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|Q.||What are the principal functions of the spine?|
|-- B. J. Palmer, Answers (1952)|
According to the International Chiropractors Association, over 30 million Americans have received chiropractic care. Today, instead of fading away in the face of modern science, chiropractic is experiencing a renaissance.
In states that permit it, some chiropractors are aggressively advertising in newspapers for patients, using case histories and testimonials to prove that chiropractic helps and cures numerous diseases.
After holding out for years, the legislatures of two of the nation's most populous states, Massachusetts and New York, succumbed to the ceaseless pressures of the chiropractic lobby in the 1960s and passed laws licensing chiropractors.
Two paperback books extolling chiropractic -- Your Health and Chiropractic by Thorp McClusky (New York: Pyramid Books, 1962) and Chiropractic: A Modern Way to Health by Dr. Julius Dintenfass, D.C. (New York: Pyramid Books, 1966) -- have been published and are available at bookstores, drugstores, and airports. The latter book was offered for sale in a display ad in the cosmopolitan New York newspaper The Village Voice in April 1968, which reaches the nation's cultural and professional elite. (For a discussion of one of the testimonials that appears in these books, see Chapter Ten.)
In Fort Worth, Texas, the Parker Chiropractic Research Foundation pours out reams of literature for chiropractors to disseminate among their patients and in their communities, and conducts three-day seminars for chiropractors on how to increase their incomes (see Chapter Four). Other chiropractic groups are turning out attractive new booklets and leaflets emphasizing the theme that chiropractic is a modern, scientific branch of the healing arts.
In a major new departure, certain chiropractors have recently been moving into the field of mental and emotional health, alleging that spinal adjustments are beneficial to sufferers of conditions ranging from neurosis to schizophrenia (see Chapter Seven).
All this activity has been paying off. The American spine is probably supporting the chiropractor more handsomely now than at any time in the past.
It is not certain how many active chiropractors there are in the United States. The 1960 census listed 14,360 persons who gave their occupation as chiropractor. A publication of the American Chiropractic Association, however, claims that there are 25,000, and a public relations firm for chiropractors gives the figure as 35,000. The discrepancies may be partly accounted for by the fact that many chiropractors do not practice full time, and may have cited some other activity as their principal occupation when interviewed by the census-taker.
The 1967 Directory issued by the Council of State Chiropractic Examining Boards states that, as of January 1, 1966, there were 23,634 currently active chiropractic licenses in the United States and 772 in Canada, making a combined North American total of 24,406. Of these, 173 of the United States licenses and 6 of the Canadian were licenses granted by reciprocity in 1966, and an additional number of the total undoubtedly represents chiropractors holding more than one state license. (Also, 537 of the 24,406, were new licenses issued in 1966, indicating the continuing influx of new blood into the profession.) A figure of 20,000 would probably be a fair estimate of the number of persons holding one or more active licenses to practice chiropractic. Chiropractors are licensed on the basis of examinations given by state licensing boards. Requirements are established by legislation, and differ in each state. Further information on chiropractic licensure appears in Chapters Six and Twelve.
How big is the chiropractic profession economically? This author's guess is that chiropractors treat about 3 million people a year, and that the profession's annual income is about $300 million.
Figures in the Textbook of Office Procedure and Practice Building for the Chiropractic Profession, published by the Parker Chiropractic Research Foundation, indicate that the initial physical exam and X ray given by a chiropractor is likely to cost the patient about $40. The chiropractor is then likely to recommend a series of twenty to fifty adjustments, which will cost the patient about $4 each. Some patients, of course, will abandon treatment before the full course of adjustments is completed.
The number of patients treated annually by licensed chiropractors varies widely. At one end of the scale are chiropractors who make their principal living at some other occupation and may see only a few patients a year. At the other end are chiropractors with highly active practices who operate private clinics and treat between 500 and 1,000 persons a year.
If we estimate that the average licensed chiropractor sees 150 patients a year, then 3 million people annually receive the benefits of the gospel according to Palmer. If the chiropractor receives an average of $100 from each patient, then chiropractic is a $300-million business.
Of course, it is clear that many chiropractors make far more than the $15,000-a-year income that would be the average if we accept the foregoing as working figures. At the Parker Seminar on Practice Building which I attended in 1967, I was told that a number of those attending had incomes in the $100,000-a-year range. Several others assured me that few of the chiropractors who attend the seminars regularly have incomes as low as $15,000.
One of the early converts to chiropractic was an Oklahoma City lawyer named Willard Carver, who established a chiropractic school in that city a few years after the Palmer School was launched in Davenport. Carver and Palmer diverged on ideology. Carver developed the view that chiropractic should employ, in addition to the chiropractic adjustment, various other types and methods of treatment such as physical and nutritional therapy, and, in some instances, methods rejected by conventional medicine. Palmer disagreed. Only chiropractic adjustments, he said, dealt with and eliminated the cause of disease. Other types of treatment, therefore, could have no higher value than the elimination of symptoms.
This schism among the faithful has never been healed. Today chiropractors who stick to adjustments as the almost exclusive treatment for illness are called "straights." Those who supplement adjustments with other means of treatment are called "mixers." The Carver School (no longer in existence) was for a long time the chief disseminator of the mixer philosophy. The Palmer School was, and still is, the headquarters of the straight approach. The bitterness of the dispute has been deepened because, like medieval controversies over the characteristics of angels, it cannot be resolved by recourse to science. The two groups even have their own associations -- the International Chiropractors Association for the straights, the American Chiropractic Association for the mixers. Chiropractic schools align themselves with one or the other of the groups and are recognized only by the association for that group.
In 1967 the two associations entered into correspondence to try to resolve their differences. But, as always in the past, they failed, and the effort ended in mutual recriminations. "Evidently we overlooked the influence of political, power-hungry individuals associated with chiropractic whose apparent ambition is to keep the profession divided," L. W. Rutherford, D.C., president of the International Chiropractors Association, wrote to Sidney C. Birdsley, D.C., president of the American Chiropractic Association. "Is it going to take a major catastrophe in chiropractic to make ACA see the need of chiropractic unity and one organization representing this profession?"
Dr. Birdsley gave back as good as he got. Until the ICA recognizes the facts of life and demonstrates a truly sincere desire for unity, rather than an inclination towards making overtures for propaganda purposes only," he replied, "the ACA will have to go it alone."
On the cause of disease, the International Chiropractors Association (the "straights") says:
The philosophy of chiropractic is based upon the premise that disease or abnormal function is caused by interference with nerve transmission and expression, due to pressure, strain, or tension upon the spinal nerves, as a result of bony segments of the vertebral column deviating from their normal juxtaposition.
On the treatment of disease it says:
The practice of chiropractic consists of analysis of any interference with normal nerve transmission and expression, and the correction thereof by an adjustment with the hands of the abnormal deviations of the bony articulations of the vertebral column for the restoration and maintenance of health without the use of drugs or surgery .
The American Chiropractic Association (the "mixers') says:
Chiropractic practice is the specific adjustment and manipulation of the articulations and adjacent tissues of the body, particularly of the spinal column, for the correction of nerve interference and includes the use of recognized diagnostic methods, as indicated. Patient care is conducted with due regard for environmental, nutritional, and psychotherapeutic factors, as well as first aid, hygiene, sanitation, rehabilitation and related procedures designed to restore or maintain normal nerve function .
To what extent do today's chiropractors believe in the gospel according to Daniel David Palmer and in its modern versions given above? This question was one of many that were considered by a Department of Health, Education and Welfare study group. When the 90th Congress passed the Medicare Act in 1967 (Public Law 90-248, Social Security Amendments), it asked the Secretary of HEW to study the question of whether certain types of practitioners, who are not medical doctors, should be included in the program. Chiropractors and naturopaths were among the types of practitioners whose status was to be studied. ("Naturopathy" is the treatment of illness by "properly arranging the intake of foods first, to eliminate the toxins in the body, and second, to build normal cells, blood, tissues and secretions."  In addition to diet it emphasizes the achieving of "a proper mental attitude" which "attracts a health atmosphere," and eschews the use of drugs for healing or preventing disease. I got a doctor of naturopathy degree by mail for $12 from a diploma mill in 1967 without doing any work.)
HEW named an eight-man expert review panel to serve as technical and scientific advisers for the study of chiropractic and naturopathy. The members of the panel were selected, HEW said, "on the basis of their scientific background and high professional reputations in their respective fields." Professional associations representing chiropractors and naturopaths were invited to make presentations and submit material, which were reviewed along with material and information compiled by HEW.
HEW's Report, entitled Independent Practitioners Under Medicare, was transmitted to Congress by HEW Secretary Wilbur J. Cohen on December 28, 1968. It recommended against the-inclusion of both chiropractors and naturopaths in the Medicare program. (The composition of HEW's expert review panel, and the complete text of the Reports conclusions and recommendations on chiropractic, appear in Appendix A of the report, "Independent Practitioners Under Medicare," which I refer to as the HEW Report.)
On the specific question of whether all chiropractors believe in the chiropractic theory of disease, the Report says, "It should be pointed out here that many chiropractors do not believe that a subluxation is the only cause of disease, that spinal analysis is the only diagnostic tool, or that the chiropractic adjustment is the only valid treatment." However, say pages 165-166 of the Report:
Because the chiropractic approach to treatment is so greatly influenced by its philosophy, the main therapeutic concern is to correct the subluxation . . . the concepts of the subluxation and of the spinal analysis and adjustment form the basis of chiropractic thinking and activities; they are greatly emphasized over other concepts of diagnosis and treatment and disease causation.
What illnesses do chiropractors treat? "Since the philosophy of chiropractic is all-encompassing," says page 157 the HEW Report, "its practitioners treat nearly every type of illness." This is amply confirmed by a review of chiropractic literature.
A chart in the Parker Chiropractic Research Foundation's Textbook of Office Procedure and Practice Building for the Chiropractic Profession, pages 151-52, shows the average number of adjustments given by chiropractors for various disorders. The chart, says the Foundation, is based on reports of approximately 250,000 cases, and lists ninety-two maladies. Here are some of the conditions and the average number of adjustments given by chiropractors to treat them:
|High blood pressure|
*Chiropractors seem to have lost their touch since the days of D.D. Palmer,
who cured Harvey Lillard's deafness with a single adjustment.
Cancer does not appear on the above chart. The Parker Textbook's handling of the cancer question is fascinating. if a patient asks about it over the phone, the book suggests that the chiropractor should not indicate that treatment of cancer is beyond the scope of his activities. Here is the question-and-answer as given on pages 65 and 57 of the book:
Q: 'What can chiropractic do for such diseases as cancer? (Any other uncommon or questionable disease.)
A: In the thirty years I have been in practice, I have seen very many serious conditions and helped a great number of them. Chiropractic therapy has grown from one man in one town to twenty thousand men all over the world, and one of the reasons has been the almost miraculous results in many seemingly impossible cases. I am sure you understand, Mrs. Jones, it would be necessary for me to see and examine you before your question can be answered fully. I can give you an appointment at 10:00 A.M. or 2:00 P.m. Which time would be more convenient? "
At the Phillips trial, the dean of the Los Angeles College of Chiropractic, Phillips' alma mater, testified that students there were not taught a specific cure for cancer, and were told that it could not be cured by manipulation, vitamins, or food supplements. There is, however, nothing in chiropractic theory that excludes cancer from the diseases supposedly caused by subluxations, and there is no doubt that some chiropractors have treated it. Others, lacking diagnostic skills, may treat cancer victims without knowing of the presence of the malignancies.
In a survey made in 1963 for the American Chiropractic Association, 7 percent of the chiropractors surveyed said that they treated cancer and 8 percent said that they treated leukemia . Until a state law prohibited chiropractors in Colorado from treating cancer, the Spears Chiropractic Hospital in Denver advertised its cancer treatments throughout the nation (see Chapter Seven). A booklet that I purchased at the Palmer College of Chiropractic bookstore in 1968, sets forth "case records to demonstrate the effectiveness of chiropractic with cases medically diagnosed as multiple sclerosis, encephalitis or sleeping sickness, epilepsy, sciatica, cirrhosis and cancer of the liver, and tumors .
The words "medically diagnosed" in this statement have a significance that the reader might not at first catch. Although some chiropractic groups have reported with alacrity the illnesses that supposedly respond to chiropractic treatment, a good deal of chiropractic literature, and many individual chiropractors, maintain that actual diagnosis of illnesses is unimportant for a chiropractor. If one is curious enough to ask how, under these circumstances, the chiropractors know that their patients were suffering from the diseases listed in the charts, one is usually told that the patients first went to an M.D., who diagnosed them, and then went to a chiropractor to get their conditions treated.
The ack of interest of some chiropractors in knowing what maladies their patients have stems from the chiropractic theory itself. Medical science knows that different diseases have different causes and require different treatments. Correct diagnosis is therefore central to successful therapy. By contrast, chiropractic theory states that most or all illnesses come from a single source. The chiropractor may therefore believe that his task is not to identify the affliction but to roll the patient over and adjust the spinal subluxations that be rarely fails to discover. The illness, according to the theory, is likely to disappear, whatever it was, so why diagnose it?
Because of emphasis constantly being placed upon diagnosis by the medical profession," says the booklet that I purchased in the Palmer College of Chiropractic bookstore, "it is difficult for the average lay person to realize that the chiropractor need not diagnose and therefore diagnosis is unimportant to him."
B.J. Palmer of course agrees. "The Chiropractor pays little, if any, attention to symptoms or pathologies. Patient can come to the B.J. Palmer Chiropractic Clinic, Davenport, Iowa, and be deaf, dumb, and blind -- not telling or indicating anything -- and we could and would locate THE CAUSE [in the spine] of whatever, wherever he had: adjust him, and send him home well." 
B.J.'s grammar might not be perfect, but his meaning is plain. It raises fascinating questions. Suppose a patient went to a chiropractor with symptoms that would clearly indicate the possible presence of a dangerous illness. Would the chiropractor recognize the symptoms? Would he try to find out if the patient actually had that illness? Or would be simply adjust the patient's back?
Again, suppose a patient bad a spine with no detectable medical abnormality. Would the chiropractor nevertheless discover that it was subluxated in such a way as to cause disease? If the patient went to two chiropractors, would they both discover subluxations? Would they find them in the same place?
Some experiences relating to these questions are described in the next chapter.
Who goes to chiropractors? The answer seems to be everybody. Chiropractic patients come from every strata of our society and from every walk of life.
John D. Rockefeller, Sr., was a chiropractic patient, Thorp McClusky says in his book Your Health and Chiropractic. Among other chiropractic patients -- according to page 20 of the book -- have been Presidents Coolidge and Eisenhower, and such notables as Fred Allen, Clara Bow, Eddie Cantor, Enrico Caruso, Clarence Darrow, Mahatma Gandhi, Elbert Hubbard, and Mme. Chiang Kai-shek.
From his own knowledge the author can add the name of the late Senator William Langer, former chairman of the Senate Foreign Relations Committee. If an item appearing in a recent issue of a chiropractic publication is correct, former President Harry S. Truman must be added to the list of United States Presidents who have had their subluxations adjusted.
Actually, my experience has been that nearly everyone has either been to a chiropractor, or has a family member or a friend who has been to a chiropractor. Among my own friends, chiropractic patients include a high school teacher, an assistant film producer, and one of the most successful lawyers on the West Coast.
Chiropractors also treat many people from poor and less well-educated segments of the population. Here, as elsewhere, chiropractors are conducting an intensive publicity drive to secure whole legions of new patients.
No matter what aspect of chiropractic one considers, there is no doubt that it is a major factor in American health care, and that it is aggressively seeking an even larger role. For that reason, one cannot be indifferent to the unanimous voice of science, which states that chiropractic theory has about the same medical validity as voodoo or witchcraft.
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