5X5 Episode 92
|5X5 Episode 92|
|28th July 2010|
|5X5 91||5X5 93|
|S: Steven Novella|
|B: Bob Novella|
|J: Jay Novella|
|E: Evan Bernstein|
Chiropractic - Part 2
You're listening to the Skeptics' Guide 5x5, five minutes with five skeptics, with Steve, Jay, Rebecca, Bob and Evan.
S: This is the SGU 5X5 and tonight we're talking about chiropractic. This is part 2 in our discussion of the history of chiropractic. We're talking now about how chiropractic became an established profession.
At the turn of the 19th to 20th century, there actually was not a stable medical system. There was many competing systems of medicine. This was at the end of a time where in the United States there wasn't even much in the way of licensure—anyone could hang up a shingle and practice medicine. And there were many competing philosophies: there were magnetic healers, many other forms of so-called drugless healers, there were the purveyors of all kinds of patent medicine, and there were medical doctors who were organizing under the AMA at this time. In addition, there were osteopaths who focused on manipulating the bones in order to free the flow of blood through the arteries, and they thought that this was responsible for many diseases. In fact, at the time there was a lot of discussion about the fact that chiropractic was just a quote-unquote "bastardized" version of osteopathy, to the point even that D.D. Palmer was accused of having trained at an osteopathic school, and deriving a lot of his chiropractic philosophy from that. In any case, there were a great number of similarities between the two, and chiropractic felt the need to distinguish itself as an entity from medicine and from osteopathy in order to survive, again as a distinct entity. And at the time, also chiropractors were under a lot of pressure. Once licensure became common in the United States, and after the Flexner Report in 1910, there were increasing requirements of quality and a scientific basis to the practice and the regulation of medicine. Osteopathy went along with that, essentially, and became part of scientific medicine. But chiropractic did not go that route.
E: No, instead the Palmers (D.D. and his son B.J.) who ran the Palmer School of Chiropractic at that time, well they seriously considered developing chiropractic into a religion unto itself. They did this because it might have provided them some legal protections under the U.S. Constitution. It was a matter of chiropractors getting around the issue of practicing their medicine without a license. So instead of going that route, though, the chiropractic community tapped into the populist movement. They emphasized craft and hard work, competition, advertisement. Remember this was the 1910s, so think about the social environment going on at this time. This was the rise of the workers around this time in the United States. They aligned themselves with these people; with the common man, against intellectuals, against trusts and against, especially, the American Medical Association, who were the vanguards of science-based medicine at the time. B.J. Palmer was quoted as saying, chiropractic was "a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it", so that is the route they decided to go.
Back in the 1910s, there were thousands of chiropractors that were prosecuted for practicing medicine without a license. D.D. Palmer and many other chiropractors were jailed as a result. In defending chiropractors, it was B.J. Palmer who argued that chiropractic was separate and distinct from medicine. B.J. asserted that chiropractors analyzed rather than diagnosed, and made adjustments to subluxations rather than treating diseases. The Universal Chiropractors Association was founded by B.J. to provide legal services to chiropractors who would find themselves under arrest. The UCA won a test case in Wisconsin in 1907, but for the most part, prosecutions initiated by state medical boards became increasingly common, and in most cases they were very successful.
But in response, chiropractors and the UCA conducted political campaigns which secured several licensing statues. It eventually succeeded in all 50 states, starting with Kansas in 1913, right up through Louisiana in 1974. To this day, this long-standing battle between chiropractors and medical doctors continues to be played out in both the legal courts and the courts of public opinion.
B: It's a bit ironic that chiropractic was founded in 1895, the same year that X-rays were discovered by Röntgen. X-rays, of course, would eventually play a very important role in the history and development of chiropractic. Some techniques for taking X-rays in the early years were in fact patented by chiropractors. Today, X-ray techniques and spinal X-ray interpretation is an integral part of the chiropractic classroom and experience.
X-rays are clearly a powerful diagnostic tool for science-based doctors. Other tools used by chiropractors seem to be more salesmanship than anything that was really functional. An example is the neurocalometer introduced in the 1920s by B.J. Palmer for chiropractic. This controversial device was and still is said to locate pinched nerves, the cause of all disease, by their nerve heat. This use of instrumentality in chiropractic, whether legitimate or bogus, defines the two separate classes of chiropractor in the early part of the 1900s: the "straights" and the "mixers". The straights, including both D.D. and B.J. Palmer, didn't believe instruments should be used. The mixers did. Eventually B.J. became a mixer, supporting both x-rays and the neurocalometer, and eventually permanently marginalizing the straights.
J: The AMA is the American Medical Association and was founded in 1847, and really brief, some information on the AMA. Its mission is to promote the art and science of medicine from the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby [for legislation favorable to] physicians and patients, and to raise money for medical education. The association also publishes the Journal of the American Medical Association, otherwise known as JAMA, which has the largest circulation of any weekly medical journal in the world.
In 1963, the AMA committee on quackery was established by its board of trustees for the purpose to study the chiropractic problem. H. Doyle Taylor, who had already served 10 years on the AMA's Department of Investigation, was appointed the secretary of the committee. In 1971, in a memo to the AMA board of trustees, Taylor wrote, "your committee has considered its prime mission to be the first containment of chiropractic and ultimately the elimination of chiropractic."
So in 1976, Chester Wilk and four other chiropractors sued the AMA, several nation-wide health-care associations and several physicians for violations of section 1 and 2 of the Sherman Antitrust Act. The Sherman Antitrust Act covers restraint of trade, and restraint of trade is when one group is trying to inhibit or limit another group's right or ability to conduct business. And that was the first federal statute to limit cartels and monopolies. Until 1983, the AMA stated that it was unethical for medical doctors to associate with an unscientific practitioner, and labelled chiropractic an "unscientific cult". Wilkes won his lawsuit on September 25th, 1987. It was ruled that [the AMA] had violated sections 1 and 2 of the Sherman Act and that it had engaged in an unlawful conspiracy in restraint of trade to contain and eliminate the chiropractic profession.
S: But it should be noted that that decision was very narrow; it really only pertained to the restraint of trade. In fact, it was specifically stated in the decision that the AMA is free to criticize chiropractic for being unscientific, and it doesn't have to accept any of the unscientific or substandard practices or claims of chiropractors. It simply couldn't tell its own members specifically not to engage with the referred-to chiropractors. So while many people do disagree with that decision, it was very narrow. However, unfortunately, the AMA responded to that decision by significantly reducing their activities against all forms of what they would consider unscientific medicine or quackery.
So a lot of the success of chiropractic as a profession is actually based upon its political promotion of itself and the promotion of chiropractic as a business. At no point in time based upon any scientific evidence or research. Although in the last 20 years, there has been a significant amount of research into chiropractic, but we'll leave that as a topic for a future segment.
S: SGU 5x5 is a companion podcast to the Skeptics' Guide to the Universe, a weekly science podcast brought to you by the New England Skeptical Society in association with skepchick.org. For more information on this and other episodes, visit our website at www.theskepticsguide.org. Music is provided by Jake Wilson.
- Doctor Who? Inappropriate use of titles by some alternative "medicine" practitioners. The New Zealand Medical Journal, 25 July 2008, Vol. 121 No. 1278.