I Visited a Chiropractic College (1968)
Medical Economics Magazine
Copyright 1968, Medical Economics Publishing
Reprinted with permission from Medical Economics
To get this exclusive report, Mr. Carlova visited one school and made a survey of all others. Some are still awful, he found, but many are striving for accreditation. If they get it, the way would be open for Federal grants—and a bigger share of the health-care market for chiropractors.
The newspaper clipping on the bulletin board told of a California chiropractor who, though blind, captained his own boat in sailing races. On the margin of the clipping, someone had inscribed, "If he can do it, you can do it!" A nearby hand-printed card struck a more subdued note: "Going out of business. For sale: Zenith stationary adjustable table. Cheap." Below it was a quote from a book by B. J. Palmer, the colorful prophet of chiropractic:
"Q. What are the principal functions of the spine?
A. To support the bead, to support the ribs, to support the chiropractor."
This strange mixture of determination, defeatism, and dollar hunger was noticeable not only on the bulletin board, but throughout a chiropractic college I visited recently. [The name of the college is withheld in order to protect sources of information.] I spoke to students and faculty members, explored the school premises, and even managed to attend several classes. What did I find? Basically, pretty much what the education director of the American Chiropractic Association discovered in 1964 when he reported on the "lacks and gaps" that needed to be corrected:
"Faculties—many part-time instructors, too few regarding their school work as their professional careers, too many teaching basic sciences without qualification. Teaching loads too heavy for many. No professional scale of salaries, tenure, retirement, etc. Students—too few to meet the needs of the schools and the field. Too many with insufficient school backgrounds to do professional-level work."
Though standards in the chiropractic college I visited—and in most others—are still low, definite efforts are being made to improve them. The primary reason is spelled out in that 1964 report by the education director of the American Chiropractic Association. He reminded officials of the organization that chiropractic colleges aren't officially accredited and that they'd have to be substantially upgraded to be recognized by the U.S. Office of Education. After noting the high costs of operating and improving the schools, the report came to the pertinent point: "Once the U.S. Office of Education's approval is obtained ... that certain of these costs can be borne by Government grants."
To practicing physicians, this means that (I) the campaign to get chiropractic colleges officially accredited is really a drive for pay as well as prestige; (2) accreditation would give chiropractors not only a claim to Government grants for schools but inclusion in Medicare and other Federal medical programs. (3) chiropractors would thus manipulate a greater share of the health-care market; and (4) more and more patients would be treated under chiropractic, a cult that the A.M.A. has repeatedly denounced as unscientific and dangerous.
Just how are the chiropractors striving to bring their schools up to snuff? Here are some examples that have come to my attention:
¶ Chiropractic colleges today aren't as hasty in their approach to training as was B. J. Palmer, who headed the Palmer College of Chiropractic in Davenport, Iowa, until his death in 1961. He stated in one of his books: "Give us a student who has straight-line thinking, and in 30 days we can make him into a simple chiropractor who can and will go forth and get more sick people well than any physician, surgeon, or practitioner of any other so-called health profession." The colleges today require students to put in four years on at least 4,000 hours of study to get a doctor of chiropractic degree.
¶ "I would rather be a chiropractor with one simple principle and practice that works, and get people well, and be called ignorant," declared B. J. Palmer in one of his outbursts against higher education, "than be a supraeducated medical man with millions of arbitrary and empiric theories, none of which work or get sick people well." Though some chiropractic educators still go along with that simple line of thinking, most can't because of increasingly stringent licensing laws. Twenty-seven of the 48 states where chiropractic is licensed require some college credits from chiropractic school candidates. This means that schools supplying those states with chiropractors have had to upgrade their standards; the usual requirement is two years of attendance at a properly accredited college. In the other 21 states, only a high school education "or its equivalent" is necessary.
¶ It used to be that nearly half the students at some chiropractic colleges attended classes only at night—a situation not to be found in any medical school in the U.S. The chiropractic colleges are now trying to phase out night classes. For instance, the current catalog of the Columbia Institute of Chiropractic in New York City carries this notice: "Reference in the academic calendar to evening school is included for the convenience of our currently enrolled undergraduates who had matriculated prior to September, 1964. All future candidates may only apply for day school admission."
¶ Not too long ago, clinical training and labs were virtually nonexistent at chiropractic schools. Today many have pathology and spinal X-ray labs and include clinical courses.
¶ One chiropractic school in New York City used to boast that it had available "one of the largest libraries in the world"—which happened to be the main public library nearby. "Libraries" at other chiropractic colleges were often nothing more than a bookcase or two in a corridor. Today there's a vast difference. The library at the Los Angeles College of Chiropractic, for example, has nearly 7,000 books, subscribes to 200 journals, and is a member of the American Library Association.
¶ Sloppy dress and "just plain folks" manners were once common at chiropractic colleges. Not now. White clinic jackets are worn by students at the Los Angeles College of Chiropractic to dress up the "doctor" image. New York City's Columbia Institute of Chiropractic requires male students to wear "a jacket, shirt, and tie" and sternly warns that "flamboyant colored sport shirts will not be tolerated. Shirts are to be inserted in trousers." To further develop professional pride, there are two chiropractic fraternities—Beta Omega Chi, "for the promotion of good fellowship," and Phi Chi Omega, an honor group for students of high scholastic standing.
¶ Chiropractic organizations have always been noted for their public relations campaigns but the current drive to build up their schools is especially high-powered. A booklet titled "Opportunities in a Chiropractic Career" is being distributed to 30,000 high schools, 11,000 public libraries, and 2,000 colleges.
¶ Finally, chiropractic is attempting to upgrade its schools through accreditation. The colleges used to be "accredited" only by chiropractic's own organizations, a status that was granted almost automatically. The schools are still "accredited" that way, but in a much stricter manner. The Accrediting Agency of the American Chiropractic Association, for instance, has fully accredited only three of the eight schools under its jurisdiction: The Lincoln Chiropractic College in Indianapolis, the Los Angeles College of Chiropractic, and the National College of Chiropractic in Lombard, Ill. Three are "provisionally accredited"—the Logan College of Chiropractic in St. Louis, the Northwestern College of Chiropractic in Minneapolis, and the Texas Chiropractic College in Pasadena, Tex. The remaining two are "approved conditionally"—the Chiropractic Institute of New York and the Columbia Institute of Chiropractic. The accrediting agency defines "provisionally accredited" as "improvement is in order." "Approved conditionally" means that a college has failed "to meet certain essential standards but assumes responsibility for doing so within an agreed-upon reasonable period of time."
In all, there are 12 chiropractic colleges in the U.S. today—a sharp tumble from the 500 or so that started up since the turn of the century. Many of those that collapsed were outright diploma mills; others had only a couple of rented rooms equipped with adjusting tables. The first school was started in 1897 by the founder of chiropractic, Daniel David Palmer, and gained momentum under the direction of his forceful son, B. J. The original Palmer school charged $450—with a $50 discount for cash for a three-month course. Today the cost of a four-year course at a chiropractic college, including books and fees along with the tuition but not room and board, totals about $3,500. This compares with a cost of about $16,800 for the four-year course at the University of Rochester (N.Y.) School of Medicine and Dentistry, which isn't considered to be an expensive school.
The Palmers were advocates of what's become known as the "straight" school of chiropractic—the theory that the spine alone is the root of all medical evil. This belief is opposed by the "mixers"—chiropractic teachers who have expanded into such areas as dermatology, neurology, OBG, pathology, pediatrics, microbiology, embryology, histology, nutrition, palpation, chemistry, economics, and public relations. Each school of thought has its own organization: the International Chiropractors Association for the "straights" and the American Chiropractic Association for the "mixers." Of the two, the American Chiropractic Association is the largest and strongest. This means that most chiropractors coming out of school today are "mixers," the ones who are moving farther and farther into fields once reserved for physicians.
How many chiropractors do the 12 colleges turn out in a year? A survey by the Department of Health, Education, and Welfare in 1965 reported 611 chiropractic graduates that year, compared to 7,409 M.D.s and 395 D.O.s. The chiropractic graduates joined 23,409 chiropractors estimated" by H.E.W. to be practicing in 1965a big jump from the 14,360 listed in the U.S. census in 1960.
A tremendous growth of chiropractic? Not really. The rate of practice failure is high among those who do graduate, and many chiropractors practice only part-time. Success, it seems, is reserved for the glib talkers, the practitioners who believe that homespun charm is the real backbone of chiropractic. This, of course, explains the emphasis placed by the schools on salesmanship and slick public relations.
Some of the schools might well switch part of that emphasis to brightening up their premises. The college I visited was dingy and depressing. From the outside, it looked like a small, somewhat tacky rooming house. Inside, there were only seven or eight classrooms, along with three "technique" rooms where chiropractic "thrusts" were taught. Under one of the adjusting tables, I noticed, someone had deposited a number of tightly twisted candy wrappers. I don't know whether this was the result of simple hunger or whether it was a bit of individual technique practicing. [These conditions don't apply to all chiropractic schools. The National College af Chiropractic in Lombard, Ill., for one, has a modern plant. Northwestern College in Minneapolis has just completed extensive renovations, and the Texas College in Pasadena, Texas, is planning a $2,000,000 addition.]
The instructors I observed appeared literally to be going "by the book." Texts were frequently consulted, and charts were everywhere, many of them outlines of the human spine with numbered points where misalignments could be attacked and cures wrought for everything from headaches to constipation. One teacher vigorously demonstrated how to make the vertebrae pop, thus presumably adding psychological sound to the fury of the treatment. Another brought out the fine points of the 11 straight thrust"—delivered with the heel of the hand—and the more complicated "dynamic thrust."
The attitudes of these instructors varied greatly. Some looked and sounded like metaphysical evangelists. One proclaimed himself "an average American teaching average Americans to take care of average Americans" with none of "that inbreeding and reserved-for-the-rich stuff you find all through the so-called medical profession." Other instructors appeared bored or cynical, as though they were biding their time until something better came along. Several were moonlighting at other jobs, and one, I learned, was studying to open a television repair shop11 where there's some real dough to be made."
All the faculty members at this particular school were called "doctor," but I couldn't determine if any had further qualification, A study of 13 recent catalogs of chiropractic schools, however, disclosed that more than half the faculty members didn't have generally recognized college degrees. A recent catalog of the Texas College of Chiropractic listed 10 instructors on the faculty who taught obstetrics, gynecology, pediatrics, and methods for combating infectious diseases and other human ailments. The only recognized advanced degree among them was a master's held by the dean, chiropractor William D. Harper. Though Harper taught pathology, his masters degree is from the Massachusetts Institute of Technology, and it's in engineering.
Some evidence of the chiropractic educator's thinking came to light in 1959 during a lawsuit brought by chiropractors against the Louisiana State Board of Medical Examiners. Louisiana and Mississippi are the two states that don't license chiropractors. In the suit, the Louisiana chiropractors sought to prohibit the state's Board of Medical Examiners from enforcing a state law that requires a practitioner to have a medical education in order to be licensed. The chiropractors lost the case, and during the trial Harper gave some revealing testimony.
Robert E. LeCorgne Jr., one of the lawyers for the Board of Medical Examiners, mentioned a book that Harper had written and then said:
Q. In your book, Dr. Harper, I get the impression that at one point you say that some workings of the individual psychic thought could cause a subluxation [the chiropractors' favorite word for misalignment]."
A. Yes, because psychic irritation of the nervous system can through irritation of the cord and into the anterior horn cause muscle contraction and in turn produce a subluxation, in which case the subluxation becomes one of the symptoms of the complex and not the cause of the phenomena as long as the original irritation, be it clinical or psychic, remains.Q. In other words, I could think myself into a subluxation?
A. You could. Now, pardon me, may I say one thing. That's one of the things, as a perfect example, I've suffered today from the irritation of being up on this stand. This is my first experience. I'm demonstrating the fact today.
Q. You mean you think I'm giving you a subluxation?
An attorney for the Louisiana State Medical Society then asked:
Q. Could you tell us what vertebra is affected by cross-examination?"
A. All of them.
Q. So that the gamut of diseases is possible as a result of having to be a witness?
A. Chronic irritation of the nervous system.
Q. You could get polio?
A. It's possible.
More fascinating details on the training of chiropractic educators came to light when Joseph Janse, president of the National College of Chiropractic, took the stand. He was asked by LeCorgne:
Q. Have you ever studied immunization?
A. I think to a moderate degree.
Q. Is it taught in a chiropractic school?
A. In the field of public health, hygiene, and sanitation, yes.
Q. But they [chiropractors] do not use it in their practice?
A. No, we do not employ the procedures of artificial immunization.
Later LeCorgne asked:
Q. What specific spinal centers would you adjust for tetanus?
A. To normalize the vasomotor extension, of course, you would adjust in the lower lumbar spine.
Q. What about polio?
A. Chiropractic treatment for polio in the initial stages of polio, in the prodroma, is the adjustment primarily used.
All this might be merely laughable if it weren't for the fact that such ideas are being passed along to thousands of chiropractic students each year. I spent some time observing and mingling with the students during my visit. They fall, I discovered, into four categories:
1. The disciples. Many chiropractic students seem to find a deep emotional satisfaction in the semireligious intensity that lies at the core of the cult. Some claim to have seen "medical miracles" performed on friends or relatives by chiropractors. Others carry around clippings—usually from chiropractic publications—telling of patients who have been "cured" of everything from acne to cancer. Talking with some of these students, I found them to be sincere but somewhat fanatical. There's something disquieting about a man who's convinced that, after four years of chiropractic training, he too will be able to perform "medical miracles" and cure cancer.
- 2. The misled. Because the public is still largely ignorant about what chiropractic really is, it's not surprising that many youngsters blindly wander into chiropractic training. Perhaps they were misled by high school vocational counselors, who are a favorite target of chiropractic recruiting campaigns. Perhaps they or their parents wanted the prestige of being a "doctor" without the cost and effort of training for an M.D. degree. Perhaps they truly thought they would become members of an officially recognized health profession.
- Whatever the reason, I found a lot of these students to be disillusioned by what they find when they get a close look at chiropractic. Some are shocked to discover that, after spending years in school and wanting to leave to study a recognized profession in another institution, their credits are worthless except in chiropractic. Others are perplexed by the fact that M.D.s, osteopaths, dentists, psychologists, optometrists, and podiatrists get officer rank in the Army, Navy, and Air Force, but no rank is authorized in any of the Armed Services for chiropractors. Still other students are dismayed or disgusted by the obvious fallacies of chiropractic. Consequently, school dropouts are numerous in this category.
- It may well be that these laxities are being tightened in the schools' drive for official accreditation, but in other areas—notably textbooks—standards are still pretty loose. Though "Gray's Anatomy" and other reputable medical texts are used, works such as these are open to all sorts of questions:
3. The desperate. It's not uncommon to find students in chiropractic schools who are anywhere up to 45 years of age. Many who have failed in other endeavors are attracted by chiropractic ads like this one: "Do you want to follow manual labor or a profession? The common labor field is crowded. There are any number of persons who want to do hard work. Let those who are anxious have it. You fit yourself for a profession!" The trouble is that many in this category simply aren't mentally equipped to fit themselves for a profession. I've seen them in class, pathetically struggling to follow even the simplest points. After graduation, a high percentage fail their licensing tests and have to return to school if they don't want to lose the time and money they've spent to become a "professional." Since most in this group have to work at a full-time job to finance their training, some become bitter. "I put in eight hours a day in a gas station," one man of about 40 told me. "I flunked my first test, but I'm not giving up. I'm gonna get that 'Doctor' in front of my name. Then there'll be no more of them big shots driving up and telling me: 'Wipe the windshield! Check the oil!' Oh, no—I'll be telling them!" The gas station attendant made a few quick, sharp "dynamic thrusts" that, to me, looked disturbingly like karate chops. Here, unmistakably, was a prospective "healer" who was just itching to work out his hostilities on ailing people.
4. The snake-oil pitchmen. There's a shady, shifty side of chiropractic that attracts a modem version of the old-time medicine man. Amiable, smooth-talking, and outgoing, he's a type I recognized frequently among the students during my visit. There was always a bunch of them around the bulletin board, comparing notes on "easy" states where licensing laws are lax and "sucker" states where the elderly and sickly flock. Surprisingly frank, they discussed pretentious but therapeutically worthless pieces of equipment they intended to buy when they entered practice and swapped stories about chiropractors who have "hit it big."
"There's this guy who operates near a big medical clinic," I heard one say. "Boy, has he got it made! He gets these people who come out of the clinic discouraged and goes to work on them. He sells them hope, see, and that's the payoff pitch! Nets him $100,000 a year!" [It's difficult to find any reliable figures on chiropractic incomes, but on "limited data available" the Department of Labor estimated in 1963 that practitioners averaged an annual net of $12,000. Chiropractic literature makes claims of from $20,000 to $50,000 "and higher."]
In a nearby tavern where students hang out, the pitchmen were even more outspoken. One got a big laugh when he proposed a toast to the day when they'd join "the only licensed medical superstition in the world!" Others schemed on how tests could be beaten—an activity that seems to be popular among some chiropractic students. In Illinois a few years ago, while 52 students were taking the state chiropractic licensing examinations, it was discovered that some had smuggled in two-way radio equipment to communicate with outside confederates on the answers. Those under suspicion were flunked. Similarly, in Iowa last year, 22 students and former students of chiropractic were indicted on Federal charges of fraud in taking examinations in six states. The 21 men and one woman were accused of cheating on basic science examinations in Colorado, Illinois, Iowa, Nevada, South Dakota, and Utah. The indictments charged the defendants with cheating in at least three ways: obtaining advance copies of the examination at a going price said to be "up to $3,000," substituting for each other in taking tests, and giving signals while the tests were being conducted. [Three of the 22 defendants pleaded guilty prior to trial, and four others were convicted by a jury. The seven were placed on probation for two to three years. The other defendants were acquitted on the ground that they hadn't had sufficient knowledge of the overall scheme.]
Chiropractic schools themselves aren't overly scrupulous in the ways they recruit students. Their literature to vocational counselors suggests that they're "fully accredited"—they don't say by whom—and sometimes hints of close ties with medical schools. One school catalog tells prospective students that "the well-trained qualified chiropractor is assured of success regardless of the area he selects for his practice, for in all cities, towns, and hamlets the suffering sick call for the hands of a skilled chiropractor."
Women aren't overlooked, either. "There is a wonderful opportunity in the field of chiropractic for the woman practitioner," declared one promotional catalog. "There are approximately 2,000 women practicing chiropractic. . . . It is not unusual for husbands and wives to attend chiropractic schools together." Another pamphlet adds: "Chiropractic offers attractive opportunities for women. Many patients prefer to go to one of their own sex for chiropractic attention, and the care of children is especially within the province of women chiropractors."
Though some chiropractic colleges have been forced by licensing laws to raise their admission requirements, others open their doors to virtually anybody. For example, in 1964 the A.M.A. reported on a test to check admission policies at chiropractic colleges. Letters from fictitious candidates were sent to seven schools. The letters were loaded with gross errors in grammar, punctuation, and spelling, along with statements indicating emotional as well as educational failings. Nevertheless, even though the applicants didn't produce high school diplomas or equivalency certificates, five of the seven schools granted conditional acceptances.
"Nonsurgical Cure of Appendicitis and Mastoiditis" by Konstant Koski. For the treatment of acute appendicitis, the author advises, "flush the large intestine with an enema . . . vibrate the appendix area with a heavy vibrator ... palpatate [sic] the lumbar spine very carefully and adjust the rotated lumbar vertebrae."
"Chiropractic: a Modern Way to Health" by Julius Dintenfass. In a long list of ailments said to be amenable to chiropractic treatment, this book includes trifacial neuralgia, commonly known as tic douloureux. H. Thomas Ballantine Jr., a Boston neurosurgeon who has made a study of chiropractic, comments: "It's of some interest in reference to this 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."
"Anything Can Cause Anything" by William D. Harper. This book contains the flat statement "Chiropractic corrects abnormalities of the intellect as well as those of the body." Nevertheless, the National Institute of Mental Health doesn't recognize chiropractic as a means of treating mental illness.
"Basic Technique" by Hugh B. Logan. The author contends that "more can be done to improve body chemistry by a lift strategically placed on the side of deficient support of the body, and by adjustments properly applied, than through the administration of any foreign material in an attempt to compensate for disturbed function of affected glands. . . ." Presumably this philosophy would advocate a heel pad and spinal manipulation rather than insulin for a patient suffering from diabetes.
"Rational Bacteriology" by J.R. Verner, C.W. Weiant, and R.J. Watkins. The authors assert that "typhoid, diphtheria, tetanus, rabies, and tuberculosis, these five inoculations should be prohibited!" Why? "This is all done for the sole purpose of furthering the financial prosperity of the Pasteur Institute!"
The financial prosperity of chiropractic, however, isn't ignored in texts on salesmanship. "The more you tell, the more you sell!" trumpeted that irrepressible propagandist, B.J. Palmer, and this note still echoes in chiropractic "practice building" classes. Students are coached on how to cultivate "chronic" patients who keep returning, how to scare a prospective patient into taking expensive treatments, how to spur advance or cash payment, how to get rid of poor payers, how to press the 'love button7 and make a patient feel wanted and welcome, and how to get testimonials for promotional advertisements. [These testimonials can backfire. One published in The Chicago Tribune read: "Before taking chiropractic and electric treatments, I was so nervous that nobody could sleep with me. After six treatments, anybody can sleep with me."]
Nor do the chiropractic schools lose sight of their own financial outlook. The catalog of the Columbia Institute of Chiropractic firmly states that "tuition fees are to be paid not later than the 5th of each month" or the student "will be automatically suspended." What's more, students must "satisfactorily clear all financial obligations at Columbia" before they can graduate.
After graduation, in 26 states, students are required to pass basic science examinations. How do they make out? In a survey made in five, states where the same basic science tests are given to students of chiropractic and students of medicine, an average of 81.4% of all graduates of medical schools passed on their first try, while an average of 84.5% of graduates of chiropractic schools failed.
With this sick record, it would seem that chiropractic schools can do little but lie down and die. That's not likely, though. There are still a lot of easy" states where examining boards composed only of chiropractors decide whether chiropractic graduates will be permitted to practice. And, as I found in my investigations, the higher standards in "tough ." states are only strengthening chiropractors' determination to get their schools officially accredited.
Meanwhile, as they grind out more graduates, the problem of chiropractic continues to grow for the medical profession. Dr. Joseph A. Sabatier Jr., chairman of the A.M.A. Committee on Quackery, calls for "a clear recognition of the fact that chiropractic is a political problem, not a scientific problem. It has not reached the scientific stage. Chiropractic is the greatest tribute to the efficacy of technically applied public relations the world has ever known. These people have been delivering a package since 1895, the sale of which depends entirely on the wrapping. The contents are not there."
This article was posted on June 9, 2001.