Medicine and Chiropractic (1968)

H. Thomas Ballantine, Jr., MD

This essay was read on October 8, 1968 in Chicago at the Third National Congress on Medical Quackery, which was sponsored by the American Medical Association and the National Health Council. At that time, Dr. Ballantine was an assistant professor of surgery at Harvard Medical School and visiting neurosurgeon at Massachusetts General Hospital. He later became chairman of the AMA Committee on Quackery. In November 1966, the AMA House of Delegates passed a resolution which called chiropractors "an unscientific cult whose practitioners lack the necessary training and background to diagnose and treat human disease." Although chiropractic education and practice have improved since that time, they still have a long way to go. — Stephen Barrett, M.D.

For the past 53 years a well-organized and determined band of practitioners has importuned the state legislatures of this country for permission to administer to the health needs of the people. Their efforts have been so successful in the political arena that 48 states license them. These individuals call themselves chiropractors. Their aggregate number is variously estimated at from 15,000 to 25,000, and it is claimed that about 4 million people consult them in any one year.

In 1966, the American Chiropractic Association published a brochure entitled What Medicine Really Thinks About Chiropractic [1]. The authors were C.W. Weiant, "dean emeritus of the Chiropractic Institute of New York," and S. Goldschmidt, "member Special Committee on Political Education, American Chiropractic Association." Two statements in their introduction to a defense of chiropractic present the salient points to be dealt with here. The first reads as follows:

In this brochure we present the inside story of a conflict of which the average layman is but dimly aware. It is the story of struggle between two professions, medicine and chiropractic, a struggle in which organized medicine seeks relentlessly to stifle the development and spread of the younger healing art, and chiropractic seeks to survive. Seen through the eyes of the M.D., the issues were at first simple enough. Medicine stood for science while chiropractic was synonymous with quackery, and the two obvious remedies were public education and legal harassment.

The second important statement by these authors is the following:

The present direction of the conflict poses a serious threat to a basic human right; namely the right to a doctor of one's choice, the right to follow a course of action with respect to one's person which, according to one's lights, holds the greatest promise for health and well-being, including the right to make a mistake.

These chiropractors have, then, raised several points which should be worth serious consideration: Those of greatest interest to this discussion are (1) a definition of quacks and quackery; (2) an inquiry into the role and obligation of the physician in reference to quacks and quackery; (3) a definition of chiropractic; (4) a description of the chiropractor as a health practitioner; (5) the characteristics of chiropractic which might or might not qualify the chiropractor to be identified as a quack.

To deal in an intelligent, impartial, and objective fashion with the points raised by the chiropractors, acceptable definitions will be of prime importance.

Definition of a Quack

The term "quack" is used commonly but usually in an indefinite manner; yet the word is capable of being clearly defined. One such definition will be used in this essay as it appears in the 24th edition of Dorland's Illustrated Medical Dictionary: "One who fraudulently misrepresents his ability and experience in the diagnosis and treatment of disease, or the effects to be achieved by the treatment he offers." The term "fraudulent," lest it be thought too severe to be included in this description of a quack is defined by Black's Legal Dictionary as: "A generic term embracing all multifarious means which human ingenuity can devise and which are resorted to by one individual to get advantage over another by false suggestions or by suppression of truth." A specific type of fraudulent activity called "constructive fraud" is further defined as "an act, statement or omission which operates as a virtual fraud on an individual, or which, if generally permitted, would be prejudicial to the public welfare and yet may have been unconnected with any selfish or evil design."

It would appear that from a legal standpoint a quack need not be ipso facto criminally dishonest: he may be ignorant or deluded. It is true, however, that regardless of his motivation, education, of mental stability the quack by definition does misrepresent his ability to diagnose and treat disease or the effects to be achieved by the treatment he offers. As a result of this misrepresentation, he carries out fraudulent activities which are prejudicial to the health of the individuals consulting him and which are injurious to the public welfare.

Medicine and Quackery

Prior to the beginning of the 20th century, it was possible for almost anyone in this country to set himself up as a health practitioner and to attempt to cure the ills of humanity in any fashion which appealed to him. For hundreds of years, however, physicians and surgeons dedicated to the discovery of the true nature of the cause and cure of disease had understood the necessity of exposing individuals who deceived the public by playing upon its superstitious and ignorant concepts concerning ill health. These individuals were and are quacks, and many of the most glaring examples of quackery were formerly to be found within the ranks of medicine itself. There was for this latter reason an additional obligation on the part of the medical profession to protect the public from misguided or dishonest practitioners. Only relatively recently has it been thought necessary to combat cultists and quacks and faddists in general.

The interest of the American Medical Association stems from the obvious fact that an organized group devoted to the same cause can be more effective than if each person within it acts upon his own initiative.

There has also developed in our culture that which I have chosen to call "the moral obligation of the informed citizen." For example, groups of engineers, lawyers, and even a nation-wide organization called the Better Business Bureau seek to protect us from fraudulent activities in fields about which they have special knowledge. If, as a result of an educational process, teachers, scientists, and laymen interested in the advancement of medical science and the healing of the sick become aware of the existence of forms of quackery in our society, then as informed citizens these individuals have the moral obligation to join in eliminating these fraudulent activities.

If it can be shown that, in the words of Weiant and Goldschmidt, chiropractic is synonymous with quackery, then some issue must be taken with their opening remarks: The confrontation between medicine and chiropractic is not a struggle between two "professions"; rather, it isĀ· in the nature of an effort by an informed group to protect the public from fraudulent health claims and practices.

For a chiropractor to be designated accurately as a quack according to the definitions used here, it is necessary to show only that he either misrepresents his ability to diagnose and treat disease or that he misrepresents the effects to be achieved by the treatment he offers, and that he does so by false suggestion and suppression of truth. It is not necessary to show that the chiropractor does these things out of selfish or evil design.

But, before arriving at an informed decision as to whether chiropractic is or is not a form of quackery, it is obviously necessary to examine carefully this so-called younger healing art and the practitioners who call themselves chiropractors.

What is Chiropractic?

Here again acceptable definitions are vitally necessary, and for the purpose of this essay one submitted in 1966, by the chiropractors to the Massachusetts Legislature and adopted by it in the passage of an act establishing a Board of Registration of Chiropractors will be used:

Chiropractic, the science of locating and removing interference with the transmission or expression of nerve force in the human body, by the correction of misalignments of subluxations of the bony articulations and adjacent structures, more especially those of the vertebra column and pelvis for the purpose of restoring and maintaining health.

This definition was used and further elaborated in 1955, when an attempt was made to overturn a ruling of the Supreme Judicial Court of Massachusetts that the practice of chiropractic was the practice of medicine. Paragraph four of the petition presented to the court by a chiropractic association stated in part:

Chiropractic is a modern scientific method of healing, based on the theory that most human ailments or diseases are the results of a displacement of the vertebrae of the spinal column, resulting in abnormal pressure upon the nerves as they emerge. Such pressure prevents the constricted nerves from transmitting to the various bodily organs the mental impulse necessary for proper functioning. Chiropractic proceeds on the principle that the nerves emanating above each vertebrae regulate particular organs and, hence, the cause of different ailments and diseases can be localized; that health is possible when all organs function harmoniously, and that by ascertainment of the subluxation of the spine and by proper adjustment to release the pressure on the nerves caused thereby, the cause of the disease is removed and the body rendered capable of natural restoration to good health. The chiropractic method of adjustment is purely manual, and never resorts to drugs or surgery, and is the antithesis of the germ theory taught and accepted by physicians and surgeons and who treat human disease as conquerable by the administration of drugs and medicines.

In another legal decision, Lawrence vs the Board of Registration in Medicine [2], the courts of Massachusetts have defined the practice of medicine as an undertaking "to cure the ills, to treat the ailments, to prevent the diseases and thus to relieve the suffering of the race." Furthermore, in 1915, as mentioned above, the Supreme Judicial Court of the Commonwealth of Massachusetts in an action entitled Commonwealth vs Zimmerman [3], found the practice of chiropractic was actually the practice of medicine.

In a book entitled Chiropractic: A Modern Way to Health, by Julius Dintenfass, 1966 [4] a partial list of diseases said to be amenable to chiropractic treatment is as follows: arthritis, asthma, bronchitis, bursitis, colitis, the common cold, constipation, digestive disorders, dysmenorrhea, hay fever, headache, hypertension, low back pain, mental illness, migraine, and trigeminal neuralgia or tic douloureux. It is of some interest in reference to this last named painful and disabling affliction that the trigeminal nerve is confined wholly within the skull, has no connection with any spinal nerve and is absolutely impervious to external manipulation.

A public information bulletin issued by the Spears Chiropractic Clinic of Denver states that " ... we have treated several thousand cancer cases by chiropractic methods. Chiropractors treat cancer by adjusting the segments of the spine to correct vertebral distortions. . . [5]

What (or Who) Is a Chiropractor?

Obviously he is one who practices chiropractic, but he is even more, according to a brochure entitled Planning a Career in Chiropractic, published as a vocational guidance manual by the Department of Education of the American Chiropractic Association [6]. This brochure states:

The chiropractic doctor is a physician-a particular kind of physician. As such he is engaged in the treatment and prevention of disease and in the promotion of public health and welfare.

In summary then, chiropractors by their own definition are physicians engaged in the treatment and prevention of disease according to a particular theory which states that human illness is caused primarily by pressure upon the spinal nerves from dislocations of the spinal vertebrae and that cure is obtained by manipulating these vertebrae and restoring them to proper alignment.

What qualifications do chiropractors need in order to be licensed? In 1966, certain of these qualifications were set down by the Massachusetts Legislature. First a chiropractor has to be a high school graduate or to have "the equivalent of a high school education." Another important qualification is that he must not be "addicted to any vice to such a degree as to render him, in the opinion of the board unfit to practice chiropractic." Finally, while all chiropractors must take an examination ( prepared by other chiropractors) , those who have been practicing illegally in Massachusetts may by virtue of a "grandfather clause" be allowed to take a less exacting examination than the chiropractors who attempt to come into the state from elsewhere.

A perusal of the list of the members of the faculties of various chiropractic colleges fails to disclose any scientists of national standing, and indeed there are few if any faculty members who are possessed of advanced degrees in any recognized specialty. One exception to this statement may be C. W. Weiant whose writings have been quoted previously. This man has a PhD degree from Columbia University, New York. He obtained his advanced degree in anthropology, and the subject of his doctoral thesis was "An Introduction to the Ceramics of Tres Zapotes, Vera Cruz, Mexico."

It is interesting to note that the father of chiropractic, Daniel David Palmer of Davenport, Iowa, and Robert Koch, the discoverer of the bacillus of tuberculosis, lived and died about the same time. Koch was born in 1843 and died in 1910. He was a Nobel Laureate. The account of his discovery of the tubercle bacillus was published in 1882. Palmer was born in 1845 and died in 1913. His so-called discovery of chiropractic occurred in 1895. It may be useful to contrast and compare the lives of these two men.

Koch attended the University of Gottingen in Germany where he came under the influence of the great pioneer medical investigator, Jacob Henle. Bacteriology, and the so-called "germ theory of disease" became Koch's life's work. His discovery of the tubercle bacillus, the cause, as physicians understand it, of tuberculosis, was perhaps his greatest contribution, but he also set down very stringent requirements for proof that a particular organism or germ was responsible for a particular illness. These are known as Koch's postulates and state: (1) The organism must be recovered in every case of the disease. (2) It must be grown in pure culture in the laboratory. (3) Inoculation of the organism into a susceptible animal must reproduce the disease. (4) The organism must be recovered from the experimental animal in pure culture.

These rigid criteria have been extended, with necessary modification, by medical investigators to all attempts to determine the cause of a given illness.

Medical science, moreover, recognizes that there are many causes of human illness but that they fall into important generic categories, four of which may be used as examples: (1) inherited defects-hemophilia; (2) infectious diseases-tuberculosis; (3) degenerative diseases-arthritis; (4) the neoplastic or cancerous illnesses.

An obvious corollary to the concept of multiple causalities is that different diseases require different treatments.

D. D. Palmer, born in 1845 near Toronto, spent the most productive years of his life in Davenport, Iowa, where the Palmer College of Chiropractic still is in existence. There are many biographies of this man, but the essential details set down here are taken from Dintenfass's book. For ten years prior to his "discovery" of chiropractic, Palmer, a former fish-peddler and grocer, practiced magnetic healing. According to Dintenfass:

Mesmerism or "magnetic healing" had many proponents. It was based on the discovery of "animal magnetism" by Anton Mesmer. Although founded on unscientific premises "magnetic healing" was in effect the first step toward current psychoanalytic and psychological methods.

On September 18, 1895, Palmer performed an experiment which blazed the trail for the development of a new healing profession which now has over 25,000 doctors of chiropractic throughout the world.

On this day when Palmer was in his office in Davenport, in came Harvey Lillard the janitor, who was so deaf that he could not hear the noise of the wagons in the street or the ticking of a watch. Palmer inquired as to the cause of Lillard's deafness. Lillard explained that he had suddenly lost his hearing 17 years earlier when he exerted himself at his work in a cramped, stooping position. He said he felt something give way in his back and immediately lost his hearing,

This interested Palmer, who, upon examining Lillard's back, located a painful prominent vertebra which appeared out of place. Lillard verified this as the spot which hurt when he lost his hearing. Palmer reasoned that if the vertebra were replaced, the man's hearing might be restored. Using the spinous process of the vertebra as a lever, Palmer applied a sharp thrust which repositioned the bone; a short time later Lillard said that he could hear better than before [4].

It is worth noting that the "nerve of hearing," the acoustic nerve, is contained completely within the skull and has no connection with any of the spinal nerves which could be affected by a "sharp thrust" using the spinous process of the vertebra as a lever!

In any event, the original hypothesis of Palmer that human disease is caused by "misalignment or subluxations of the bony articulations and adjacent structures, more especially those of the vertebra column and pelvis"; and that by "proper adjustment to release the pressure on the nerves caused thereby, the cause of the disease is removed and the body rendered capable of natural restoration to good health"; and finally that "the chiropractic method of adjustment is purely manual and never resorts to drugs or surgery and is the antithesis of the germ theory" has been handed down virtually intact and unchanged over the past 70 years and forms the basis for modern chiropractic fully as completely as it did in 1895.

We are now concerned with a matter of truth, and two documented examples of patients treated by chiropractors will suffice as a basis for discussion. These cases have been chosen because the details are a matter of court record.

In 1951, a man was found to be suffering from tuberculosis. The condition remained dormant for ten years while the patient was under the care of a physician. In 1962, however, the tuberculosis became active again. Hospitalization and drug therapy were recommended but the patient refused and went to a chiropractor in New York state for treatment. The patient was treated without drugs and by diet for two years by two chiropractors working together. The patient died. The two chiropractors were convicted of manslaughter for having caused the death of the patient through culpable negligence.

In the second case, a chiropractor undertook to treat the infected foot of a patient whom he knew to be suffering from diabetes; he advised against the use of insulin in the treatment of the diabetes: The infection spread and the patient died.

The Florida appellate court, in finding that there was sufficient cause for the chiropractor to be indicted for manslaughter, summarized its ruling in the following language:

If a person undertakes to cure those who search for health and who are, because of their plight, more or less susceptible of following the advice of anyone who claims the knowledge and means to heal, he cannot escape the consequences of his gross ignorance of accepted and established remedies and methods for the diseases which he knows his patients suffer, and if his wrongful acts, positive or negative, reach the degree of grossness he will be answerable to the State.

The chiropractor was tried and found guilty of manslaughter.

A quack was earlier defined as "one who fraudulently misrepresents his ability and experience in the diagnosis and treatment of disease or the effects to be achieved by the treatment he offers." At this juncture, a simple but stern question awaits an answer: who are the quacks? Are they the physicians in our society who believe that different diseases have different causes and require different methods of treatment including, where indicated, the use of medicine and surgery? Or-are they individuals who believe that "most human ailments or disease are the results of a displacement of the vertebrae of the spinal column" (one cause) and that "by ascertainment of the subluxation of the spine and by proper adjustment to relieve the pressure on the nerves caused thereby, the cause of the disease is removed" (one cure) ? Are these the quacks? For the sake of the remainder of this discussion, I shall assume that it is the chiropractors who are the quacks.

If chiropractors are quacks, how can they be tolerated in this modern so-called scientific age and, even more important, how does it come about that chiropractic is given a certain stamp of approval by 48 of 50 state legislatures who have passed acts establishing boards of registration in chiropractic? A partial answer seems to lie in the following facts: First, there is among the general public a profound ignorance of the scope of chiropractic and the character of the chiropractor. Second, there is an apathetic attitude on the part of those lay groups interested in stamping out heart disease, cancer, mental illness, etc, in regard to this problem. That they should have such an interest is indicated by the list of diseases which the chiropractor purports to be able to treat successfully and by the fact that, in the case of cancer, delay can be deadly. Finally, there is a distaste on the part of the average physician for engaging in an unpleasant controversy.

Examples of general ignorance are surprising indeed: The author had occasion to consult three prominent lawyers, one a past president of the Massachusetts Bar Association, in reference to an attempt to counter the successful effort by the chiropractors to become licensed in Massachusetts. All three wondered what "the fuss was all about." One said that, since chiropractors were essentially physiotherapists and practiced under the direction of physicians, he felt that they deserve to be licensed! A prominent state senator, a graduate of Harvard University, gave it as his opinion that licensing chiropractors would improve the practice of chiropractic. Would he just as readily have stated that the licensing of quacks would improve the practice of quackery?

As to the distaste for engaging in public controversy, when the author's views on chiropractic became a matter of public record, the following letter, among others equally vituperative, was received:

I am certain the chiropractors will leave enough people for medics to kill even if they are licensed. A good chiropractic treatment would do you a world of good. But you medics would rather die so go your merry way-but as long as I live I shall shout of your mistakes. Do you know that an educated chiropractor does not want to be a needle pusher, a prescription pusher or a knifer—they leave that to medics-who kill and sign the death certificates? What more do you want—well here is the answer—BLOOD.

On the other side of the chiropractic controversy we find a well-organized, well-financed group of determined men who are careful to avoid submission of the claims of chiropractic to impartial scientific analysis. J.R. Verner, in collaboration with C.W. Weiant, has written a book entitled The Chiropractor Looks at Infection [7]. On page 21 there appears the following:

There are six criteria by which to judge the value of a therapy and estimate the relative methods of differing therapies, namely:

Is it logical?
Is it effective?
Is it scientific?
Is it rational?
Is it peerless?
Is it infallible?

These authors then make the claim that chiropractic is logical because it makes no unwarranted assumptions; it is effective because people go to chiropractors; it is scientific because it "depends on the data of anatomy, physiology, neurology and pathology in analyzing every case and it uses radiography and other scientific techniques in the examination of the patient." This last claim for chiropractic is comparable to stating that astrology is a scientific method for predicting the future because it uses certain data derived from astronomy!

These authors state further that chiropractic is rational "because it is not content to be scientific." It is peerless because it thrives on the failures of other methods. They do admit that chiropractic is not infallible but that, of course, no other healing method can make that claim.

It is doubtful that these claims for the advantages of chiropractic would satisfy the critical faculties of the average high school student. However, the chiropractors, through their chiropractic associations, have preferred to concentrate upon the political aspects of their problem, and here they have been clever and successful. Through the payment of fairly substantial dues, they have a well-financed propaganda machine which has continually stressed the theme stated by Weiant and Goldschmidt that "organized medicine seeks relentlessly to stifle the development of the younger art and chiropractic seeks to survive." In other words, they have given an uninformed, somewhat gullible public the idea that the physicians, for their own selfish reasons, are trying to keep the chiropractors from their legitimate goals of acting as doctors in every sense of the word. They have turned this problem not into a search for truth vs nontruth, but a struggle between two "healing professions."

What is the solution? No easy answer is available.

Certainly public education is vitally necessary. It is also imperative that the ethic of the moral obligation of the informed citizen be strongly invoked. It would be wise to eliminate this struggle between the physicians and the chiropractors and to have chiropractic confronted with the strong opposition of lay medical groups interested in good medical care.

Finally we come to the second statement of Weiant and Goldschmidt quoted in the introduction to this communication:

The present direction of the conflict [between chiropractic and medicine] poses a serious threat to a basic human right; namely the right to a doctor of one's choice, the right to follow a course of action with respect to one's person which, according to one's lights, holds the greatest promise for health and well-being, including the right to make a mistake [1].

How sacred is this right? What safeguards must surround this right to make a mistake? Does the general public have the right to make the mistake of indiscriminately ingesting LSD, heroin, morphine, or cocaine? In reference to the choice of a doctor, it would seem reasonable to attempt to make certain that the public has access to all available information concerning the qualifications of the practitioners which they wish to consult. Punch, the English magazine which combines humor, satire, and perceptive social insight, had something to say on this subject as long ago as 1845:

Great outcry has been raised of late, in the Lancet and other journals, against Quacks and Quackery. Let them not flatter themselves that it is possible to put either down. The Quack is a personage too essential to the comfort of a large class of society to be deprived of his vocation. He is, in fact, the Physician of the Fools—a body whose numbers and respectability are by far too great to admit of anything of the kind. However, as there are some people in the world who are not fools, and who will not, when they want a doctor, have recourse to a Quack, if they can help it, the practice of the latter ought certainly to be limited to its proper sphere. For this end we could certainly go rather farther than Sir James Graham's sympathies permitted him to proceed last session. We would not only prevent him from assuming the title of a medical man, but we would oblige him to take that of Quack [8].

Perhaps with this advice from Punch we might make a beginning.

References

  1. Weiant CW and Goldschmidt S: What Medicine Really Thinks About Chiropractic. Des Moines, Iowa: American Chiropractic Association, 1966.
  2. Lawrence vs the Board of Registration in Medicine, 239 Mass 424, 132 NE 174, 1921.
  3. Commonwealth vs Zimmerman, 221 Mass 184, 108 NE 893, 1915.
  4. Dintenfass J: Chiropractic: A Modern Way to Health. New York: Pyramid Publications, Inc., 1966.
  5. Spears Sanigram, Denver: Spears Chiropractic Clinic.
  6. Planning a Career in Chiropractic. Des Moines, Iowa. American Chiropractic Association, 1963.
  7. Verner, JR and Weiant CW: The Chiropractor Looks at Infection, Englewood, NJ, 1942, p 21.
  8. Graves CL: Mr. Punch's History of Modern England, New York: Frederick A. Stokes Co., vol 1, p 239.

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