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On August 27, 1987, Judge Susan Getzendanner, United States District Judge for the Northern District of Illinois Eastern Division, found the American Medical Association, The American College of Surgeons, and The American College of Radiology, guilty of having conspired to destroy the profession of chiropractic in the United States.
In a 101-page opinion, Judge Getzendanner ruled that the American Medical Association and its co-conspirators had violated the Sherman Antitrust Laws of the United States. Judge Getzendanner ruled that they had done this by organizing a national boycott of doctors of chiropractic by medical physicians and hospitals using an ethics ban on interprofessional cooperation.
Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country.
Judge Getzendanner ruled:
I conclude that an injunction is necessary in this case. There ore lingering effects of the conspiracy; the AMA has never acknowledged the lawlessness of its post conduct and in fact to this day maintains that it has always been in compliance with the antitrust laws; there has never been an affirmative statement by the AMA that it is ethical to associate with chiropractors; there has never been a public statement to AMA members of the admission made in this court about the improved nature of chiropractic despite the fact that the AMA today claims that it made changes in its policy in recognition of the change and improvement in chiropractic; there has never been public retraction of articles such as "The Right and Duty of Hospitals to Deny Chiropractor Access to Hospitals"; a medical physician has to very carefully read the current AMA Judicial Council Opinions to realize that there has been a change in the treatment of chiropractors and the court cannot assume that members of the AMA pore over these opinions*, and finally, the systematic, long-term wrongdoing and the long-term intent to destroy a licensed profession suggests that an injunction is appropriate in this case. When all of these factors are considered in the context of this "private attorney general" antitrust suit, a proper exercise of the court's discretion permits, and in my judgment requires, an injunction. (Opinion pp. 11).
Evidence in the case demonstrated that the AMA knew of scientific studies implying that chiropractic care was twice as effective cis medical care in relieving many painful conditions of the neck and back as well as related musculoskeletal problems. The court concluded:
There also was some evidence before the Committee that chiropractic was effective - more effective than the medical profession in treating certain kinds of problems such as workmen's back injuries. The Committee on Quackery was also aware that some medical physicians believed chiropractic to be effective and that chiropractors were better trained to deal with musculoskeletal problems than most medical physicians. (Opinion pp. 7)
The Opinion found:
The AMA and its officials, including Dr. Sammons, instituted a boycott of chiropractors in the mid-1960s by informing AMA members that chiropractors were unscientific practitioners and that it was unethical for a medical physician to associate with chiropractors. The purpose of the boycott was to contain and eliminate the chiropractic profession. This conduct constituted a conspiracy among the AMA and its members and an unreasonable restraint of trade in violation of Section I of the Sherman Act.
The AMA sought to spread the boycott to other medical societies. Other groups agreed to participate in the boycott by agreeing to induce their members to forego any form of professional, research, or educational association with chiropractors. The defendants which knowingly joined in the conspiracy were ACS, ACR, and AAOS. None of the defendants established the patient care defense. The plaintiffs are entitled to injunctive relief against the AMA, ACS, and ACR, but not against AAOS or Dr. Sammons. The court shall conduct further proceedings regarding the form of the injunction. The actions of the other defendants, JCAH and ACP, were taken independently of the AMA boycott and these defendants did not join the conspiracy. Accordingly, defendants JCAH, ACP, AAOS and Dr. Sammons are dismissed. (Opinion pp. 2)
The Committee on Quackery disbanded in December 1974 and considered its activities a success:
The AMA believed that chiropractic would hove achieved greater growth if it had not been for the Committee's activities. (opinion pp. 4)
The Court of Appeals stated that enforcement of a code of ethics was not necessary to obtain compliance with the boycott:
The anti-competitive effects of the boycott were generally conceded by the defendants' expert, William J. Lynk of Lexecon, Inc. Some of the anticompetitive effects acknowledged by Mr. Lynk include the following: it is anti-competitive and it raises costs to interfere with the consumer's free choice to take the product of his liking; it is anti-competitive to prevent medical physicians from referring patients to a chiropractor; it is anti-competitive to impose higher costs on chiropractors by forcing them to pay for their own x-ray equipment rather than obtaining x-rays from hospital radiology departments or radiologists in private practice; and it is anti-competitive to prevent chiropractors from improving their education in a professional setting by preventing medical physicians from teaching or lecturing to chiropractors. Mr. Lynk agreed that in an economic sense a boycott such as the one described by plaintiffs raises the costs of chiropractic services and creates inefficiencies and economic dislocations. (Opinion pp. 6)
The anti -competitive effects of the AMA boycott were established by defendant's witnesses:
The activities of the AMA undoubtedly have injured the reputation of chiropractors generally. This kind of injury more likely than not was sustained by the four plaintiffs. In my judgment, this injury continues to the present time and likely continues to adversely affect the plaintiffs. The AMA has never made any attempt to publicly repair the damage the boycott did to chiropractors' reputations. (Opinion pp. 10).
Based on the findings of fact and conclusions of low set forth in this opinion, the case is dismissed against defendants JCAH, ACP, AAOS, and Dr. Sammons, and an injunction shall issue against defendants AMA, ACS, and ACR. The plaintiffs and the AMA, ACS, and ACR, are directed to confer on the form of injunction and to report to the court on the progress of those discussions. The case is set for an in-chambers conference on September 4, 1987 at 3:00 P.M.
It is so ordered.
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