Jim Crow, MD
The recent murders of nine parishioners during Bible study at Charleston’s Emanuel African Methodist Episcopal Church has rekindled the race issue and the symbols many people in the South mistakenly take as Southern heritage and the “good ol’ days” of Gone With the Wind.
For African-Americans and many non-blacks who still believe in justice for all, those were not such “good ol’ days” and these symbols—the Confederate flag, statues of Confederate soldiers, schools and streets named for so-called Rebel heroes—all represent the era of slavery, a disastrous civil war, and the lingering hate and racism that still prevails as we witnessed with the murderer in Charleston who proudly held the Bars and Stripes in a show of defiance.
DCs should view the preponderance of medical symbols in the same light as the Confederate flag. Just as we see these remnants of racism regaled as so-called “Southern pride”, we chiropractors continue to see evidence of medical segregation, for example, whenever we see “Medical Center” replacing “Hospital” on the signs of public hospitals, a clear indication that only “medical” professionals are welcomed on staff to the exclusion of DCs.
The renaming of our public hospitals to “medical centers” represents to me the same attitude as “Whites Only”!
Think of the ramifications of this “MD Only” policy. Although I have a license to practice chiropractic anywhere in the state, if my wife were injured and hospitalized, legally I could not treat her in the local public hospital, err, medical center, that my taxes built and support because the local medical association lays claim to this facility.
Keep in mind chiropractic is the third-largest physician-level health profession in the world and MSDs are the leading cause of disability and expenditures. Indeed, we are a big profession now dealing with a huge problem terribly mismanaged by medical spine care, so we should have a voice in this matter and be available at any public venue to anyone rather than being marginalized and segregated.
Despite the fact that medicine needs our help badly, let’s look realistically at other examples of medical segregation:
Name one chiropractor who ranks in the history books among Lister, Koch, Pasteur, or Salk or any of the scientists who advanced healing?
Name a health reporter on television who is a DC and not an MD.
Name the last time you’ve heard chiropractic mentioned on NPR, CNN or even FOX News.
Name a state-supported major university that has a chiropractic program.
Name a major political appointee who is a DC.
Name a major television character who is a DC and, certainly, don’t suggest the wimp on “Two and a Half Men.”
As you can see, we chiropractors are missing in the history books, media, university academia, political sector, and entertainment world. We are, in effect, the proverbial ‘elephant in the room’ that continues to be segregated due to chirophobia; indeed, we remain the Mystery Science Profession in bondage.
Jim Crow, MD
I liken this dilemma to the entrenched KKK after the Civil Rights Movement began. Arguably the redneck Jim Crow who was taught to hate blacks is much easier to dismiss as a bigot than Jim Crow, MD, who is a wealthy, highly-educated, and politically well-connected person was also taught to hate chiropractors.
The policy of segregation practiced by Jim Crow, MD, became evident in 2008 when the AMA officially apologized for its history of excluding black physicians from membership, for listing black doctors as “colored” in its national physician directory for decades, and for failing to speak against federal funding of segregated hospitals and in favor of civil rights legislation.
“The AMA failed, across the span of a century, to live up to the high standards that define the noble profession of medicine,” said AMA Immediate Past President Ron Davis, MD, in a commentary published in the Journal of the American Medical Association.[1]
Certainly the AMA did not live up to “high standards” in regards to chiropractors either, but it did reflect its historical standard to “contain and eliminate” anyone who competes with the Ivy League medical model of medicine promoted by Big Pharma.
Don’t think for one moment the AMA was sincere in this act of contrition. Recall this apology came when Barack Obama was about to be elected president of the USA. To say it was a whitewash of its true intention to maintain an exclusive medical monopoly is an understatement, not unlike the supposed integration of the Augusta National Golf Club.
In 2012, Emory University also apologized for years of anti-Semitism at its dental school, when dozens of Jewish students were flunked out or forced to repeat courses.[2] Under dental school dean John Buhler from 1948 to 1961, about 65 percent of Jewish students were flunked out or forced to repeat courses, while the rate of failure or repeats was dramatically lower before that period, according to statistics compiled by then-director of the Anti-Defamation League, Art Levin. Apparently the “noble profession” of dentistry also has some soul-searching to do.
Medical Mea Culpa?
Considering these apologies in the news by the two largest health professions, when will the third-largest chiropractic profession have its redemption with official apologies from the AMA, AHA, and the other co-conspirators of the medical industrial complex who lost the Wilk v. AMA antitrust trial? Perhaps when a new president is elected who happens to be a chiropractor? Okay, stop laughing!
In the Court Opinion at the conclusion of the Wilk trial, Judge Susan Getzendanner wrote of the damage inflicted upon chiropractors and described the conspiracy as “systematic, long-term wrongdoing, and the long-term intent to destroy a licensed profession.”[3]
“By labeling all chiropractors unscientific cultists, injury to reputation was assured by the AMA’s name-calling practice,” which was exactly the goal of the medical association—to defame its main competition, to invalidate our superior expertise and spinal treatments, and to capture the healthcare marketplace.
After the “patient safety” issue was invalidated by experts in court, Judge Getzendanner admitted in a 1991 interview that the medical war was primarily a turf battle about money, not about safety. “Absolutely,” she confessed. “Chiropractors compete with doctors. There’s no question about it: it’s basic competition.”[4]
Although George McAndrews orchestrated this monumental legal victory, the AMA’s objective was fait accompli and the PR damage was done. So, how do we get our reputations back after this massive defamation campaign that continues to this day?
The judge found “injury to chiropractors’ reputations which resulted from the boycott have not been repaired,” but the AMA was not required to do a public apology, no mea culpa, or to compensate the thousands of chiropractors whose reputations were soiled or those 12,000 who went to jail for allegedly practicing medicine without a license when, in reality, they were practicing chiropractic only—no drugs, shots, or surgery.
The judge also noted, “Chiropractors suffer current economic injury as a result of the boycott,”[5] but no reparations were given to the chiropractic stalwarts who suffered from this boycott. Indeed, the AMA’s holocaust was done and no one atoned for this attempted assassination of the chiropractic profession.
George McAndrews noted in his speech before the National Chiropractic Legislative Conference in March, 2002.
“Thirty years ago our goal was getting rid of the quack label, now it’s about equality and fairness. If we go hat-in-hand, they’ll give us nothing. They’re still launching salvos because we’re taking their money. I don’t care if they get angry, that passed a long time ago. We don’t need to apologize. It’s all about money now.”[6]
It has always been about money for the AMA; for the chiropractors, it was always about survival.
New Direction
Like Rosa Parks who refused to move to the back of the bus, by now chiropractors should also be tired of being thrown under the medical bus. Even harder is driving this broken down medical bus filled with public passengers in a new direction away from opioids, epidurals, and disc fusions.
Just as the Civil Rights Act did not stop Jim Crow’s discrimination, neither did Jim Crow, MD, embrace Judge Getzendanner’s decision with open arms. After the Wilk decision, our profession mistakenly thought it would open doors to hospitals and foreshadowed equality in healthcare for patients, chiropractors, and other CAM providers.
Unfortunately, the Wilk victory caused the AMA to hunker down in opposition just as the KKK dug in its heels to oppose integration. At the same time as Jim Crow will never apologize for the years of slavery, racism, and symbols of bigotry, the AMA and Jim Crow, MD, will never apologize for its genocidal campaign to “contain and eliminate” the chiropractic profession.
Just as Jim Crow, medical student, is not taught about musculoskeletal disorders (MSDs) or the benefits of complimentary and alternative medicine (CAM), neither is he or she taught about following guidelines, doing what’s best for the patient, and free enterprise in healthcare by referring to chiropractors. As Mr. McAndrews aptly deemed, these students are taught early on that MD stands for “Major Deity.”
There is simply too much money in spine care for the AMA to do the right thing, even when medical spine care has become a national scandal. We must push the tipping point in spine care to bring this sordid situation to the public that is suffering from MSDs, chronic back pain, disability, and now face an opioid dependency unlike ever seen in the history of our country.
If we don’t stand up like Rosa Parks and demand to sit in the front of the medical bus, then we will continue to be thrown under the bus along with millions of patients mismanaged daily by pills mills and unethical surgeons.
Welcome to Georgia
I’ll never forget my introduction to this so-called “Southern pride” when I arrived in middle Georgia in 1980. As a Californian boy from Berkeley, I mistakenly thought the racist attitudes were bygone, but I was rudely awakened when I saw KKK members in full costume every Sunday soliciting at a busy intersection in town.
Here in the Buckle of the Bible Belt, I soon learned other forms of bigotry were also very much alive, such as chirophobia. In my first encounter with my farmer-neighbor at the fence line, after the customary platitudes, he finally asked me what I did for a living. When I mentioned I was a chiropractor, his demeanor changed from one of Southern hospitality to one of indignation. He told me in no uncertain terms, “Some people around here don’t take kindly to chiropractors,” then walked away, never to speak with me again.
Apparently his Southern hospitality did not include chiropractors, and I soon learned he was not alone.
Shortly after the Wilk v. AMA antitrust trial had ended, I applied for hospital privileges at the local public hospital. George McAndrews had sent me valuable court information and I delivered a thorough presentation to the hospital board. Afterwards I was told by the hospital head administrator it was the “second-best” presentation he had ever heard.
However, the chirophobes on the board struck back. Being well-prepared, I answered each one with facts, not just my opinion. In frustration, the board chairman actually said to me, “Well, Dr. Smith, you seem to have all the answers.” There was no pleasing this kangaroo court; indeed, I felt like a black man applying to the local white-only golf club. I could have been Tiger Woods, but that would have made no difference to these medical racists.
The board chairman also showed his medical bigotry after I mentioned the Wilk v. AMA decision. He told me in no uncertain terms, “We ain’t gonna have a Yankee judge tell us how to practice medicine in Georgia.” I could only think that Georgia never rejoined the Union after the “War Between the States.”
After I ended my presentation, the board’s attorney told the members that if they allowed a chiropractor on staff, the hospital would lose its license. I refuted his claim since that was the essence of the Wilk case that the AMA and AHA could not punish MDs or hospitals that cooperated with DCs. He was oblivious to the Wilk decision and said, “I’ll check into that.” He obviously had not done his homework.
By then the board members were stunned and my presentation was sabotaged. He figuratively dropped an f-bomb on my talk. I checked the next day with the state attorney general who told me emphatically there was no such regulation to keep DCs out of public hospitals.
Perhaps the strangest part of this saga occurred a month later. I had been told at the conclusion of the first meeting that the board would discuss my proposal and let me know at the next monthly meeting. As the next meeting approached, I inquired with the hospital administrator’s office where and when it was to meet, but never got an answer.
Since I had season tickets to the local high school football games, as usual I went to the Friday night game. At 10:30 PM after I returned home, my phone rang and the local newspaper reporter asked me why I wasn’t at the board meeting.
“What meeting?”
To my amazement, the board met on a Friday night in another town, never informing me of the time or location. The next morning newspaper had the article of the board’s decision denying me approval. Incredulously, the board’s attorney said, “Let the record show Dr. Smith didn’t have the decency to show up.”
Someday I hope to adjust his TMJ with a right cross (and I don’t mean a crucifix).
Par for the Course
Certainly many chiropractors have gone through similar experiences, whether being denied hospital privileges, excluded from social clubs like Rotary or the local private country club, or excluded from workers’ comp panels. Being marginalized socially and limited in health insurance programs is par for the chiropractic course, just as African-Americans have been discriminated against and segregated despite the Civil Rights Act of 1964.
While tokens of the Wilk victory are seen with a few DCs on hospital staffs and in the VA and TRICARE systems, as a whole this is mere puffery compared to the real need of chiropractic care in a nation and military riddled with MSD disability. Considering we only serve less than 10 percent of the population and are on staff of few hospitals in the VA or military health services, for the most part, Jim Crow, MD, continues to segregate chiropractors to the margins as mere tokens.
After living in Warner Robins, a federal Air Force town for the last 35 years, I can see no changes. I have never had a referral from the base’s workers comp program. In fact, I did a Freedom of Information Act petition and found in 2012 there were 2,512 neck, back, and leg pain cases on base, and none were referred to any chiropractor in town. TRICARE still excludes coverage for the retired military despite the federal law, and the Dublin VA hospital sparingly refers injured vets but only after they are forced to have steroid injections and take opioid painkillers.
As we know, every guideline now recommends conservative care before these medical procedures, but there seems to be no medical cops enforcing this process in the VA, TRICARE, and workers’ comp programs.
Consequently, we continue to see the wake of disability when patients with back pain are railroaded on the medical train to opioids, epidurals, and spine fusions based on the outdated ‘bad disc’ diagnosis. Now this wake leaves 46 people dead daily from opioid abuse.
This begs the question: what good is research or guidelines when no one follows them?
In effect, medical racism still exists throughout our country despite our scientific, legal, and legislative efforts. Like the Civil Rights Act of 1964, the laws integrating chiropractic care into TRICARE, the VA, workers’ comp, public hospitals, and group health insurances may have changed, but the bigoted medical gatekeepers’ attitudes have not, and no one is enforcing the guidelines calling for conservative care before medical spine care.
Certainly there are a few sympathetic MDs, hospitals, and managed care programs that cooperate with DCs, but as a whole, we are still on the outside waiting to help millions and saving billions.
Where’s Our Champion?
Sadly, no one in the media has ever cleansed the public’s palate from the poison fed to them by the medical trolls. We need an articulate spokesman who can carry our torch.
Martin Luther King, Jr. in his “I Have a Dream” speech called for racial equality and an end to discrimination. King’s delivery of the speech on August 28, 1963, from the steps of the Lincoln Memorial, urged Americans to judge a person not by the color of his skin, but by the content of his character.
It’s past time for the medical profession and the public to do the same – to judge chiropractors not by the medical propaganda, but by their good clinical results that we can easily show them today. It’s time for our good actions to speak louder than ugly medical words.
Unlike racism, sexism, or homophobia, we have not gained the moral support of the media to promote our cause for equality in healthcare because we have not publicly broached the injustice of chirophobia. Like second-class citizens, we seem content to sit in the back of the medical bus, hoping someday to go in a new direction without changing the driver, Jim Crow, MD.
Until we do, we will remain second-class providers who still suffer from the AMA-contrived imagery created by Morris Fishbein and later the Committee on Quackery that still permeates the mindset of most newsmen and most of the public.
Overcoming this problem requires transformational programs, not an occasional Wonder of Chiropractic ad by a celebrity. We need to purify the public and press from their medical stinkin’ thinkin’ to a true appreciation of our healing art in a nation suffering from MSDs and plagued by opioid abuse. The door is now wider than ever before to present our case.
Certainly both the public and medicine need our help. The question remains: do we have the backbone to “act up” and make our case against medical spine care or will we remain in the back of the bus with our “billions of positive impressions” in hand not wanting to make waves?
[1] Kevin B. O’Reilly, AMA apologizes for past inequality against black doctors, Black physician leaders welcome the apology but call for more efforts to diversify the physician work force and reduce racial health disparities, amednews.com July 28, 2008.
[2] Kate Brumback, Emory apologizes for anti-Semitism, Associated Press, 10/11/2012
[3] Associated Press, “U.S. Judge Finds Medical Group Conspired Against Chiropractors,” New York Times (1987)
[4] Bryan Miller, Chiropractors vs. AMA, Chicago Reader ,June 27, 1991
[5] Wilk et al v AMA et al., US District Court Northern District of Illinois, No. 76C3777, Susan Getzendanner, presiding judge; Judgment dated August 27, 1987.
[6] George McAndrews speech before the American Chiropractic Association at the National Chiropractic Legislative Conference in Washington, DC, March 2002.