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Bonesetting, Chiropractic, and Cultism

Chapter 12:
The Divided Doctors

©1963, Samuel Homola, D.C.

The divided doctors are the disrupters of medicine. The one can do this, the other that, but in none of them is there the wisdom all should share. For he who knows only a part knows nothing, nor does he know what he can do.
                                                                             PARACELSUS (1493-1541)
 
As we men of medicine grow in learning we more justly !appreciate our dependence upon each other. . . It has become necessary to develop medicine as a cooperative science, the clinician, the specialist and the laboratory workers uniting for the good of the patient. . . . The people will demand, the medical profession must supply, adequate means for the proper care of patients, which means that individualism in medicine can no longer exist.
                                                                         DR. WILL MAYO (1861-1939) [1]

Regardless of what might be said about "over-specialized" medicine, there is little doubt that the tremendous progress of medical science has created a greater need today for the medical specialties than ever before. Surgical skills, diagnostic and treatment methods, within the bounds of any particular field, demand the full time and attention of the physician who would be thoroughly competent and informed in his specialty. All this specialization, however, has created an even greater need for the internist who would make the correct diagnosis (in referring a patient to a specialist) and the general practitioner who would "treat the whole person."

Obviously, the specialist and the general practitioner are quite dependent upon each other for a complete and competent service to the sick and disabled -- and each practitioner, regardless of his line of practice, is equally important. Fortunately, the 20th century finds medical science bound together, in its specialties, by knowledge and by reciprocity, with the general physician referring, perhaps, 5 or 10% of his practice to the specialist who is better trained to carry out a special service. Unlike the days of Dr. Theophrastus Bombastus ab Hohenheim (Paracelsus), the "cure" does not differ from doctor to doctor or from group to group. Today, when certain abnormal conditions are encountered, treatment is uniformly carried out according to the latest technics, and referral of a patient to a specialist, when necessary, assures the most skillful and scientific treatment available for serious and complex conditions. Under such circumstances, it is natural and desirable that the high standards of medical practice be jealously guarded against invasion by those who would disrupt the quality of existing medical care with inferior standards and obsolete methods. Today, more than ever, it has become necessary to develop medical care on a cooperative basis, with all practitioners, technicians, and related workers united for the good of the patient.

Further enhancement of today's high-quality medical care seems to be found in greater use of group medical services, with all the necessary personnel and facilities brought together for more efficient, less expensive, "one stop" service for the individual whose health and finances do not permit him to make repetitious trips from the office of the solo physician to the laboratory, to the specialist, back to the doctor's office, and then to the hospital. Even though group medical practice is not yet widely used, there is no doubt concerning the interdependence of all allied healing arts and the need of such dependence for the good of the patient. Although many doctors remain divided economic and social wise, no qualified doctor can work entirely alone, without scientific reciprocity, and none do.

Outside the closely bound medical group, however, is another group: the chiropractic group. Here none of the rules or problems of medical practice seem to apply at all. Peculiarly, many chiropractors, in offering a single treatment method, attempt to maintain their positions individually as competitors of the medical physician and, consequently, medical science.

Socialism, Science, and Reciprocity

It might be suspected that the success of individualistic cultism is, at its best, a temporary occasion, since it follows that socialistic trends and a common unification of related sciences and arts will eventually make it impossible for any science or art to stand alone and survive. The expanding horizon of science, and the resulting spread of general knowledge, will ultimately make a common and clear distinction between that which is true and that which is possible, as opposed to that which is obviously false. All that is true will be united in fact for the common good, while that which is false, in standing alone, will perish under the weight of general public opinion or be forgotten in the absence of reciprocity with related fields. The danger that lies ahead for the chiropractic profession finds its substance in the fact that a clear distinction has never been made between that which is true and that which is false in the chiropractic theory. Until the profession finds reciprocity with the nation's academic system and earns the support of the nation's scientific authorities, it might possibly live and die as a cult in the educational backwaters of the nation.

Since only a small part of the public is schooled or informed in the ethics of business, and few, save the physician, are aware of the correct procedures in the art and ethics of handling the sick, few will recognize or critically scrutinize the unorthodox practice of the cultist who fears or recognizes no authority and who operates almost entirely without disciplined supervision. Normally, the code of ethics of a professional body of healers is, of necessity, stricter than the law in such matters. Without such a code, the opinion of each individual, within the legal limits of the law, is a basis for cultism.

A diversity of treatment methods in the chiropractic profession has made it difficult for chiropractors to reciprocate among themselves, and impossible for accredited medical practices to extend the courtesy of reciprocity to the chiropractic profession as a whole. In addition to there being no uniform method of treatment and diagnosis in the ranks of chiropractors, the conclusions of most chiropractors, being guided by the doctrine of vertebral misalignment, are most often in opposition to the procedures of medical practice. For this reason, the chiropractor has been almost completely excluded from medical programs of health and education that require close cooperation among participating practitioners.

In the book, Medical Care for Tomorrow, by Michael Davis, Ph.D., discussion of plans for National Comprehensive Health Insurance leads to this question: "What practitioners other than physicians should be accepted as primary providers of services? Licenses to practice any of the healing arts are granted by state law. The laws of the states vary. In general, a national law would follow normal federal-state relations consistently, by recognizing not only physicians -- who in all states have licenses unrestricted to any particular field of practice -- but also recognizing those other practitioners within any particular state, who in that state have unrestricted licenses. This in many states would bring in osteopathic physicians. Practitioners with limited licenses -- e.g., chiropractors in most states -- would be excluded from recognition as providers of service who might be paid from health insurance funds, unless such practitioners worked under the supervision of a fully licensed professional. Optometrists, practicing independently within their special area, are recognized by law in all states. There are good reasons . . . that a national health insurance law permit optometrists to continue independent practice and be paid for their services by health insurance funds, although it would be desirable to encourage the already growing cooperation of optometrists with physicians, group practice units, and hospitals." [2]

It seems very likely that the opinion of Dr. Davis, who is an expert in all phases of medical economics, will be shared by other experts and groups in consideration of national health insurance. Although few of these experts are familiar with the actual technic of chiropractic, it is quite clear that no single, independent group of practitioners can accept the responsibility for treating the entire gamut of human disorders with a single treatment method, and that any attempt to do so characterizes any classical dictionary definition of cultism. The independence and recognition enjoyed by the dentist, the optometrist, and the chiropodist are due to the fact that these specialties are limited and do not overlap into the practice of other fields offering a better treatment for certain conditions. These specialties can and do work in cooperation with the various practices in the field of medical science.

When I refer to "medical science," I do not mean simply the practice of giving pills and potions as some naive persons imply; I mean the collective efforts of the nation's universities, educators, scientists, doctors, and technicians, all working cooperatively to improve the quality of care found in medical practice. The failure of the chiropractor to become a part of this team as yet is due primarily to the nature of the practice and the attitude found among those who subscribe first to the chiropractic doctrine. The stand of chiropractic, in remaining separated from the main stream of science, has continued to maintain a quality in its ranks that is not yet acceptable in cooperative scientific realms. This is especially unfortunate since specialized manipulation is a service not easily found in medical practice.

Such conditions as those that would exclude the chiropractor from participation in comprehensive and cooperative health programs reveal an odd situation relative to the status of the chiropractic "physician." The chiropractor, as a competitor of the medical physician, is legally licensed, in most states, to practice under a limited license (in his manner of treatment), yet is not prohibited from treating most human disease. The fact that he could not be recognized under national health insurance plans, or in group medical practice, unless he "worked under the supervision of a fully licensed professional" who has an "unrestricted license," seems to indicate that the permission given to chiropractors to treat human disease independently and in competition with the medical physician, while having only a limited license, has been a profound error . . . a speculation that I am inclined to support. A review of the various chiropractic laws and methods of practice would seem, at the present time, to justify exclusion of chiropractic from recognition and support by national health insurance plans.

The Second Largest Healing Profession

Chiropractic literature, in claiming to be the "2nd largest healing profession," states that it is "classified by the Office of the President of the United States, Bureau of the Budget, Washington, D. C., as one of the four major healing professions in America. The other three professions being medicine and surgery, osteopathy, and dentistry." [3]

The Standard Industrial Classification Manual, prepared and published by the Bureau of the Budget for the purpose of presenting statistical data, simply classifies all American establishments by the type of activity in which they are engaged. A 1957 edition, for example, classified medical and other health services under "Major Group 80" as follows:

In classifying chiropractic as one of the four major healing professions, the manual does not imply the approval of the practice of chiropractic as a method comparable with the practice of medicine. ". . . General grouping of medical and other health services for the purpose of gathering and presenting statistical information in a more orderly or understandable manner . . . should not be interpreted as an endorsement or approval of the Federal Government of one kind of service in competition with another," advised a letter from the Bureau of the Budget [4]. This is to say, in essence, that any separate school of healing will be classified according to its size in numbers. If there were 30,000 naturopaths, for example, the practice of naturopathy, in treating the whole body, would be classified as a major healing group, or the "2nd largest healing profession," regardless of its merits as a profession of healing. It is interesting to note that a 1958 supplement to the Standard Industrial Classification Manual included "Christian Science practitioners" under Major Group 80 9 of "Medical and other Health Services."

"Of the 270 specific categories in the detailed list of occupations used in the 1950 Census, 18 are usually considered health occupations." [5] These 18, according to Health Manpower Source Book, are:

Chiropractors, dentists, dietitians and nutritionists, professional nurses, student professional nurses, optometrists, osteopaths, pharmacists, physicians and surgeons, psychologists, medical and dental technicians, veterinarians, attendants in physicians' and dentists' offices, opticians and lens grinders and polishers, attendants of hospitals and other institutions, midwives, practical nurses, and therapists and healers "not elsewhere classified," which include "Chiropodist, corn doctor, drugless doctor or physician, eclectic doctor, electro therapist, faith doctor or healer, foot specialist, gymnast [miscellaneous personal services], healer, hearing therapist, helio-therapist, herbalist, herb doctor, hydrotherapist, magnetic doctor or healer, massage operator, masseur, mechanotherapist, medicine man, mental healer, musical therapist, naprapath, occupational therapist, physical therapist, physiotherapist, podiatrist, recreational therapist, sanipractic physician, speech therapist, therapist." [5]

In spite of the fact that physical therapists are a dependent group of technicians working under the supervision or prescription of medical practitioners, the chiropractic profession has expressed much consternation over the fact that increasing numbers of physical therapists now outnumber the total membership of the National Chiropractic Association. There are presently more than 500 physicians specializing in the practice of physical medicine, with over 10,000 technicians registered as physical therapists in the United States. About 5,000 of these are members of the American Physical Therapy Association. It has been estimated that there is an immediate need for at least 14,000 more physical therapists to meet the present needs of the nation. There is also a great need for more physicians specialized in the field of physical medicine (physiatry). A qualified man who wishes to do research and promotional work in the use of manipulation would certainly find ideal opportunity as a physiatrist. The specialty in physical medicine seems to have originated as late as 1947. Records indicate that there were 234 physiatrists licensed by 1949, and 480 by 1959.

Thus, it seems that competition driving the "2nd largest healing profession" toward extinction might come from technicians licensed under a medical specialty that is cooperatively working with other accredited specialties and technical fields.

Manipulation is only one remedy out of many in the department of physical medicine, while physical medicine is only one department out of many in the field of medical practice. The chiropractor who includes all the "drugless" or physiotherapeutic measures in his practice is employing a single method in the treatment of human disease, however valuable it might be under the proper indications, while the chiropractor who employs only the spinal adjustment ("straight chiropractic") in the treatment of disease is depending upon a single remedy.

The 1961 edition of the Occupational Outlook Handbook, prepared by the Bureau of Labor Statistics, United States Department of Labor, states:

Approximately two-thirds of the 16 chiropractic schools in the United States restrict their teaching to manipulation and spinal adjustments. The others offer a broader curriculum including training in such subjects as chiropractic physiotherapy and clinical nutrition [6].

Recognizing the fact that chiropractic is strictly a "drugless method," with most of its schools restricting treatment to "manipulation and spinal adjustments," the Handbook goes on to define chiropractic as follows:

Chiropractic is a system of treatment based on the belief that the nerve system largely determines the state of health of the body and that any interference with this system impairs normal functions and lowers the body's resistance to disease. Chiropractors treat their patients primarily by specific adjustment of parts of the body, especially the spinal column. Many also use such supplementary measures as diet, exercise, rest, water, light, and heat. Because of the emphasis on the spine and its position, most chiropractors use X-ray extensively in their practice. Chiropractic as a system of healing does not include the use of drugs or surgery [6].

It is strange to note that chiropractic, as a system of healing based upon a "belief," should be referred to as the "2nd largest healing profession," while offering a single method or remedy for most human disease.

Crisis and Cultism

The ablest man is dragged down by the weakest and dullest, who necessarily sets the standard, since he cannot rise, while the other can fall.
                                                                     SIR JAMES GEORGE FRAZER [7]

In spite of the fact that many chiropractors claim that the chiropractic profession is a growing and dynamic profession, it is generally admitted among the leaders of the profession that the profession is slowly dying. So much so, in fact, that a great many are occupied with the task of devising methods of attracting new students. This is particularly significant since "25,000 practicing chiropractors" are apparently not stimulating sufficient student interest, by their own examples, in communities where they practice.

The situation of the chiropractic profession is, in fact, so serious that the President of the National Chiropractic Association made this statement in the October, 1958, Journal of the National Chiropractic Association:

Bad news and gloomy forecasts do not make for good reading. Yet, in order to remedy a situation which threatens the very existence of our profession, it is necessary to acquaint you with the facts.

The chiropractic profession is not being forced out of existence by any other competitive profession or by state laws, but it is dying from within. Yes, this is a very strong statement, and yet, we assure you, it is true. Unless something drastic is done immediately by the members of the NCA to increase enrollments at NCA accredited colleges, the profession will, within a few years, be forced into extinction.

The late Dr. B. J. Palmer, of the International Chiropractic Association, felt that the failure of many of the chiropractic schools to teach "pure chiropractic," and the tendency of some of the schools to dwell "too long" upon basic science and "other medical subjects," has resulted in the present-day "hard times" being experienced by the chiropractic colleges.

"Most N.C.A. schools are begging for support," wrote Palmer in 1958:

One asks the State Medical board to finance it. Another was supported by one association until it gave up. Another is heavily in debt, with a reduction in enrollments year by year, struggling along, and doesn't know when it will close its doors. Another is begging for handouts, eking along one semester to another. Two others are ready to close any month, students not knowing whether or not to enroll there. Most of these schools, knowing little, if anything, about the basic fundamental philosophy of chiropractic, were teaching anything and everything -- physiotherapy, naturopathy, vitamins, pro-medical subjects. That was their downfall.

One school closed its doors within the past month. It is now trying to peddle its 30 students to another school. Another school has 55 students and owes $90,000, with no prospects of it ever being paid. Another school had 7 students, closed, and auctioned off its equipment a short time ago. Another school is $19,000 in debt, and mortgages more than that. Its enrollment is down one-half less. Another had 3 students this semester .

One can get a fair idea of the crisis and the cultism in the field of chiropractic today simply by quoting the chiropractor himself. If there is anything good in the practice of chiropractic (there surely is in the use of manipulation), it would seem, in view of the multiple brands of chiropractic being taught in struggling chiropractic colleges, that the chiropractor has not recognized it. If all chiropractic schools uniformly taught what they contend "medicine is stealing from chiropractic," I am sure the situation could be bettered.

References

1. Clapesattle H. The Doctors Mayo. Garden City, NY: Garden City Publishing Company, 1943.
2. Davis, MM. Medical Care for Tomorrow. New York: Harper & Brothers, 1955.
3. New stature for the second largest healing profession. Healthways, Feb1959.
4. Executive Office of the President, Bureau of the Budget. Personal correspondence, Feb 28, 1959.
5. Health Manpower Source Book (Section 5, Industry and Occupation Data from 1950 Census). Washington DC: U. S. Department of Health, Education, and Welfare, 1954.
6. Occupational Outlook Handbook. Washington DC: United States Department of Labor, 1961.
7. Frazer JG. The Golden Bough. New York: The Macmillan Company, 1956.
8. Palmer BJ. Shall Chiropractic Survive? Ist Edition,. Davenport, Iowa: Palmer School of Chiropractic,1958.
 

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