. Undoubtedly, just as Fishbein swayed the mainstream media for decades with yellow journalism, Bellamy did the same on this battlefront to, as he said, “getting the public educated.”
Obviously Bellamy ignored the point of the FSU chiropractic program espoused by John Triano, DC, PhD, who served on the advisory committee for the FSU School. “The chiropractic profession as a whole . . . is ready to step up to the plate and to let its belief systems be tested scientifically,’’ said Dr. Triano. “Let the chips fall where they may.’’ [47]
Bellamy did admit to the Palm Beach Post that many patients do feel better after visiting a chiropractor, and confesses he has seen studies that show some improvement to low-back pain, although he believes it is minimal. He also acknowledged research showing patients are more satisfied with chiropractors than with doctors. [48]
“Other than for low-back pain, in very specific instances of recent back pain, almost everything they do is bedside manner and placebo effect…Patients like to be fussed over,” Bellamy said. “I think doctors need to learn to listen to patients more and be more hands-on and more caring.” [49]
I certainly agree with his last point that explains why in polls patients prefer chiropractors over MDs because we use hands-on care and are more caring than MDs. Instead of “fussing over” patients as he suggests, chiropractors do something more impactful when they adjust their patients’ spines to correct joint dysfunction, a physiological benefit ignored by Bellamy as an effective treatment.
Not only did he not step up to the plate in a fair fight, Bellamy rigged the game before it started with intimidation of officials, “I’m trying to avoid embarrassing FSU or threatening their funding, but it may not be possible,” and by fomenting public support of his warfare when he told the press, “Everybody wants somebody else to kill it.”[50] Considering this proposal passed the state legislature by a combined vote of 151-1, it does not appear “everybody” else wanted to see it killed.
Indeed, the press never took Bellamy to task to reveal his conflict of interest as an orthopedist and member of a rival trade association who spewed misinformation without verification.
Certainly, it was academic demagoguery at its worst – a medical lynch mob that fought to eliminate a rival on spurious grounds using inflammatory rhetoric with gross misrepresentation of the truth and mischaracterization of their opponents. This FSU mob became the driving force behind this perfect storm with Bellamy as its ringleader.
Perhaps the most shocking question not asked was how this demagoguery happened on a public university campus where diversity of thought and intellectual honesty are cornerstones of higher education. With emotions running on high and the strong presence of Bellamy and his medical mob, opposition to Bellamy by other academicians must have been impossible for fear of being branded as traitors.
Did rational academicians really believe, as Bellamy claimed, that “FSU is for sale” or their degrees would be “devalued” if there were a chiropractic graduate program on campus? Did the public actually believe Bellamy when he touted chiropractic was a “pseudoscience” all the while making chiropractic services the third-most sought health care behind medical and dental care? Did the medical researchers believe Bellamy when he said there was “not one shred of science” behind chiropractic after the landmark AHCPR study and numerous other studies proved otherwise?
Bellamy’s action typified Mencken’s definition of a demagogue as “one who will preach doctrines he knows to be untrue to men he knows to be idiots.”
This alludes to a larger question: where were the stalwart defenders for academic freedom at FSU? Where was the Board of Trustees or the Provost of the University or the Board of Governors when this academic assault began? Were they also afraid of the public display of medical power and rather than confronting this bully, they capitulated to his whim?
This mirrors the same situation Wilk attorney George McAndrews noted during the 1970’s when the AMA coerced and intimidated colleges offering pre-chiropractic programs:
… you haven’t had anything like that in modern history except down in the South where they used to say you can’t educate blacks. There aren’t many instances of anything like that in the history of the United States, that you can’t educate someone and you can exercise sufficient power to bully a university system supported by taxpayers into not giving education to someone.[51]
Apparently McAndrews was prophetic in his opinion and accurate when he likened it to the Southern attitude of bigotry that now exists at FSU. Instead of demeaning black Americans, Bellamy and his mob demean chiropractors as unworthy of a university education alongside them.
“I may not agree with what you say but I will defend to the death your right to say it,” was attributed to Voltaire [François Marie Arouet] (1694–1778), French philosopher and author. Apparently Voltaire’s concept of freedom of speech is not mutually held by the medical mob in the FSU fiasco.
When a medical demagogue like Dr. Ray Bellamy, an orthopedist, can use the media to spread ridicule in order to kill his main competition for spinal disorders and get it banned as an academic study from the university, both the ethos of Socrates and Hippocrates were violated. His medical demagoguery was enough to convince hundreds of medical mobsters to abridge academic freedom to follow their political agenda instead.
The Socratic ethos “nurtures a critical spirit and immunizes students against the facile notion that any view is as good, or bad, as any other. Students are taught to distinguish clearly untenable views from the few positions that appear to be defensible.”[52]
Certainly Bellamy’s assassination of the chiropractic program violated any resemblance that “nurtures a critical spirit” nor were students given the opportunity to distinguish for themselves “positions that appear to be defensible.” Rather than open this matter up to debate, Bellamy figuratively burned the books beforehand.
What is so shocking is the fact that this demagoguery would never happen in any other academic discipline. For example, imagine the uproar if Democrats were able to bar the study of conservative Republican politics from the FSU poli-sci program. What if faith-based Creationists were allowed to ban Darwinism and the study of evolution from the biology program? Imagine the outcry if peaceniks were able to bar the ROTC program from campus as war-mongers.
Of course, none of this would be tolerated, but when the medical society harangues and attacks chiropractic on bogus charges leftover from the Fishbein era, the FSU administration and media kowtowed to their demands and the medical faculty led by Bellamy goose-stepped in formation to display their hatred of the medical heretics. This is a sad indictment of higher education at FSU, but typical of the Iowa Plan.
Certainly fair-minded academicians had to exist at FSU, but Bellamy and his medical mob made it impossible for them to express their opposition to this academic demagoguery, just as fair-minded Americans were voiceless when Jim Crow protestors were spraying Civil Rights activists with fire hoses in Selma, Alabama, not too far literally and figuratively from the mindset on the FSU campus.
Moreover, the whole idea of this program would be to separate fact from fiction as well as to do credible research into the arena of neuroscience and spinal mechanics, the subject of Dr. Triano’s doctoral expertise, and one that is virtually ignored due to the prevailing medical bias toward manual medicine and, particularly, chiropractic care.
As Bellamy told the press, “I’ve got hundreds of petitions saying that this school is not wanted. It’s a stupid idea.”[53] On the other hand, there were probably just as many if not more fair-minded people in a silent majority who disagreed with him but where intimidated by his outlandish rhetoric. As well, where were these petitions when the state legislature voted on this issue? The time to be heard was before the vote, not afterwards.
Sadly, once this bill had been christened by the legislature, Bellamy as the lightning rod struck it down before it could find a safe harbor in the sanctity of the university. This perfect storm was a disaster for both chiropractic and for academic freedom in Florida.
FSU Science Map
Unquestionably the most outlandish, if not the most childish, stunt by the medical lynch mob occurred with the distribution of the infamous “FSU Science Map.” Bellamy further mocked the proposal by circulating to the press a map of the campus, placing a “Bigfoot Institute” and a “Crop Circle Simulation Laboratory” next to the proposed Chiropractic Medicine School. This map included other such whimsical landmarks like the School of Astrology, Yeti Foundation, Institute of Telekinesis, Department of ESP, Faith Healing, School of UFO Abduction Studies, School of Channeling and Remote Sensing, Foundation of Prayer Healing Studies, Creationism Foundation, Past Life Studies, College of Dowsing, Palmistry, Tarot Studies, School of Acupuncture, Institute of Tea Leaf Reading, School of Parapsychology, Pyramid Power Studies, and Alien Autopsy Laboratory.
This mockery illustrated the mindset of the medical mob at FSU; another sad indictment of higher education at FSU. This childish stunt fanned the flames of ridicule and prejudice among the faculty and student body in a symbolic act of hanging a chiropractor in effigy. Bellamy was unapologetic when he admitted his role in this mob’s behavior:
I did not design the “FSU Science Map,” but did forward it to others, including the press. It was sent to me by a biochemistry professor. [54]
Just to play fair, I might recommend a few additions to this FSU Science Map to include a Sanitarium for Victims of Failed Back Surgery Syndrome, a Rehab Clinic for Medicinal Drug Abuse and Addiction, an Institute for the Study of the Modern Epidemic of Super Germ Infections, a Center for Late Term Abortions, a Rescue Shelter for People Bankrupted by Medical Bills, or the Medical Museum of Bloodletting, Leeches, and Lobotomies.
All of these buildings could be sponsored by the Tobacco Institute that has already paid millions to the AMA to endorse its cancer-causing products in medical journals. Indeed, two can play at this game if Bellamy wants to throw mud and cast aspersions, but in this case, these are realistic and not ridiculous claims.
Rather than apologetic for this childish display, Bellamy was proud of the reaction it fomented among the FSU faculty.
There were nearly 500 email responses from the FSU science faculty opposing the chiropractic school. About 93 from the FSU College of Medicine, with about 12 clinical faculty declaring their intent to quit the teaching faculty if the chiropractic school came to FSU. I did forward to the press some of these emails opposing the chiropractic school if given permission by the sender.”[55]
“I would no longer wish to volunteer my teaching energies to FSU medical school, should it encompass a school of chiropractic,” said Dr. Ian Rogers, an assistant professor at FSU’s Pensacola campus. “This is plainly ludicrous!” [56]
“If they resign, so be it,” said state Senator Dennis Jones, a chiropractor himself. The instructors don’t deserve to teach at FSU “if they’re putting their credentials with people known for promoting professional bigotry.”[57]
The medical mob at FSU was, in reality, members of one trade association that politicked to have its rival association barred from campus. Once again, the medical profession lived up to its reputation as the most terrifying trade association on earth that extended into our university classrooms as the Iowa Plan intended.
The FSU administration also played an interesting under-handed role to sabotage the chiropractic program when it was discovered that they had already spent the $9 million allocated to the chiropractic program by the Florida legislature.[58] According to the Palm Beach Post newspaper, allegations swirled that the FSU president and its board conspired with the press by allowing the medical critics to impugn chiropractic in the minds of the public, faculty, and Board of Governors to justify their rejection, knowing all the time the money was already spent.
This may explain why the media was so one-sided in its account of this situation and, if a covert conspiracy did occur, it would explain why this program was blindsided so suddenly by the media and the FSU mobsters after five years of work in the Florida legislature that voted to fund $9 million for its implementation. Indeed, where were these opponents during the legislative battle when they would have met a stronger and more objective resistance? Apparently the medical mob was waiting in the wings to ambush the effort on the FSU campus rather than in the battlefield of the state legislature.
The Enemy of Your Enemy is Your Friend
Another twist in this perfect storm of the defeat of this chiropractic proposal was the fact that not all chiropractors were pleased to see the creation of a public chiropractic program at FSU. Regrettably, this storm also brought together chiropractic demagogues who joined forces with the medical opposition to destroy this effort, illustrating the idiom that the enemy of your enemy is your friend.
First, there was the presence of Life Chiropractic College (LCC) in Marietta, Georgia, located only a few hundred miles north of Tallahassee, Florida, where FSU resides. LCC enjoyed a virtual monopoly in the Southeast United States as the biggest chiropractic college in the world and had no wish to see its market in Florida cut into by a state university that reportedly would have charged less in tuition, offered better funded graduate programs, and, most of all, emphasized science rather than the Palmer philosophy as its core.
It must be emphasized strongly that the majority of accredited chiropractic colleges do not subscribed to the BJ Palmer tenets or the LCC style of curriculum to only “detect and correct subluxations,” eschewing responsibility of primary care physicians such as differential diagnosis, the use of other physical modalities, or the obligation to refer when necessary to medical doctors. (This is discussed in the following chapter)
The National College of Chiropractic branch founded in 1906 by JFA Howard in Chicago and led for decades afterwards by William Charles Schulze, MD, DC, and then by the Chiropractic Renaissance Man, Joseph Janse, DC, ND. Janse was “fully aware that spinal adjustments is the basis of the chiropractor’s treatment as it should be, he realizes and teaches that … the chiropractor is a doctor, and Chiropractic is a system of healing, not merely a technique.”[59] This is the antithesis of the LCC brand of chiropractic.
Today, chiropractic colleges such as Western States in Portland, Southern California University of Health Sciences in Los Angeles, and Logan Chiropractic College near St. Louis, are but a few of the fifteen accredited programs in eighteen locations (some of which are currently under review for approval) that have taken an evidence-based approach to health care producing primary care chiropractic physicians as dictated by the CCE. Outside the USA there are twelve accredited programs, plus one candidate program. In all, accredited or provisional, there are forty one chiropractic colleges worldwide.
For Bellamy to paint all the chiropractic colleges with the same “pseudoscience” brush also completely misrepresented the upgrading of curriculum demanded by the CCE. However, LCC was an easy target for Bellamy to use to exemplify all that was wrong with chiropractic education – a faith-based diploma mill owned and operated by Sid Williams, a non-academician who resembled a born-again Pentecostal preacher rather than a true educator.
Moreover, the loss of CCE accreditation at Life Chiropractic College only two years beforehand in 2002 fueled the perfect storm of these medical critics at FSU as proof of the spurious chiropractic curriculum and academic leadership. Indeed, when the antics of LCC and Williams were called out by CCE, it proved the need but undermined the promise of Dr. Triano when he said, “The chiropractic profession as a whole . . . is ready to step up to the plate and to let its belief systems be tested scientifically. Let the chips fall where they may.’’ [60]
To the medical mob at FSU, his plea came too little, too late, and fell on deaf ears that stemmed from a closed mind. The loss of accreditation and failed leadership of Williams at LCC certainly fueled the prejudice, but this bias predated the FSU fiasco as noted by Paul Goodley, MD, author of Release from Pain,[61] who noted there has always been chiropractic charlatans to justify this attitude.
“Eventually, the prejudice against manipulation self-perpetuated and evidence was always available to justify this attitude. There have always been [chiropractic] charlatans…So, instead of the manipulative fundamental dynamically developing as a cohesive, trustworthy guide within traditional medicine, it was discredited as the synonymous derelict symbol of its most despised competitor – chiropractic.” (emphasis added)
Sid Williams, then-president of LCC, embodied this “charlatan and derelict symbol” when he said among other ridiculous comments, “To hell with the scientists. They haven’t proven a bumble bee could fly.”[62]
Obviously this nonsense will make anyone question the sanity of traditional chiropractic education. The medical opponents had plenty of incriminating evidence of vendor-turned-president Williams, once described as a “wild-eyed philosopher”[63] who espoused many anti-science remarks, as such as when he reportedly said, “These conspirators would convince us that the ‘scientific approach’ to chiropractic is the only approach acceptable to the public community, the professionals, and the legislatures.”[64]
Without a doubt, the scandal at LCC with its loss of accreditation made for a difficult defense by mainstream chiropractic educators such as Drs. John J. Triano and Alan Adams, heralded chiropractic academicians well-experienced in research and administration, who were slated to implement the chiropractic program at FSU.
Secondly, another chiropractic president, Guy Riekeman, from Palmer College of Chiropractic hurt this effort when he announced in 2002 the proposal to establish a new campus branch – the Palmer College of Chiropractic-Florida at Port Orange.
Both Riekeman and Williams were arch rivals in the chiropractic education business as presidents of the two largest chiropractic colleges and neither wanted to see the development of a state university chiropractic program to cut into their potential markets.
Despite being professional rivals, they were united ideologically as “straight chiropractors,” and these two chiropractic enemies joined ranks figuratively with the FSU medical foes to undermine the proposed program. Rarely in chiropractic’s sordid history of in-fighting has one group worked so hard at such great expense to undermine another chiropractic group as evident in the FSU issue.
When LCC lost its own accreditation in 2002, Williams turned his interest to the battle with CCE and left Riekeman to fight the FSU battle against the wish of the Florida Chiropractic Association and its legislative supporters who knew another private college would not meet the needs of a university level research institution as the FSU proposal.
The establishment of the Palmer campus in Port Orange made for an easy excuse by the Board of Governors to veto this proposal when the war became intense.
Palmer College of Chiropractic Florida expects to graduate 188 students per year starting in 2006, which is more than sufficient numbers to cover AWI projected openings in Florida.[65]
However, FSU does not need to implement a chiropractic degree program in order to participate in chiropractic research. Most of the extramural research funded by the National Center for Complementary and Alternative Medicine has not been targeted at chiropractic care, and for the most part the organization’s grants have been awarded to medical schools and research universities with strong biomedical programs.[66]
Apparently the Palmer tactic convinced the board that the state could avoid the $60+ million cost of establishing a new chiropractic college by having Palmer pick up the tab. To a cost-conscious governor and board with a skeptical attitude about chiropractic, they no doubt felt this was an excellent solution to this fiscal problem — have the renowned Palmer folks pay the bill, appease the medical critics at FSU, and still have a local chiropractic college to service the citizens of his state.
“Shame on those who continue to sow division within the chiropractic profession,” said Representative Frank Farkas, DC, (R-St. Petersburg). “Palmer spent in excess of $100,000 hiring lobbyists to undermine our goals,” claimed Farkas, himself a Palmer graduate. “Unfortunately, this is just another instance in which a few colleagues from within our profession are our own worst enemy.”[67]
Understandably, the entire FCA administration and supporters were crestfallen by the governor’s veto and the lobbying by Riekeman to sabotage their effort. “It makes no sense for the governor to veto this funding when he approved a million dollar appropriation last year to implement planning for the school,” said Ed Williams, DC, and the FCA’s CEO emeritus. “Palmer’s meddling clearly confused the issue,” he added. Palmer’s unfortunate and atrocious timing and aggressive lobbying activity gave the Governor an ‘out.’ This is yet another classic chiropractic scenario of shooting ourselves in the foot.”[68]
“The whole purpose of this project was to provide the same in-state, low-cost educational opportunity for chiropractic students as there is for every other major profession,” explained Dr. Dennis Jones, R-Treasure Island, former Florida House of Representatives Speaker Pro Tem, who authored the original legislation. He added: “A private institution cannot increase the number of minority candidates. It cannot attract anywhere near the same level of research dollars. It will not increase the acceptance and prestige of our profession.” [69]
“There are 160 of us up here with full-time professional staffs, and it passed without hardly any dissenting votes,” Jones said, referring to his fellow legislators. “Then you have a volunteer board of 17 with limited staff and they vote against it. What does that say to Floridians?”[70]
Political Battle
This conflict of power within the state government bodies became another factor in this perfect storm, creating a face-off between the Board of Governors and legislators. “We don’t know what their authority is or isn’t,” said Dr. Jones.[71]
The chiropractic school became a flashpoint in the debate because traditionally, university programs are proposed and vetted by faculty members before reaching trustees for approval. Since the constitutional amendment creating the Board of Governors, there had been confusion over who has oversight power in the university system: lawmakers, the board of governors or individual trustees.
“This process has been turned upside down,” said Larry Abele, FSU provost. The FSU’s Board of Trustees eventually did not even take a position on the chiropractic school. Instead, Trustees forwarded the Board of Governors a proposal for a chiropractic school, but said they could not support or oppose it until it had gone through the proper faculty review.[72]
Setting the stage for a showdown with the Florida Legislature, the new Board of Governors that oversees Florida’s public universities, created just two years before by a constitutional amendment approved by voters, asserted that Florida State University must get its approval for a new chiropractic college, even though lawmakers had approved the college’s creation and guaranteed it $9 million a year.[73]
The legislative process was “totally backward from the usual method of starting new academic programs,” according to Bellamy. “This alarmed many in the state’s universities as a dangerous precedent and a loss of control by those entrusted to make these decisions.” [74]
Bellamy noted “because of the confusion arising out of the powers created by the new constitutional amendment, the FSU Trustees essentially punted the issue to the Board of Governors, which voted it down by a wide margin, 10 to 3. Interestingly, at the Board meeting, three chiropractors spoke out against the school.” [75] Three disgruntled chiropractors speaking out should be considered an insignificant amount of the thousands who supported the proposal, but it did illustrate that the enemies of enemies are often friends.
From the Palmer perspective, this came as a great political victory that enabled the Palmer chiropractic empire to become the largest in the world. Not only does Palmer maintain the Fountainhead in Davenport, Iowa, presently Palmer also extends to both coasts — San Jose and Port Orange – and they even have had a hand in the chiropractic college in Brazil.
On one hand, Palmer’s extension into Florida must be seen as a feather in their hat since Florida is ripe for chiropractic with a large and aging population that suffers from musculoskeletal disorders. Guy Riekeman, then-president of Palmer, explained the justification for his action to squash the FSU effort as a “serious threat to the future of our profession.”
“I’ve written for years that the number one threat to chiropractic is that a major public school of medicine would open a chiropractic school. I’m not opposed to public funding of chiropractic education as long as that education teaches our philosophy as well as our clinical procedures. They are not ready to do this yet. Florida State University is evidently the first to seriously consider opening a school of chiropractic medicine. The million-dollar study they commissioned was extremely positive about chiropractic, but nowhere in the 200-page report did it mention the neurological connection to patient care. It was pure orthopedics. This is a serious threat to the future of our profession. As Jesse Jackson said, ‘If they can define you, they can confine you.’ We must resist this.”[76]
This battle between modern and historical chiropractic education has not escaped Dr. Triano who pointed out: “It’s not what we do, but what we say about what we do that matters most.”[77] And much of what was said during this storm came from belief systems developed nearly 70 years ago fomented by two extremists – BJ Palmer and Morris Fishbein. Indeed, the medical war has become the equivalent to a modern Hundred Years War with no end in sight.
To bolster its position, the Florida Chiropractic Association had retained the services of a consulting firm, MGT of America, Inc., to investigate the proposed chiropractic program at FSU. The mission of MGT is “to improve the efficiency and effectiveness of government, nonprofit, and other organizations serving the public.” [78]
The MGT Executive Summary, “Costs of Chiropractic Education,” addressed many conflicting issues in the proposal from among the medical, university, and between the opposing chiropractic factions and concluded:
“A chiropractic program at a major university such as FSU can both preserve the unique contributions of chiropractic health care principles and the culture of higher education and research to better serve the needs of graduate chiropractors and their patients.”[79]
This conclusion did not satisfy the straight chiropractic leadership. At the center of this issue is the neurological component that Riekeman commented on when he said, “The million-dollar study they commissioned was extremely positive about chiropractic, but nowhere in the 200-page report did it mention the neurological connection to patient care. It was pure orthopedics.”
Of course, he is alluding to the claim that chiropractic can help Type O visceral disorders as well as common Type M spinal pain problems, an issue at the center of the controversy surrounding chiropractic and medicine that research hopefully would have addressed.
The MGT Executive Summary spoke of chiropractic’s effectiveness with these non-spinal disorders:
“The effectiveness of chiropractic care for non-spine-related disorders has not been proven by research, although the research in these areas has been sparse.
“Very little research has been conducted on the wellness/preventive effectiveness of chiropractic care. Thus, no evidence currently exists either supporting or denying the hypothesis that chiropractic care improves the overall health of an individual.” [80]
The irony of Riekeman’s and Williams’ position that chiropractic care is beneficial to Type O disorders, the “non-spine problems” mentioned by the MGT report, is the glaring fact that the BJ Palmer Research Center at Davenport and the Sid Williams Research Center at Life Chiropractic had produced scant proof on the impact of chiropractic care on visceral disorders.
The whole idea of the FSU chiropractic program was to access the resources of a major university to investigate these claims. Triano admitted his torment with the faith-based dogma within the chiropractic profession. “How long will we let these radical DCs drive the agenda of this profession? Who’s in charge of chiropractic’s destiny?”[81]
The strongest argument offered in support of the proposed program focused on research on the efficacy of chiropractic techniques that would be of value to the profession and the general public good, as well as informing future curricula development according to Dr. David Wickes, vice-president of Western States Chiropractic College and consultant to the Board of Governors.
He wrote in his report to the board that “There is an increasing demand for evidence-based, scientific chiropractic healthcare by consumers and other healthcare professionals” and that this was an “opportunity for FSU to take a leadership position in research related to chiropractic and other forms of complementary medicine, and to tap into the steadily increasing grant money for this purpose.”[82]
The MGT Executive Summary in its recommendations also noted the problem with the faith-based versus science-based elements in chiropractic:
In chiropractic, the differences are based on a major gap in philosophical beliefs, which seems almost too wide to breech. The separatists are almost religious in their belief that the basic philosophy of chiropractic, as originally espoused by BJ Palmer…are as true today as they were in the early 1900s when they were developed and should not be altered. Any attempt to expand the scope of practice of chiropractors to include other forms of health care (e.g., acupuncture) or even to integrate it with other forms of health care is a violation of the separatists’ beliefs. The integrationists, on the other hand, believe that as the knowledge of effective health care maintenance and treatments expand, along with related technology, so should the scope of practice of chiropractors … The [FSU] school must not be caught in the profession’s philosophical battle. [83]
Riekeman commented on the philosophical fight within the chiropractic profession in the Palmer College of Chiropractic’s publication, Streams from the Fountainhead. His attitude clearly indicated his own brand of chiropractic demagoguery.
“But when it comes to philosophical orientation, either you accept, study, debate and acknowledge the principles of our profession, or you reject them. You either apply them, or you practice something else; you either enhance them, adding new components to the conversation, or you negate them as dogma.”[84]
Indeed, to both Triano and the FSU faculty, this brand of chiropractic is seen as dogma, not the critical mindset typically seen in the enclaves of higher education.
The MGT report also addresses the problem of keeping chiropractic aligned to historical chiropractic concepts:
“As a part of the nation’s health care system, chiropractors will have no choice other than to respond to the demands of consumers if they want to remain as providers. As new research reveals new chiropractic treatments that are effective and new combinations of chiropractic and other health care providers that are effective, consumers will demand those services. Innovative health care providers will provide them, leaving behind those who refuse to do so. Thus, there is no question that the future trend of chiropractic is an expanding and integrated scope of practice.”
Storm Damage
The perfect storm finally came to an end, but not before leaving destruction in its path. The Board of Governors voted down the proposal after years of hard work by the FCA and supporters in the state legislature whose hopes were capsized. As fate would have it, both Riekeman and Williams went down with their ship, too.
Riekeman resigned under pressure from Palmer in February 2004 and, paradoxically, was hired in March 2004 by an ailing Life University that had fired Williams after losing its CCE accreditation two years before in June 2002. Apparently Williams’ resistance to a science-based curriculum did not sit well with the Council on Chiropractic Education and Riekeman’s leadership did not please the Palmer Board of Trustees. Both of them were gone by the end of this storm, but not without leaving battle scars that this profession still endures.
After the unlikely marriage of the medical and chiropractic demagogues succeeded to kill the FSU chiropractic program, Dr. Raymond Bellamy could not hide his elation. “I’m delighted. I’m ready for the champagne,” he told the media.[85]
Once the heat of the battle had diminished, I contacted Dr. Bellamy to discuss his role in this warfare and I found his attitude had not changed and he reaffirmed his opposition. To my surprise, he also admitted a few failings that were also omitted in the press during this medical war.
First, let me thank Dr. Bellamy for his frank answers, which were stunning, to say the least, and left me trembling with disbelief and anger, to be honest. His remarks were shocking, but he gladly responded to my request as the conqueror touting his victory to the vanquished, an attitude resembling the Morris Fishbein supremacist attitude that still permeates the medical profession: “Scientific medicine absorbs from them that which is good, if there is any good, and then they die.”[86] And Bellamy was delighted to talk about the death of the FSU chiropractic program.
I asked him to elaborate on his opposition to the chiropractic program at FSU in light of the recommendations of AHCPR and other international guidelines that supported spinal manipulative therapy that were never mentioned in the media, obvious oversights that would have been persuasive.
“Several comments,” he replied back in private communication with me. “First, please refresh my memory on what ACHPR is about? Second, I am proud of my efforts regarding the FSU events and I will attempt to explain in good faith.”[87]
Bellamy’s unfamiliarity with one of the most significant studies in the history of low back pain research to date was unexpected considering the uproar and backlash it generated from the North American Spine Society (see Chapter 6). His professional amnesia was shocking coming from an orthopedist and adjunct professor at FSU who should be expected to be on top of this learning curve.
Dr. Bellamy also hurled a huge bomb when he said,
Unfortunately, in my opinion, there is abundant evidence that virtually all of chiropractic treatment is placebo, and there are strong forces within chiropractic through the last 110 years preventing the acknowledgement of that fact, and thus we have patients delaying appropriate treatment of a medical nature for their conditions, enuresis, otitis media, scoliosis, headaches, dizziness, etc. because they are diverted into placebo treatment by chiropractors. That results in an outcome worse than placebo, because of wasted expense and delay of appropriate medical care. There are the occasional, fortunately uncommon, strokes and death from vertebral artery dissection and carotid artery dissection caused by chiropractic neck manipulation, a procedure of no known value beyond placebo. [88] (emphasis added)
Now that is a mouthful — the standard medical talking points throughout the decades used to besmirch chiropractors. In one paragraph he condemns chiropractic on many levels as entirely “placebo” and “dangerous” because of “delay in proper medical care” and “neck manipulation causing strokes.”
Placebo Effect
Let me address these accusations by Bellamy to show his claims are baseless and reek of the old Fishbein propaganda rather than scientific evidence. In many cases, the proof will show medicine can be accused of the same, if not worse.
The placebo effect is the so-called ‘sugar pill’ effect when a patient gets better simply from believing they have been helped.
“Unfortunately, in my opinion, there is abundant evidence that virtually all of chiropractic treatment is placebo…”
If that is true, just where are his references to support this allegation? He cites not one study. Obviously Bellamy’s professional amnesia forgot the recommendations of the many guidelines that endorsed manipulation. Here is a list of notable international studies on low back pain that occurred before the FSU fiasco:
1978: New Zealand Royal Commission on Chiropractic
1990: RAND study on appropriateness of spinal manipulation
1993: Manga Report Ontario (Canada) Ministry of Health
1994: AHCPR Acute Low Back Pain Guideline
1994: Clinical Standards Advisory Group (UK)
1995: Council on Chiropractic Guidelines and Practice Parameters
2003: Ontario Workers’ Safety and Insurance Board
2003: Norway Spine Study
2004: European Back Pain Guidelines.
2004: The UK Back Pain Exercise And Manipulation Trial
2004: Swedish Lumbar Spine Study
During the same time period in 2004 as the FSU fiasco, the editors of The BACKLetter were also adamant that spine surgeries were generally ineffective:
The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate…Despite a steady stream of technological innovations over the past 15 years—from pedical screws to fusion cages to artificial discs—there is little evidence that patient outcomes have improved.[89]
Subsequent studies since the FSU fiasco have also recommended the paradigm shift in spinal care:
2007: Guideline on Back Pain: American College of Physicians
2008: Decade of Bone & Joint Disorders: CLBP
2008: The Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders
2009: The National Institute for Clinical Excellence (UK-NICE)
A 1998 editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine completely contradicted Bellamy’s accusation that chiropractic is placebo and noted that “spinal manipulation is the treatment of choice”:
The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain[90]. The 1994 guidelines for acute low back pain developed by AHCPR concluded that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidal anti-inflammatory drugs. At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases. Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice. [91] (emphasis added)
I also queried Bellamy about the many medical physicians who have called for a reform in spine surgery, including Richard Deyo, MD, MPH, one of the leaders in this charge. Bellamy responded to earlier criticism by Deyo of the “gravy train” of back surgeries in America (see Chapter 7):
No argument with Deyo’s statement. Repeatedly during the 2004-2005 FSU chiropractic battle I referred to the fact there are many surgical procedures which may eventually turn out to be no better than, or not as good as, placebo treatment…[92]
While he admits that “fact there are many surgical procedures which may eventually turn out to be no better than, or not as good as, placebo treatment…”[93] he omits this admission in the media, but chose to slam chiropractic for the same.
Bellamy did admit that much of his own orthopedic treatments for spine problems are questionable:
“By the way, I am also of the opinion that far too much spinal surgery is done and hopeful that double blind studies and evidence based medicine will reduce that unfortunate situation.”[94]
As the list of international studies proved, this type of comparative research has already been done. Secondly, his call for such research while scuttling the FSU program speaks of doubletalk. This is exactly the type of comparative research proposed to be done at the FSU chiropractic program but killed by Bellamy himself.
He also admits to the placebo effect in medicine and suggested that medicine works to eliminate them:
Again, not to deny the fact that much of mainstream medicine utilizes the placebo effect, but fortunately, major efforts are constantly underway to identify which treatments are only placebo or worse, and after identifying them, to eliminate them. [95]
Bearing in mind research now shows it takes 17 years for a new method to be incorporated into mainstream medicine while it takes 44 years for an ineffective method to be removed, it is hard to take Bellamy seriously when he suggests medicine works to identify and eliminate ineffective treatments.[96]
Medical intransigence is well known to have held back medical progress throughout its history. In this case, for example, as far back as 1994 the AHCPR announced that only one in 100 back cases required surgery, but the tsunami of spine fusions has experienced a 15-fold increase in spine fusions from 2002-2007.[97] Bellamy’s estimation of his own profession to solve this problem flies in the face of these facts.
The endeavor to analyze spinal treatments began in the early 1990s with AHCPR. Either the result of Zombie science or professional amnesia, Dr. Bellamy acts as if it had never started. (chapter 7) Perhaps he has forgotten that researchers have already concluded that spine surgery is out of control in the U.S., abnormal discs are considered incidentalomas, much of surgery is ineffective in the long term compared to conservative care, there is too much variation from region to region, and surgery should be a last resort after conservative care. This is the consensus of the many studies, but none were mentioned by Bellamy in his diatribe against chiropractic in the press.
The fact that Bellamy appears unaware of this paradigm shift in spine care makes one wonder if he is qualified to teach orthopedics in a major university. It certainly questions his objectivity toward chiropractic care since he apparently is unaware of the supportive research.
Safety
Dr. Bellamy also impugns spinal manipulation as dangerous and “of no known value.” He states that
“…strokes and death from vertebral artery dissection and carotid artery dissection caused by chiropractic neck manipulation, a procedure of no known value beyond placebo… and never should the cervical spine be manipulated.” (emphasis added)
Once again the facts belie his allegation. His tactic is to scare the public away from chiropractors with the fear that chiropractic care might cause strokes as he and other medical alarmists have claimed. Once again, the research contradicts this fear-mongering.
In fact, patients need to be warned of medical procedures as dangerous rather than chiropractic care. According to a study[98] by Anthony Rosner, PhD, comparing medical procedures to chiropractic care concerning strokes, he mentions “the statistics really begin to spin one’s head.” Using a baseline figure of one per one million as an estimate of stroke incidence attributed to cervical manipulations, one finds a:
two times greater risk of dying from transfusing one unit of blood;[99]
100 times greater risk of dying from general anesthesia;[100]
160-400 times greater risk of dying from use of NSAIDs;[101]
700 times greater risk of dying from lumbar spinal surgery;[102]
1000-10,000 times greater risk of dying from traditional gall bladder surgery;[103]
10,000 times greater risk of serious harm from medical mistakes in hospitals.[104]
Obviously these medical risks are unknown by the public and untold by the medical profession to the media, yet the same MDs who criticized chiropractors forget to mention these facts (the “professional amnesia” Dr. Rosner suggests) of the remote danger of manipulation or the fact that patients who seek medical care are equally susceptible, if not more so, to medical mistakes and iatrogenic problems.
Once again, Dr. Bellamy ignored the research and simply parrots old talking points from the old Committee on Quackery. However, recent investigation of this issue reveals just the opposite — spinal manipulation is among the safest of treatments for neck pain.
In 2006 Dr. Triano was also involved in research concerning the stroke issue with his publication, Current Concepts in Spinal Manipulation and Cervical Arterial Incidents, that included 675 references and a comprehensive discussion of cervical artery injury and manipulation. He also came to a much different conclusion than Bellamy, such as:
The increased risk of death resulting from NSAID use is 1,500 times greater than the risk of tetraplegia following cervical SMT. [105]
On analysis, SMT as delivered by chiropractors is one of the most conservative, least invasive and safest of procedures in the provision of health care services.
The risks of SMT pale when compared to known medical risks. Chiropractors, by their training and skill in SMT and special emphasis on the spine, are the best positioned to deliver this mode of health care to the public.
Conclusion: VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. [106] (emphasis added)
Another study omitted by Bellamy by Alan Terret et al. showed the rate of iatrogenic problems associated with spinal manipulative therapy as rendered by doctors of chiropractic was only 1 in 5.85 million cases, which is less than the chance of stroke in a hair salon or being hit by lightning (one in 600,000). It equated to one occurrence in 48 chiropractic careers.[107]
In comparison, the rate of iatrogenic problems associated with back surgeries is 15,600 per one million cases.[108] For Bellamy to suggest spinal manipulation is dangerous flies in the face of the facts, but that is typical of demagogues to misrepresent their rivals.
The medical defendants in the Wilk trial (chapter 4) also had a hard time finding significant cases to prove its claim of chiropractic malpractice; in fact, the AMA was unable to find one malpractice witness to testify against the plaintiff-chiropractors and urged the defendants to avoid the issue altogether:
“Doyl Taylor of the AMA is sending 3 or 4 examples of criminal actions against chiropractors. He urged that we stay clear of attempts to show civil malpractice situations. With the relative weight in numbers [of malpractice] against physicians, he felt we’d be playing with dynamite.”[109] (emphasis added)
Undoubtedly the safety of chiropractic manipulation is the reason why chiropractors pay on the average only about $150/month in malpractice insurance compared to spine surgeons who pay from $200,000 to $300,000 per year. Obviously the insurance companies know what is hurting patients, and it is clear spinal manipulation is much safer than drugs, shots, or surgery.
Researchers again disagreed with Bellamy’s claim “of no known value” in a study that compared neck surgery to alternative treatments, “Treatment of Neck Pain: Noninvasive Interventions: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.”[110]
This panel concluded:
Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain…However, no form of cervical surgery has been proven to be superior to nonsurgical care—or waiting out the symptoms. [111]
Dr. Scott Haldeman, DC, MD, PhD, also noted:
The deliberations of the Neck Pain Task Force suggest that there is currently no justification for surgery in patients with axial neck pain without radiculopathy, myelopathy, or serious pathology.[112]
In another 2002 article in the Annals of Internal Medicine, Koes et al. did a randomized controlled trial on neck pain and compared manual therapy, physical therapy and care by general practitioners. They also contradicted Bellamy when they concluded: “In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.”[113]
Obviously Bellamy’s claim of “insufficient evidence” for manipulative therapy is, once again, proven to be false. Just as MDs testified against the AMA defendants in the Wilk trial, these “admissions against interest” research studies by MDs should have been used to counter the demagoguery Bellamy spewed during the battle at FSU. The fact that no one in the media revealed his lack of authenticity and proof is shocking.
Vertebral Subluxation
Bellamy also revealed his disdain for the concept of “subluxation”:
As for fear of truth: let chiropractors design true double blind studies to compare their treatments with placebo (admittedly difficult to accomplish) and admit there is no such thing as a “subluxation” as used by every chiropractic licensing authority in every state in the U.S. (emphasis added)
First of all, the research clearly shows spinal manipulative therapy is more than placebo and better than standard medical care. Secondly, Bellamy makes the same mistake that the New Zealand Inquiry noted in its inquiry. A vertebral subluxation is not merely a spinal misalignment seen on imaging, but includes the loss of joint motion along with nerve involvement, issues that cannot be seen on x-rays or MRI scans. This is referred to as a “segmental buckling effect” according to research by John Triano, DC, PhD.[114]
Once the joint buckles, neurologic problems commence with proprioceptors, nociceptors, and mechanoceptors that all fire causing the pain, inflammation, and spasm associated with back pain. [115] Spinal manipulative therapy to restore joint play and improve alignment relieves these neurologic issues to decrease disc herniation and inflammation, nerve root compromise, muscle spasm, and pain.
This orientation, of course, eludes Dr. Bellamy who believes this complex spinal problem is all “pseudoscience” and “placebo”. Indeed, the more we understand about spinal mechanics and joint dysfunction, the more absurd the medical disc theory, and drugs, shots, and spine surgery appear to be. (chapter 7).
Mr. RJ Craddock, leading counsel for the New Zealand Chiropractic Association, recognized the failing of the medical profession to understand the concept of a vertebral subluxation:
The problem is a functional not a structural one…the abnormal function of the spine may produce a vascular involvement as well as the neurological one, and this vascular involvement, originally emphasized in osteopathy, is not accepted by chiropractors generally … the medical profession simply fails to see the direction and subtlety of the chiropractic approach towards spinal dysfunction. Because the chiropractor uses x-ray extensively the medical practitioner thinks he is looking for a gross bony change, and when the medical practitioner cannot see this on the x-ray the chiropractor is using he immediately becomes skeptical. He might as well expect to see a limp, or a headache or any other functional problem on x-ray.[116] (emphasis added)
With this dynamic, functional approach in mind, the New Zealand Commission concluded the medical opposition is “an unreasonable and unscientific stance.” In other words, the medical profession has created a conceptual falsehood about what constitutes the vertebral subluxation, and then has the temerity to condemn it publicly.
Education
Bellamy also ridiculed the quality of chiropractic education when he suggested it could be taught in one semester rather than four years. Again, he just does not understand the quality of chiropractic education since the inception of CCE.
“From a scientific standpoint, all of the beneficial part of chiropractic, that is better than placebo, could be taught in a one-semester course at a physical therapy school,” rather than a full-fledged university program, he said to a news reporter.[117] Once again Bellamy’s inflammatory rhetoric may be an effective sound byte, he has not done his homework when he minimizes the expertise of chiropractors.
Scott Haldeman, MD, DC, PhD, an international authority on spine matters and someone extremely familiar with both medical and chiropractic curriculums, disagrees that the length of time for an MD or PT to learn the many chiropractic treatments is longer than Bellamy assumes.
In 1979, Dr. Haldeman testified to this point to the Royal Commission of Inquiry on Chiropractic in New Zealand that concluded:
The Commission accepts the evidence of Dr. Haldeman, and holds, that in order to acquire a degree of diagnostic and manual skill sufficient to match chiropractic standards, a medical graduate would require up to 12 months full-time training, while a physiotherapist would require longer than that.[118]
It was also revealed in 1980 by John McMillan Mennell, M.D., prominent medical educator and author, during the Wilk trial (chapter 4) that the average general medical practitioner receives scant training in the musculoskeletal system, and absolutely none in manual medicine. He also testified that the musculoskeletal system comprises about 60% of the body. [119]
Many studies have shown the incompetence of general practitioners for diagnosing and treatment of musculoskeletal disorders, such as (Freedman and Bernstein[120]), (Joy and Van Hala[121]), (Schmale[122]), and (Matzkin, Smith, Freccero, Richardson[123]). (chapter 8)
Yet many MDs purport to be qualified to diagnose and treat these musculoskeletal conditions rather than to refer these cases to chiropractors. The fact that most general practitioners know very little about musculoskeletal disorders is now clear and remains unconscionable that they pose as experts. If chiropractors had as little training as MDs, patients would be in peril as Bellamy suggests. However, in this case it appears that MDs are the real danger to the public, not chiropractors.
It may come as another surprise to Dr. Bellamy, but a study from Australia revealed the lack of expertise regarding treatment for back pain by many physicians, especially those like him who “specialize” in back pain. This study, “Doctors with a Special Interest in Back Pain Have Poorer Knowledge about How to Treat Back Pain,” showed that “MDs with a special interest in back pain is associated with back pain management beliefs contrary to the best available evidence.” The authors concluded, “This has serious implications for management of back pain in the community.”[124]
I also asked him if he ever referred to chiropractors and how he treated patients.
I have referred an occasional patient to the chiropractor. I show patients simple back exercises when appropriate and reassure them when it is the thing to do, give advice regarding weight loss and encouragement for healthy life style, perhaps consider further imaging when indicated… [125]
Indeed, Bellamy’s medical advice – simple back exercises, weight loss and encouragement – is equivalent to telling a patient with chest pains to wait it out. While the pain may subside temporarily, this encouragement has done nothing to change the underlying cause of the problem, which explains why people relapse and their spines degenerate. When the condition worsens later, the orthopedic surgeon will diagnose disc degeneration and recommend fusion when, in all probability, this could have been prevented early on with chiropractic spinal care and the pain alleviated by restoring joint motion via manipulative therapy.
Bellamy’s “lip service” to patents was the subject of another recent study found again that both orthopedists’ and family practitioners’ knowledge of simple low back pain management was deficient.
A.S. Finestone et al. published in Spine a revealing article, “Orthopaedists’ and Family Practitioners’ Knowledge of Simple Low Back Pain Management,” that affirms once again the dearth of knowledge held by many MDs, including orthopedists like Bellamy that concluded:
Both orthopaedic surgeons’ and family physicians’ knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.[126] (emphasis added)
This comes as little surprise since many studies have found medical training is “woefully inadequate,” but one would think by now with the plethora of research and guidelines for low back pain that astute MDs would know by now the recommendations for care include spinal manipulation.
According to Stephen Perle, DC, MS, associate editor of Chiropractic and Osteopathy and professor of Clinical Sciences at University of Bridgeport, he opines why most MDs lag far behind the research and recommendations:
There is evidence that goes back two decades that a majority of MDs do not recommend treatments that are supported by good evidence.[127] In fact they still recommend treatments, such as bed rest, which the literature has shown is harmful.[128] Most surprising is a recent study that finds that those generalists with a self-professed interest in back pain are actually more behind the times than those who don’t have this interest.[129]
Thus, penetration into actual practice of evidence based approaches to treatment of LBP is poor. This could be due to truthiness in medicine. ‘I know that chiropractic doesn’t work, so I don’t believe the research.’[130]
Type O Disorders
Certainly Bellamy’s greatest objection stemmed from opening the Pandora’s Box of neurophysiology, an issue discussed at length by the New Zealand Commission (chapter 5). Since he is unaware of the research into manipulative therapy helping Type O disorders, like many MDs, he suggests this amounts to “dangerous delays” that might affect the outcomes.
Dr. Bellamy illustrated this point when he said,
…thus we have patients delaying appropriate treatment of a medical nature for their conditions, enuresis, otitis media, scoliosis, headaches, dizziness, etc. because they are diverted into placebo treatment by chiropractors.
It is obvious that he is simply parroting the standard medical bias that any non-allopathic treatment will inevitably fail and only cause delayed proper medical treatment. Again, Dr. Bellamy is unaware of the research for many of these conditions because, as you will learn, there are studies, although more are needed, that support chiropractic care for these conditions.
A study in 1991 of children with nocturnal enuresis found 25% of children were helped. Children with a history of persistent bed-wetting at night received eight chiropractic adjustments and the number of wet nights fell from 7 per week to 4. At the end of the study, 25% of the children were classified as successes. [131]
Another study of the chiropractic management of primary nocturnal enuresis found 25% of the children receiving chiropractic care had 50% or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction.[132]
A large study of 217 children attending a chiropractic college teaching clinic was done in 1988 at Western States Chiropractic College public clinic with ordinary complaints of ear-infection, sinus problems, allergy, bedwetting, respiratory problems, and gastro-intestinal problems. Complete or substantial improvement had been noted in 61.6% of pediatric patients of their chief complaint, 60.6% received maximum level of improvement while only 56.7% of adult patients received maximum level of improvement.[133]
In a 1985 study by N. Nilsson of 132 infants with colic treated by chiropractors, 91% of the parents reported an improvement, which occurred after an average of two to three adjustments, and within one week of care. [134]
In this 1989 study, 73 chiropractors adjusted 316 infants (median age 5.7 weeks at initial examination) with moderate to severe colic (average 5.2 hours of crying per day). The infants’ mothers were provided a diary and kept track of the baby’s symptoms, intensity and length of the colicky crying as well as how comfortable the infant seemed. 94% of the children within 14 days of chiropractic care (usually three visits) showed a satisfactory response. After four weeks, the improvements were maintained. One fourth of these infants showed great improvement after the very first chiropractic adjustment. The remaining infants all showed improvement within 14 days. It was also noted that 51% of the infants had undergone prior unsuccessful treatment, usually drug therapy.[135]
Childhood asthma was also shown to be helpful by G Bronfort and R Evans who concluded:
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. [136]
RL Graham and RA Pistolese reported clinical success using chiropractic treatment for asthmatic children:
Eighty one children under chiropractic care took part in this self-reported asthma related impairment study. The children were assessed before and two months after chiropractic care using an asthma impairment questionnaire. Significantly lower impairment rating scores (improvement) were reported for 90.1% of subjects 60 days after chiropractic care in comparison to their pre-chiropractic scores. In addition, 30.9% of the children voluntarily decreased their dosage of medication by an average of 66.5% while under chiropractic care. Twenty four of the patients who reported asthma attacks 30-days prior to the study had significantly decreased attacks by an average of 44.9%. Six different chiropractic techniques were used by the different chiropractors who participated in this study.[137]
RM Froehle published an article about chiropractic care helping ear infections in the Journal of Manipulative Physiology and Therapeutics that found:
93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments…this study’s data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.[138]
Once again Bellamy did not do his homework when he lashed out, yet he continues to warn:
Thus we have patients delaying appropriate treatment of a medical nature for their conditions…that results in an outcome worse than placebo, because of wasted expense and delay of appropriate medical care.
He cites a fear tactic often used by spine surgeons to scare patients into surgery by telling them trying chiropractic care first would cause severe harm if they delayed surgery and may risk permanent nerve damage, perhaps a weakened leg or even losing bowel or bladder control. Once again Bellamy had not done his homework.
Nothing like that occurred in the two-year SPORT study comparing surgery with waiting in nearly 2,000 patients.[139] Dr. Eugene J. Carragee, professor of orthopedic surgery at Stanford said that he had never believed it himself, but that the concern was widespread among patients and doctors.
“The worry was not knowing,” he added. “If someone had a big herniated disk, can you just say, ‘Well, if it’s not bothering you that much, you can wait.’ It’s kind of like walking on eggshells. What if something terrible did happen?” [140]
‘“It says you don’t have to rush in for surgery. Time is usually your ally, not your enemy,” said Dr. Steven R. Garfin, chairman of the department of orthopedic surgery at the University of California, San Diego. [141]
Research
Not only was Dr. Bellamy wrong about the clinical effectiveness of chiropractic care, he then criticized chiropractors for not producing more research, which again illustrates his complete lack of the obstacles chiropractors have faced or the awareness of the research done by chiropractors who have contributed to every major spine-related journal and have participated on every major study on back pain such as the AHCPR and Decade of Bone and Joint Disorders.
His professional amnesia of the research is actually bewildering, but Bellamy continues:
Face it, chiropractic has had over 110 years to come up with a major discovery or scientific advancement and has nothing to show for it.
The fact that chiropractic colleges have not produced more research projects has more to do with the lack of funding than interest. Compared to the billions medical schools receive, chiropractic research more closely resembles Oliver Twist asking for more gruel.
In his testimony before the National Institute of Medicine, Anthony Rosner, PhD, and former director of the Foundation for Chiropractic Education and Research, mentioned the scant “homeopathic doses” of federal monies awarded to chiropractic research:
Even more remarkable is the efficiency of chiropractic research. When compared to the NIH budget of nearly $20 billion, the $10 million investment in federal funds is substantially less than a tenth of 1 percent, which makes it less than a rounding error. Put another way, as a couple of wags have offered in the past, the federal government must believe in alternative medicine, because it has given chiropractic researchers homeopathic doses of money with which to work.[143] (emphasis added)
Due to the chiropractic witch hunt begun by Morris Fishbein, the chiropractic profession was fighting for its survival during the first half of the 20th century when chiropractors were more likely dodging the political bullets of the AMA than doing research.
This subjugation reminds me of the Warsaw ghetto Jews trying to survive the Nazi onslaught, and then being condemned for not producing “a major discovery or scientific advancement,” as Bellamy suggests. Not only is Bellamy ignorant of research, he appears ignorant of the impact of medical war itself upon chiropractors.
The fact is chiropractors have developed the major techniques for manual spinal care, certainly more than MDs, osteopaths, or physical therapists who were afraid to delve into this area due to the bias from their medical demagogues. The chiropractors carried the banner of spinal manipulation, flexion-distraction, spinal decompression, active rehabilitation, to name a few of the many advances to help the millions of people suffering from the pandemic of back pain and NMS disorders.
Professional Image
Bellamy also wrote of his greatest fear – the enhanced image of chiropractors. Certainly like many MDs, he cannot tolerate any other professionals to stand aside him atop his pedestal:
To have a ‘research presence’ for chiropractic on the FSU campus would be a major advance in prestige for chiropractic but would amount to chiropractic forcing themselves on the campus by political means when all other scientific disciplines represented on campus were invited and embraced by the scientific community…
Florida taxpayers would then be out many millions of scarce education dollars with nothing to show for it. Or, as FSU Trustee Manny Garcia succinctly put it, “Why should we be the guinea pig?” [144](emphasis added)
Must chiropractors find the cure for cancer before invited on campus at FSU before they are “invited and embraced” or must they capitulate like osteopaths?
Bellamy makes FSU sound like a white country club only inviting their white friends rather than a club based on members with merit. Obviously he is more concerned about the medical “race defilement” image than advancing science.
Bellamy’s attitude that chiropractic should be “invited and embraced by the scientific community” is nonsense considering the political nature of medical academia. The fact is Dr. Bellamy knows that healthcare has always been political and he politicized this program not to protect the university’s image as much as to protect his own profession’s dominance.
This is another example of “Zombie science,” according to Bruce Charlton MD, who defined it as “a sinister consequence of evaluating scientific theories purely on the basis of enlightened self interest.” [145] (Chapter 9),
Certainly, if Dr. Bellamy and the FSU faculty were so self-assured that chiropractic is placebo, why then would they not want to “let the chips fall where they may” as Triano suggested and let chiropractic hang itself? Bellamy suggested it would be a waste of “millions of scarce education dollars.”
Especially concerned was the sciences faculty, who saw chiropractic as ignoring the scientific method and the use of the university to establish scientific credibility as inappropriate…The FSU faculty and other opponents were well aware that the proposed school was an attempt to bring scientific respectability to chiropractic.
I find this comment perplexing considering he admits the faculty did not vet chiropractic, but assumed the worst undoubtedly from the loss of accreditation stemming from Life Chiropractic College. Nor did anyone on the faculty visit a credible chiropractic campus like National or Western States to review the curriculum, facilities or meet with the faculty.
Certainly it would be difficult for members of the most terrifying trade association on earth to be objective about their arch rival. Academic freedom and research funding are only appropriate when it works to the advantage of the medical profession.
Freedom of Choice
Just as Fishbein accused people who used chiropractic as suffering from “abject ignorance,”[146] Bellamy also chided the idea of freedom of choice in healthcare since he believed patients were too gullible to know what is best for themselves.
You mention the “right” of the patient to choose. This “right” is illusory if the patient is without sufficient information to evaluate any particular treatment and make an informed choice. Yet by your own admission chiropractors have insufficient evidence upon which to base their claims, thus requiring the help of a state university to sort things out. Are you arguing for a “right” to choose implausible treatments? [147] (emphasis mine)
It appears Bellamy has a double standard when it comes to research: while the medical profession receives billions for research, when chiropractors want the same opportunity, he demeans this request of “requiring the help of a state university to sort things out.”
Furthermore, his assertion, “Are you arguing for a ‘right’ to choose implausible treatments?” is unreasonable considering the volume of research supporting chiropractic care as very plausible care. His attitude illustrates the medical supremacist belief that there are right ways to get well (drugs and surgery) and wrong ways to get well (everything else).
Bellamy’s brand of freedom of choice in treatment was similar to his version of academic freedom:
Your comments about “academic freedom” miss the mark by a wide margin. Academic freedom does not mean that all comers get a place at the table, no matter how implausible their ideas. If that were true the map created by the FSU professor you mentioned would become a reality. [148] (emphasis added)
In reality, if it were up to Bellamy, he might have also added, “no matter how plausible their ideas” since only medical allopathic methods are welcomed in his university. The intellectual dishonesty at FSU is mind-boggling.
This medical backlash demonstrates the mob mentality more than it does a rational decision by academicians. This mirrors Liberty University that decided not to let students who were Democrats to speak on campus. Liberty University’s Democrat students club received notice from the administration that it would no longer be able to associate the University’s name with any of its activities. The club’s leadership was told “we are unable to lend support to a club whose parent organization stands against the moral principles held by” the school. [149]
Certainly a chiropractic program at FSU similarly offended the “moral principles” of the medical mob. This is not higher education that is tolerant, but academic demagoguery that stirs the passions, fears, and prejudices of followers, and then manipulates them to their goal.
Undoubtedly the most bewildering and offensive response by Bellamy concerned the lack of academic freedom at FSU: “Not opposing chiropractic presence at FSU would have been an egregious lack of academic freedom.”[150]
Do you really think that the academicians, business men and women, scientists, lawyers, journalists and others who populate these groups are such dimwits that they cannot make up their own minds? [151]
Obviously Bellamy ignores the vote of 151-1 by the Florida state legislature who made up their own minds to vote in favor of this program. In his mind, as long as he can speak out and shout down his opponents with misinformation, that alone constitutes freedom of speech. His version resembles an autocratic rather than a democratic attitude.
He has shown himself to be unaware of the supportive research, he is ignorant of chiropractic education, and he mocks the contribution of chiropractors to the development of this ageless healing art. Bellamy now suggests “academic freedom does not mean that all comers get a place at the table, no matter how implausible [or plausible] their ideas.”
The biggest shock to me was Bellamy’s idea of academic freedom when he thinks my criticism to his ability to purge an academic discipline would have been “an egregious lack of academic freedom”? While he certainly has the right to object, his effort to eliminate the study of the third-largest health profession in the world speaks volume of his distorted idea of academic freedom.
I find just the opposite — to reject an academic discipline outright due to political rivalry, professional self-interests, and academic prejudices exemplifies the complete lack of academic freedom and more closely resembles Zombie science.
Dr. Benjamin Rush, considered the Father of American Psychiatry, as well as a Founding Father and signer of the Declaration of Independence, probably would have warned of this repression of freedom of speech in health care:
Unless we put medical freedoms into the Constitution, the time will come when medicine will organize into an undercover dictatorship.
The FSU project would have cleared the air on this subject matter and either proved chiropractic to be placebo as Bellamy contends or else it would have brought an ageless healing art to the forefront to help millions of people who suffer from both musculoskeletal disorders and those who suffer from spinovisceral reflex nerve disorders that mimic serious visceral disorders (discussed in next chapter).
As a graduate of the University of California during the aftermath of the Free Speech Movement, I find Bellamy’s version of academic freedom to be the antithesis of what I experienced at Berkeley — censorship is not academic freedom by any sense. Thomas Jefferson must be turning over in his grave by this perversion of the First Amendment.
What escapes Dr. Bellamy’s sense of freedom is the fact that he does not realize we are colleagues in the battle against pain and suffering, our mutual enemy. In this light, the enemy of my enemy should make us friends. Sadly, the fact that the medical profession has yet to understand this simple truth keeps the Hundred Year War waging.
The issue of freedom of academia and research seeking the truth reminds me of Dr. Hidde’s statement in 1959:
The educated man knows that progress is the necessary life blood of any human endeavor. He knows that freedom of thought and unrestricted research and testing of his scientific principle can only add to its acceptability and to its soundness.[152]
Doorway Diplomacy
Bellamy contends the medical mob at FSU was acting out from academic integrity, but I believe they were actually medical bigots afraid to let the chiropractic “niggers” on campus (please excuse my explicit portrayal of chiropractors as the subservient class of healthcare practitioners).
Just as former Gov. George Wallace stood in the doorway at the University of Alabama in 1963 to prevent the entrance of black students after President Kennedy sent in the federal troops to desegregate Bama, Bellamy and his medical mob did the same at FSU.
Despite the popularity of Wallace’s stubbornness by his white supremacist supporters, it took Coach Paul “Bear” Bryant to press for the integration Bama, not the myopic and racist Gov. Wallace. Indeed, imagine Bama today without black athletes on its football team.
This over-reaction to the integration of chiropractic into the medical program on the FSU campus is clearly reminiscent of the days of racial desegregation in the South. While Bama benefitted in the long run from integration not just on the football field, but in the classroom and in a pluralistic community of graduates of all colors, so too the FSU program could have led to discoveries far beyond the present known benefits of chiropractic care into the area of spinovisceral reflexes and Type O disorders.
Gov. Wallace demonstrated his political demagoguery to the world and Dr. Ray Bellamy felt justified with the same intense prejudice to keep the “niggers-chiropractors” out for his medically-biased reasons. Bellamy’s doorway diplomacy prevented the FSU chiropractic program to discover the pros and cons of chiropractic care in an objective, scientific manner.
Sadly, the academic warfare led by “naysayer” Dr. Bellamy killed this golden opportunity to expand upon the role of manipulative therapy not only for Type M and Type O disorders relating to the spine, but the benefits of manipulative therapy for all types of joint dysfunction in the entire human musculoskeletal system.
Imagine how many knee surgeries might be avoided if manipulation was available before surgery. The same can be said of carpal tunnel syndrome, TMJ disorders, tennis elbow, shoulder pain, and certainly ankle and foot pain. Imagine how many nerve related problems might be helped instead of having a society addicted to psychotropic and pain killing drugs. As you will read in the next chapter, there is more to chiropractic care than back pain relief.
Call for Reform Continues
Despite Bellamy and the medical mob at FSU that unfairly criticized chiropractic, progressive MDs and researchers still call for a change and more investigation into spinal care, which is what the FSU program would have accomplished. These objective medical personnel are willing to admit what Bellamy would not – that the spine care professions need to think out of the medical box to find new solutions to this growing problem.
Daniel Cherkin, PhD, a leading spine researcher, called for a new paradigm in spine care, admitting there is the
…possibility that our thinking about back pain is fundamentally wrong. We may be missing something important. And that could be why we have not come up with any dramatic advances. And it that is the case, then the implication is that we need new paradigms. And that once we find the best paradigm, we will make more progress. [153]
Renowned spine research Richard Deyo, MD, MPH, agrees to the need to think out of the medical box:
“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 far.” [154]
Concedes Dr. Paul Shekelle who directed one of the RAND studies: “Their [chiropractic] philosophy of disease is totally foreign to us. But for some conditions it sure seems to work.”[155]
As TIME reporter Andrew Purvis concluded, “If spinal manipulation could ease even a fraction of that financial burden, remaining skeptics might be forced to stifle their misgivings or get cracking themselves.”[156]
It is a shame the FSU board did not listen to these progressive MDs for advice in their call for reform instead of the medical mob when it made the decision to kill the chiropractic program. The prospect of both medical and chiropractic experts working side-by-side would have revealed the evidence and truth from the babble and gobbledygook from both sides.
Francisco Kovacs, MD, commented that “One way to ensure that a problem remains unsolved is to continuously repeat the same failed approaches over and over again.” [157]
Aage Indahl, MD, agreed that “Many of our ideas about low back pain have been wrong. The slow pace of change in giving up old ideas is probably a result of the lack of new ideas.” [158]
Apparently the medical demagogues will resist new ideas if the FSU rejection of the proposed chiropractic program is any indication of the unwillingness by the medical academicians to explore new ideas. Rather than believing the repetitious lies of Morris Fishbein and the Committee on Quackery parroted by Bellamy, one would think an academic body would have the backbone to form its own opinion by applying the same principles of critical thinking to an analysis of chiropractic art, science, and even its philosophy.
Obviously the failure by FSU to implement the hopeful chiropractic program was a huge disappointment to members of the chiropractic profession who wanted to see an evidence-based research program that was well-funded unlike the research departments at small chiropractic colleges that, in fact, still wither on the vine for lack of funding.
The Board’s veto was the final blow of a terrible storm during the FCA’s five-year effort to have a chiropractic program implemented in their state’s university system. Making this storm worse was also learning that another chiropractic group led by Palmer College of Chiropractic sabotaged this effort was a knife in the FCA’s back.
Regrettably, the real damage from this perfect storm to the FCA and the mainstream chiropractic profession was not just in the dollars spent and broken dreams, but also in academic esteem and the likelihood that chiropractic education might someday evolve into mainstream universities.
The hidden agenda here is not the worthiness of chiropractic science or research or treatment as Bellamy suggests — the facts are clear there is validity to all three. Either way, the truth would have been found in the freedom of academia rather than killed by the hands of political medicine and academic demagogues.
The real agenda is money and power, of course, and AMA, Inc. is not about to let go. Its 1963 Iowa Plan remains in effect to deter chiropractic education whenever possible and certainly if it invades the medical sanctuary of a major university. The FSU fiasco was an example of that strategy.
Until every public university offers a pre-chiropractic program and until every state-sponsored health science program offers a graduate level chiropractic program, we must consider the medical boycott continues and that this perfect storm has not truly ended.
It’s time to weather the storm, it’s past time stop burning books, and it’s time to let there be light shined on chiropractic our nation’s universities.
[1] Kimberly Miller, “FSU Faculty Members Debate Chiropractic School,” Palm Beach Post, January 14, 2005.
[2] George McAndrews, closing argument, Wilk II, June 26, 1987, p. 3057
[3] Ibid. p. 3082.
[4] Gary Null, PhD, “Medical Genocide, Part Four: Painful Treatment,” Penthouse magazine, November, 1985
[5] Reed B. Phillips ,DC, PhD, “Joseph Janse: the Apostle of Chiropractic Education,” (2006): 164-181.
[6] Joseph Keating, PhD, “The England Case and the Wilk Case: A Comparison, Part 1, Dynamic Chiropractic, 25/19, September 10, 2007.
[7] R. Beideman, In the Making of a Profession: The National College of Chiropractic 1906-1981. National College, Lombard, Ill. (1995): 260.
[8] Phillips, ibid. p. 161.
[9] Ibid. p. 180.
[10] George McAndrews, closing remarks before the Honorable Nicholas J. Bua, December 9, 1980, Wilk et al. v. AMA et al., page 66.
[11] Ibid. p. 7078-79
[12] Minutes of “Meeting of the Logan College Board of Trustees” in St. Louis (Logan Archives) (June 17, 1971):
[13] Null, ibid.
[14] Ibid.
[15] McAndrews, closing arguments Wilk v. AMA, June 26, 1987, Honorable Susan Getzendanner. p. 3082-83.
[16] Ibid. p. 3082-83.
[17] Ibid. p. 3085-86.
[18] Fishbein, Ibid, p. 98
[19] McAndrews, December 9, 1980, p. 7086.
[20] Null, Ibid.
[21] McAndrews, closing argument, p. 6800
[22] Ibid.
[23] Ibid, p. 6800-01
[24] Historical summary taken from the appeal brief filed by attorney George McAndrews. The complete appeal brief is available online at www.chiroweb.com/trigon.
[25] PX-56, 156A
[26] McAndrews, ibid. p. 7090.
[27] McAndrews, ibid, p. 7091
[28] McAndrews, Wilk II, ibid. p. 3090.
[29] McAndrews, ibid. p. 3087-88.
[30] “M.D..D.C. Debate: ‘Chiropractic Is Not On Trial,’” Digest of Chiropractic Economics 8/5 (Mar/Apr1966): 53.
[31] JC Keating, “Wilk et al. vs. AMA et al.” National Institute of Chiropractic Research (05/11/08): 45.
[32] Ibid.
[33] Joseph A. Sabatier, MD, Minutes from the “Chiropractic Workshop,” Michigan State Medical Society, held in Lansing on 10 May 1973, exhibit 1283, Wilk.
[34] McAndrews, Wilk II, ibid., p. 3055.
[35] Null, ibid.
[36] Editorial Staff, “Florida Legislature Approves Funding for Chiropractic College at FSU,” Dynamic Chiropractic 22/8 (April 8, 2004)
[37] Ibid.
[38] Melanie Yeager, “Question of Science,” Tallahassee Democrat, 12/12/2004
[39] Florida Board Of Governors Minutes, Subject: Implementation Authorization for a Doctor of Chiropractic at FSU, January 27, 2005
[40] Gary Fineout, “Chiropractors, Doctors Feud Over FSU Plan,” Miami Herald, January 13, 2005
[41] Ibid.
[42] Kimberly Miller, “Confused FSU Trustees Ok Chiropractic Plan,” Palm Beach Post, January 15, 2005
[43] Kimberly Miller, ibid.
[44] Melanie Yeager, “Question of Science,” Tallahassee Democrat, 12/12/2004
[45] McAndrews, Wilk I closing argument, December 9, 1980, p. 6798
[46] Melanie Yeager, “Question of Science,” Tallahassee Democrat, 12/12/2004
[47] Kimberly Miller, “FSU Faculty Members Debate Chiropractic School,” Palm Beach Post, January 14, 2005.
[48] Kimberly Miller, “FSU Faculty Members Debate Chiropractic School,” Palm Beach Post, January 14, 2005.
[49] Ibid.
[50] Ron Matus, “Chiropractic School Angers FSU Professors,” St. Petersburg Times, December 29, 2004
[51] McAndrews, ibid. p. 3087-88.
[52] Walter Kaufman, The Future of the Humanities 29 (1977)
[53] Ron Matus, “Chiropractic School Angers FSU Professors,” St. Petersburg Times, December 29, 2004.
[54] Raymond Bellamy, private communication with Dr J C Smith, Sat 6/20/2009 12:10 PM, RE: response to FSU chiropractic school commentary.
[55] Ibid.
[56] Ron Matus, “Chiropractic School Angers FSU Professors,” St. Petersburg Times, December 29, 2004
[57] Ibid.
[58] Kimberly Miller, “President Says FSU Can’t Return Chiropractic School Money To State,” Palm Beach Post, February 23, 2005
[59] R. Beideman, ibid., p. 84
[60] Kimberly Miller, “FSU Faculty Members Debate Chiropractic School,” Palm Beach Post, January 14, 2005.
[61] PH Goodly, Release from Pain, Don’t be a victim of the pain pandemic, 2005. www.Dr.Goodley.com
[62] Sid E. Williams, Campus Life, December 1993
[63] Mark Goodin, “Winning The Battle In Legislative And Regulatory Arenas,” Journal of the American Chiropractic Association, (July, 1992): 45-47.
[64] Sid E Williams, “Quo Vadis”, Campus Life, December 1993.
[65] Minutes of the Florida Board of Governors, January 27, 2005, p. 14.
[66] Ibid.p.16.
[67] Editorial Staff, “FCA Fulminates over Funding Veto,” ibid.
[68] Editorial Staff, “FCA Fulminates over Funding Veto,” Dynamic Chiropractic 19/16(July 30, 2001)
[69] Ibid.
[70] Kimberly Miller, “Board Snubs Legislature, Rejects Chiropractic School,” Palm Beach Post, Jan 28, 2005
[71] “Board Turns Down Chiropractic School,” Knight Ridder/Tribune Business News, January, 2005
[72] Ibid.
[73] Gary Fineout, “Turf Battle Shapes Up For Control Of Tuition Rates At Florida Universities,” The Miami Herald, November, 2004
[74] Ray Bellamy via private communication with JC Smith, 07-12-09.
[75] Ray Bellamy via private communication with JC Smith, 07-12-09.
[76] Guy Riekeman, DC, “What’s Right & Wrong with Chiropractic” Streams from the Fountainhead, Summer 2001.
[77] JJ Triano, ACC-RAC Plenary Session, Las Vegas 2005.
[78] http://www.mgtofamerica.com/
[79] MGT of America, Inc., “Costs of Chiropractic Education,” Final Report Submitted to: Florida State University, Tallahassee, Florida, Prepared in response to legislative proviso in Specific Appropriation 161 of the 2000 General Appropriations Act, December 15, 2000
[80] MGT of America, ibid.
[81] JJ Triano, ACC-RAC Plenary Session, Las Vegas 2005.
[82] Florida Board Of Governors, Minutes of January 27, 2005, “Implementation Authorization for a Doctor of Chiropractic at FSU,” p. 17.
[83] MGT of America, ibid.
[84] Guy Riekeman, DC, “What’s Right & Wrong with Chiropractic” Streams from the Fountainhead, Summer 2001.
[85] Melanie Yeager, “State Board Votes Against Program,” Democrat Staff writer, 1/28/05
[86] Morris Fishbein, Medical Follies, (New York, Boni & Liveright, 1925): 43.
[87] Ray Bellamy via private communication with JC Smith, 6/20/2009.
[88] R Bellamy, private communication, 6/20/2009.
[89] The BACKPage editorial, The BackLetter 12/ 7 (July, 2004): 79.
[90] SJ Bigos, O Bowyer, G Braea, K Brown, R Deyo, S Haldeman, et al. “Acute Low Back Pain Problems in Adults: Clinical Practice Guideline no. 14.” Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1992. AHCPR publication no. 95-0642.
[91] Marc S. Micozzi, MD, PhD, “Complementary Care: When Is It Appropriate? Who Will Provide It?” Ann Intern Med 29/1 (July 1, 1998): 65-66
[92] Ray Bellamy via private communication with JC Smith, 6/20/2009.
[93] Ibid.
[94] R Bellamy, private communication, July 12, 2009.
[95] Raymond Bellamy, private communication with Dr J C Smith, Sat 6/20/2009 12:10 PM, RE: response to FSU chiropractic school commentary
[96] “Refuting Ineffective Treatments Takes Years,” The BackLetter® 101 23/9, 2008.
[97] RA Deyo, SK Mirza, BI Martin, W Kreuter, DC Goodman, JG Jarvik, “Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults,” JAMA. 303/13 (Apr 7, 2010):1259-65.
[98] Anthony Rosner, PhD, “Evidence or Eminence-Based Medicine? Leveling the Playing Field Instead of the Patient,” Dynamic Chiropractic 20/25 ( November 30, 2002)
[99] J. Paling www.healthcare speaker.com, 2000.
[100] Paling, ibid.
[101] V Dabbs, W Lauretti. “A Risk Assessment Of Cervical Manipulation Vs Nsaids For The Treatment Of Neck Pain,” Journal of Manipulative and Physiolgical Therapeutics 18/8 (1995):530-536.
[102] RA Deyo, DC Cherkin, JD Loesser, SJ Bigos, MA Ciol, “Morbidity and Mortality In Association With Operations On The Lumbar Spine: The Influence Of Age, Diagnosis, And Procedure,” Journal of Bone and Joint Surgery Am 74/4 (1992):536-543.
[103] Paling, ibid.
[104] Paling, ibid.
[105] JJ Triano and G Kawchuk. “Current Concepts in Spinal Manipulation and Cervical Arterial Incidents,” NCMIC: Clive, IA. 118. ISBN: 1-892734-14-1. (2006): 75.
[106] Ibid.
[107] AGJ Terret, “Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation,” NCMIC Group Inc, West Des Moines, Iowa, 2001.
[108] Paul G Shekelle et al, “RAND Corporation Report, The Appropriateness of Spinal Manipulation for Low-Back Pain,” RAND, 1992
[109] George McAndrews, et al., “ 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-439.
[110] Hurwitz, Haldeman et al. Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine 15/33(4 Suppl) ( Feb 2008):S123-52
[111] The BackLetter® 46 23/ 4 ( 2008)
[112] The BackLetter® 46 23/ 4 (2008)
[113] Hoving, Koes et al, “Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain,” Ann Intern Med. 136 (2002):713-722
[114] J Triano, Biomechanics of Spinal Manipulation,” Spine 1 2001):121-30
[115] D. Seaman, “Joint Complex Dysfunction, A Novel Term To Replace Subluxation/Subluxation Complex. Etiological And Treatment Considerations.,” J. Manip Physiol Ther 20(1997):634-44.
[116] Ibid. p. 55.
[117] Kimberly Miller, ibid.
[118] BD Inglis, B Fraser, ,BR Penfold, Chiropractic in New Zealand, Report of the Commission of Inquiry into Chiropractic, PD Hasselberg, Government Printer, Wellington, New Zealand. (1979): 244.
[119] Spokes of Chiropractic Progress prepared by George McAndrews, copyright by the American Chiropractic Association, 2003.
[120] KB Freedman, J. Bernstein, “The Adequacy Of Medical School Education In Musculoskeletal Medicine,” J Bone Joint Surg Am. 80/10 (1998): 1421-7
[121] EA Joy, SV Hala, “Musculoskeletal Curricula in Medical Education: Filling In the Missing Pieces,” The Physician and Sports Medicine. 32 (2004): 42-45
[122] GA Schmale, “ More Evidence Of Educational Inadequacies In Musculoskeletal Medicine,” Clin Orthop Relat Res. 437 (Aug 2005):251-9
[123] E Matzkin, ME Smith, CD Freccero, AB Richardson, “Adequacy of Education In Musculoskeletal Medicine,” J Bone Joint Surg Am. 7-A/2 (Feb 2005):310-4
[124]Rachelle Buchbinder, PhD, FRACP; Margaret Staples, PhD; Damien Jolley, MSc, “Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain,” Spine 34/11 (May 2009)
[125] Raymond Bellamy, private communication with Dr J C Smith, Sat 6/20/2009 12:10 PM, RE: response to FSU chiropractic school commentary
[126] AS Finestone, A Raveh, Y Mirovsky, A Lahad, C.Milgrom, “Orthopaedists’ and Family Practitioners’ Knowledge Of Simple Low Back Pain Management. Spine 1 34/15 (July 2009):1600-3.
[127] DC Cherkin, FA MacCornack, AO Berg, “Managing Low Back Pain–A Comparison Of The Beliefs And Behaviors Of Family Physicians And Chiropractors,” West J Med. 149/4 (1988):475-80.
[128] BM Fullen, GD Baxter, BG O’Donovan, C Doody, L Daly, DA Hurley, “Doctors’ Attitudes And Beliefs Regarding Acute Low Back Pain Management: A Systematic Review,” Pain 136/3 (June 2008):388-96.
[129] R Buchbinder, M Staples, D Jolley, “Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain,” Spine 15; 34/11 (May 2009):1218-26.
[130] Private communication, July 24, 2009, Stephen M. Perle, D.C., M.S., Associate Editor, Chiropractic and Osteopathy, Professor of Clinical Sciences at University of Bridgeport.
[131] C LeBouf, P Brown, A Herman et al. “Chiropractic Care Of Children With Nocturnal Enuresis: A Prospective Outcome Study,” J Manipulative Physiol Ther. 14/2 (Feb 1991): 110-115.
[132] WR Reed, S Beavers, SK Reddy, G Kern, “Chiropractic Management Of Primary Nocturnal enuresis,” J Manipulative Physiol Ther. 17/9 (Nov-Dec 1994): 596-600.
[133] J Nyiendo. E Olsen, “Characteristics of 217 Children Attending A Chiropractic College Teaching Clinic,” J Manipulative Physiol Ther. (11/2 Apr 1988): 78-84.
[134] N Nilsson, “Infantile Colic And Chiropractic,” Eur J Chiro 33/4 (1985):264-65.
[135]N Klougart, N Nilsson and J Jacobsen, “Infantile Colic Treated By Chiropractors: A Prospective Study,” J Manipulative Physiol Ther. 12/4 (Aug 1989): 281-288
[136] G Bronfort and R Evans, “Chronic pediatric asthma and chiropractic spinal manipulation: A prospective clinical series and randomized clinical pilot study,” Journal of Manipulative Physiology and Therapeutics, 24/6 (July 2001):369-77.
[137] RL Graham and RA Pistolese, “An Impairment Rating Analysis Of Asthmatic Children Under Chiropractic Care,” Journal of Vertebral Subluxation Research, 1/ 4 ( 1997).
[138] RM Froehle, “Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors,” Journal of Manipulative Physiology and Therapeutics, 19/3 (Mar-Apr 1996):169-77.
[139] JN Weinstein et al., “Surgical vs. Nonoperative Treatment For Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT) Observational Cohort,” JAMA 296 (2006):2451–9
[140] Gina Kolata , “Surgery Need Is Questioned In Disk Injury,” NY Times, November 12, 2008.
[141] Ibid.
[142] JC Keating, B.J. of Davenport: The Early Years of Chiropractic, (1997): 279.
[143] Anthony L. Rosner, PhD, National Institute of Medicine Hearings, Foundation for Chiropractic Education and Research, February 27, 2003.
[144] Ray Bellamy via private communication with JC Smith, 07-12-09.
[145] Bruce G Charlton, ”Replacing Education With Psychometrics,” Medical Hypotheses, 71 (2008) :327–9.
[146] Morris Fishbein, MD, Medical Follies, New York, Boni & Liveright (1925): 24-5
[147] Ray Bellamy via private communication with JC Smith, 07-12-09.
[148] Ray Bellamy via private communication with JC Smith, 07-12-09.
[149] Katie Connolly, “Liberty University Bans Democrat Club,” Newsweek, May 22, 2009
[150] R Bellamy, private communication, July 12, 2009.
[151] Ibid.
[152] Orval L Hidde, “Historical perspective: CCE & COA, 1961-1980,” unpublished, circa February 2004
[153] The BACK Letter, 23/5 ( 2008): 55.
[154] Ibid.
[155] Andrew Purvis, “Is There a Method to Manipulation?” TIME magazine, Sept. 23, 1991.
[156] Ibid. http://www.time.com/time/magazine/article/0,9171,973881-3,00.html#ixzz0lCQjnqvY
[157] The Back Letter, 23/5( 2008): 55.
[158] Ibid.