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"There was considerable pressure from chiropractors and their patients for the inclusion of their services under Title 18 [of the Medicare Act] this year. I dislike intensely being in a position between two professional groups [medical doctors and chiropractors] requiring me as a layman to evaluate the relative merits of their services. If chiropractors should not be practicing the healing arts, the remedy is to stop the state from licensing them or to insist on an upgrading of the profession to the point where the public will not be threatened."
A member of the U.S. House of Representatives made these comments in correspondence with one of his constituents in 1967. They provide some insights into how chiropractic achieved its status as the only legally recognized and licensed medical superstition in the United States. They also place ultimate responsibility for both the problem and its solution where it properly belongs --on the doorsteps of the state legislatures.
The public cannot be blamed for not realizing that chiropractic has no scientific foundation. This is the legislatures' fault. People should be able to assume, and obviously do assume, that a state-licensed "doctor" is practicing a valid healing art.
This feeling is reinforced by the general public awareness that substantial provisions for safety and scientific accuracy surround other areas of health care. In the field of drugs, for example, Congress has enacted legislation prohibiting the use of any new drugs on human beings until both their safety and their efficacy have been established in a series of highly scientific procedures, involving continuous tests and complex safeguards. Laws of this kind represent an alliance between science and legislation to protect the public. By contrast, chiropractic licensing acts bring science and politics into direct conflict. Chiropractors have had great success in confusing this issue by representing their differences with medicine as being a scientific controversy between "two professional groups" instead of what it really is -- a conflict between science and a scientific fairy tale.
From its infancy chiropractic looked to politics and licensing, not as a way of working with science but as a protection against science. An important factor in chiropractic's present position is that it succeeded in getting licensure laws through thirty-two of the nation's forty-eight rurally dominated state legislatures by the year 1925, almost before the modern era of health care and health legislation began. From then on, with a comfortable majority of states granting recognition and use of the title "doctor" chiropractors conducted intensive campaigns to reduce the remaining legislatures one by one. Today all states except Louisiana and Mississippi have passed laws licensing chiropractors. In some instances the laws were passed after years of ceaseless activity by chiropractic groups. The last two holdout states are being kept under heavy siege, of which the Jerry R. England case in Louisiana was a characteristic feature.
From the early 1920's on, legislators who were aware of the conflict between chiropractic and science felt that they were in a dilemma because so many states had already licensed chiropractors. A possible way out, they thought, was to vote for the license law, which would at least give the state the power to control and limit chiropractic practice. This attitude was cultivated by chiropractors, who joined the side of the angels by noting that they had come voluntarily to the legislature to seek an act which would permit the state to oversee their activities. Chiropractic licensing acts thus secured the votes not only of legislators who were acting as vote brokers, but of some more civic-minded ones who thought that it might be the best way to deal with an anomalous situation.
The truth, of course, is that the limitations placed on the scope of their practice by the state laws are of little moment to chiropractors compared to the granting of the state's "doctors" license.
Even the best-intentioned provisions of the best state laws bring about perverted results. The requirement that chiropractic aspirants pass state-sponsored basic science exams does not qualify chiropractors to treat the sick. What it has done is to arm chiropractic schools with a shiny new rationale for existence, and a shiny new hunting license to prey on innocent persons, many of them with limited educational backgrounds, who are seeking a career. They prepare these people to pass the exams. While doing so they give them a limited education, and inculcate a false theory.
The most important limitations posed on chiropractic by the licensing laws prohibit chiropractors from prescribing drugs or performing surgery. This does not grieve chiropractors. A licensing act was not necessary to place these prohibitions on chiropractors in the first place, since existing medical practice acts exclude all non-doctors from these activities. Moreover, it is a "limitation" with which the chiropractor lives easily. "It is apparent," says the HEW Report, "that state licensing laws do not restrict the scope of chiropractic practice since they do not infringe upon chiropractic philosophy or approach to health and disease. A practitioner operating under the chiropractic philosophy has no interest in the use of major surgery or drugs and therefore a prohibition against these treatments does not alter his mode of practice."
The Parker seminar Textbook contains a number of comments for the chiropractor to make to his patients to undermine their belief in medical drugs, for example:
"Health cannot be found in a bottle, Mrs. Jones."
"Chiropractic searches for, and removes, causes of diseases, Mrs. Jones, rather than treats effects. That is why chiropractic has been successful, many times after all other methods of healing have failed."
In 1963 chiropractors succeeded in getting a licensure law through the New York State Legislature after a fifty-year struggle. In the steps leading to the passage of the act a familiar scene was enacted. The bill was introduced, sent to committee, and hearings were held. Scientists testified that chiropractic theory is false and that its practice is a public health hazard.
The pressure on well-intentioned legislators to vote for licensure anyway because it would allow the state to oversee chiropractic was discussed by Dr. Milton Helpern, Chief Medical Examiner of the City of New York. "The argument that, by licensure, more effective control would be obtained over the activities of chiropractors is specious and fallacious," Dr. Helpern said. "It serves some good and is practicable to license podiatrists, whose work is well defined and activities limited by definition, and the public is protected by the limitations and hygiene supervision that such licensure provides; but podiatrists do not practice on the basis of any spurious theory like that of spinal nerve impingements."
Many of the witnesses were obviously mystified that such legislation could be the subject of serious consideration in modern America. A joint statement prepared by Dr. Frank W. McKee, associate dean of the University of Rochester School of Medicine and Dentistry; Dr. Charles H. Saunders, associate dean of Cornell University School of Medicine; Dr. Marcus D. Kogel, dean of the Albert Einstein College of Medicine; and Dr. Ralph E. Snyder, then president and dean of New York Medical College, said, "It is an incredible anachronism that in an age when this nation leads the world in many areas of scientific endeavor, New York State should be asked to place its seal of approval on a group of persons claiming to be practitioners who are largely ignorant of the accepted and proven science of health and disease."
The legislators listened gravely to this and other scientific testimony. They then went back into private session and reported the bill out favorably. The legislature passed it, and Governor Rockefeller signed it. [The chiropractic licensing laws of many states have "grandfather clauses"; that is, chiropractors already in practice when the law was passed were not required to meet its educational requirements or to take prescribed tests. Under these provisions, substantial numbers of chiropractors have been admitted to practice who have little or no education of any kind and got their "doctors degrees" from fly-by-night diploma mills. New York State's law did not contain a grandfather clause and required chiropractors to take examinations in order to get their licenses. Chiropractors, who had fought so long for the law, promptly waged another campaign to avoid its examination requirements. They first challenged the constitutionality of requiring such exams. When this suit failed, almost 1,800 chiropractors showed up to take the examination in April, 1964, but they then filed another suit to prevent the state from grading the exams. This suit, too, was unsuccessful, and a compilation of the grades showed that more than a thousand had failed, including chiropractors who had been treating the sick for many years.]
Such scenes, enacted for decades in state houses throughout the country, make it obvious that scientists and chiropractors are communicating with legislators on different wavelengths, and the chiropractors are on the one that counts. Scientists come to legislative hearings armed with information, and chiropractors come armed with votes.
The tactics by which the chiropractic lobby achieves its victories are now being displayed in campaigns to have chiropractic treatment covered under federal Medicare and state-sponsored Medicaid programs. The key to their success is the recruitment of friends, allies, and supporters at the community level.
CHIROPRACTORS UNDER MEDICARE?
The local "doctor" was, of course, a chiropractor.
Some of these stories got fifteen to twenty inches of news space, far more than could be accounted for by the newspapers occasional need for small filler material. They were, in many instances, the fruit of years of friendly cultivation of the local press.
The letters-to-the-editor columns of these papers were also flooded by letters praising chiropractic and Urging its inclusion under Medicaid. Some of the letters were signed by chiropractors. Others appeared under such signatures as "Friend of the Chiropractors," and "Satisfied Chiropractic Patient." Little of this intensive coverage was answered by the scientific community.
In a "Meet Your Friendly Chiropractor" campaign, chiropractors conducted old-fashioned community gatherings in local schools and churches, providing free hot dogs, cotton sandy, and soda pop. Themes of these gatherings included:
"Come learn the truth about chiropractic. Learn why AMA is fighting us."
"Find out for yourself about the plot by organized medicine to thwart the greatest medical treatment of the age. Come one, come all."
At these gatherings chiropractors offered free medical or health checkups and a free "posture analysis." It is a safe bet that they found many a subluxation in urgent need of chiropractic adjustment. Free chiropractic treatment was offered to children under twelve, along with reduced rates for senior citizens, and money-back guarantees for all comers who accepted treatment.
Chiropractors have long been involved in campaigns among their own confreres to become highly active in local affairs and civic activities, such as PTA's, Boy Scout troops, and church groups. They even volunteer to serve as "team health officers" for Little League baseball teams. When the time comes to secure community help for such measures as chiropractic licensing or chiropractic inclusion under Medicaid, they are already well placed.
In the New York Medicaid campaign they approached community leaders, especially ministers, and collected reams of signed statements from these persons urging the legislature to look on the chiropractors' request favorably. In a supplementary activity, chiropractors conducted an intensive petition campaign among their patients and community friends. By March, 1967, when a bill to place chiropractic care under Medicaid was introduced in the state legislature, the chiropractors already had over 100,000 signatures.
The legislators went into executive session on the matter and decided that a bill wasn't even necessary; the matter could be quietly handled by the State Department of Health. On July 31st the state health department mailed letters to chiropractors informing them that they were included in the Medicaid program, and providing them with information on standards and fees. There was no public announcement.
The major weapon used by chiropractors to avoid discussion of the scientific validity of chiropractic is to charge that anyone doubting or attacking chiropractic is, prima facie, part of a vaguely defined "organized medical monopoly" or "medical conspiracy." Every medical person, from local physicians who speak out in opposition to chiropractic at the community level, to deans of the nation's medical schools and heads of research laboratories who testify at state and federal hearings, is tarred with the same brush.
In all this intensive and amazingly skillful political campaigning, state and county chiropractic groups receive expert help and strong back-up from the two national chiropractic associations. Much of the program of these two groups is oriented toward political action, and the activities are guided by political veterans who have both the experience and the contacts. The executive director of the American Chiropractic Association, the larger of the two groups, is Norman A. Erbe, former governor of Iowa.
While carrying out these activities, chiropractors have been able to prevent unfavorable publicity from appearing in the nation's press by establishing a reputation for being litigious. Recently a leading science writer was commissioned by a major national magazine to do a research piece on chiropractic. He submitted the piece and the magazine accepted it. In one of its issues the magazine noted that the piece would appear in a near-future issue. A chiropractic group contacted the magazine, and received affirmation that the article would be unfriendly to chiropractic. A spokesman for the group told the magazine that if the piece were published, large numbers of chiropractors would file individual libel suits against the publication, charging that they had been professionally damaged. The magazine's lawyers, who had gone over the piece with great care, were confident that such actions could be successfully defended. But the magazine decided that the whole project was not worth the many thousands of dollars that such defense would require. It paid the writer in full, and never ran the article.
At this writing, chiropractors are involved in a series of aggressive new legislative campaigns, some of them involving state legislation, and others representing bold new efforts to secure equality and parity with the medical profession in broad areas of national health care. A partial list of these tireless activities of the chiropractic lobby appears in Appendix C of this book -- if decisive measures are not taken, there is every reason to believe that these new efforts to make chiropractic a central feature of health care in the United States will succeed. "Do not expect any senator to oppose chiropractic on the floor of the Senate," a U.S. senator told a Louisiana physician in 1967. "There is too much voter support.
It is of course obvious that the U.S. representative whose comments to a constituent are cited at the beginning of this chapter put his finger on the nub of the problem -- the official licensing of chiropractors by the states. From this initial misstep everything else follows. His suggestion that chiropractic could perhaps be "upgraded" to conform with science is one for which there is little practical hope, since the central, unifying belief of chiropractic theory is false. To "upgrade" chiropractic would require the elimination of this theory -- and that would mean the elimination of chiropractic.
Whatever the difficulties involved, state legislatures can no longer ignore their public obligation to face the issues and the facts, to acknowledge their error, and to set things straight. First of all, legislation in scientific fields that pays no attention to science is bad law, and shows a deep failure on the part of legislators to fulfill their responsibility to their constituents. Second, in this country at this time, anyone claiming to have a valid treatment for human illness should be required to show its validity before the bar of science before receiving a state license to use it on the sick. Third, the correct way to deal with treatment methods that cannot or will not submit to the judgment of scientific research is not to limit and oversee them, but to prohibit them. By abandoning all these precepts in the face of the political pressures created by chiropractors, state legislatures have created a state-supported medical superstition.
Nothing is to be gained, and a great deal -- including human lives -- will be lost by further postponing action on the problem. The theory of chiropractic is scientifically false, and treatments given in accordance with the theory bear no relationship to the cause or cure of human disease. Its practice should therefore be prohibited, and its personnel should be retrained to enter other professions.
The first step and one that must be taken immediately, is to prohibit further use of X ray by chiropractors. The dangers of X ray are so manifest that its use in the pursuit of any invalid or irrational healing procedure should be strictly against the law. In permitting chiropractic X ray, legislators have failed their responsibility to the public in a most serious way.
The next step is for each state to create an orderly program for withdrawing chiropractic licenses. As part of this program, consultations should be held between state legislators and the scientific community to discover where needs exist for persons in physiotherapy, physical rehabilitation, and other areas which make use of paramedical personnel. People are badly needed in many of these fields. Chiropractors should then be consulted, and those wishing to remain in the field of health should be offered full retraining in order to pursue skilled careers in one or another of these areas, where their activities will promote scientific progress and serve important public needs. Chiropractors wishing to leave the field of health entirely should have available to them special assistance -- a "chiropractor's GI bill" -- for reschooling and retraining in any other field that they might wish to enter.
Such a program is the least that the states can do in view of the central responsibility that they bear toward both chiropractors and the public for creating the current situation. It should never have happened in the first place.
When public servants, some misguided and some cynical, fail in their responsibilities, there is always a price to pay.
A guiding principle for state action is provided by the Jerry R. England case. As the reader will remember, England and other chiropractors sued the Louisiana State Board of Medical Examiners, to try to force the board to permit chiropractors to practice in Louisiana. Louisiana and Mississippi are the only states in the Union that refuse to license chiropractors.
In 1965 a three-judge Federal District Court for the Eastern District of Louisiana ruled against the chiropractors. The chiropractors appealed to the Supreme Court, but the Supreme Court affirmed the District Court's ruling in July, 1966.
The essence of the District Court's position is simple, and it seems remarkable that it has been lost sight of in the chiropractic controversy. The state, said the District Court, has a right to insist on uniform educational and scientific standards for entering the healing arts. This test, which is an elementary one, is nevertheless one that chiropractic cannot meet because its beliefs and practice are scientifically false. While all but one of its sister states succumbed to the political skills of the chiropractic lobby, Louisiana, its legislature, and its public health officials have stubbornly and steadfastly pointed out that the Emperor has no clothes.
The only proper course that other states can take is to follow Louisiana's precept that health care laws should accord with science. This inescapably means the end of the Iowa grocer's dream.
Contents ||| Appendix A
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