May 1992

Five years after Wilk ...

The door has been kicked wide open!

by Dr. Michael D. Pedigo

I am writing in response to the article "Five years after Wilk...has anything really changed?". This article appeared in the March 1992 issue of The Chiropractic Journal. The author(s) was not identified. As one of the plaintiffs in the Wilk v AMA anti‑trust lawsuit I feel compelled to respond.

The article was based on incomplete data and incorrect assumptions about the lawsuit, and then arrived at the false conclusion that little has changed as a result of the lawsuit.

The major flaw in the article is that it reached its conclusion without comparing the way things were before the lawsuit to the way things are now. When one does that, it is clear that massive, major positive changes have occurred for our profession. Furthermore, the benefits are continuing.

The lawsuit has become a "landmark" case that has forever changed health care in America for all health care professions, not just chiropractic. Whenever lawyers write about anti‑trust health care issues they cite Wilk as the standard. It has become to anti‑trust health care issues they cite Wilk as the standard. It has become to anti‑trust health care issues what Roe v Wade is to the abortion issue.

Another mistake the article makes is that it presents expectations beyond the scope of the lawsuit.

The plaintiffs never expected nor promoted the lawsuit to be a panacea for all of the profession's problems. Nor was it a suit to restrict freedom of speech, or force individual doctors to accept or make referrals. It was not even a lawsuit to prove the value of chiropractic. Even so, one of the side benefits that came out of the suit was testimony and documentation by M.D.s that chiropractic care was twice as effective as medical treatment for some conditions.

The article states, "horror stories abound." The examples given have to do with the individual right of free speech and the right of an individual M.D. to accept or make a referral from or to a chiropractor. In the U.S.A. the Constitution grants freedom of speech to all.

It is illegal, however, for a group to band together as the AMA and others have done, to stop interprofessional cooperation between M.D.s and D.C.s. To those who want to take away the individual M.D.'s right to free speech and to choose who s/he will associate with or which patients s/he will accept. I ask, are you willing to give up those rights?

The Wilk v AMA case was a simple anti‑trust lawsuit. As important as that was, that is all it was. The Sherman antitrust laws state that it is illegal for a group of individuals to join together in order to boycott another group or an individual. A successful lawsuit would have been one that stopped the boycott. We got that and much more.

There is a major difference between a simple anti‑trust suit and a class action anti‑trust suit. Our simple suit represented only the four plaintiffs, while a class action suit would have represented the entire profession, cost much more, and been more complicated and difficult to win.

However, our victory had the same effect that a class action suit would have had. That is almost unheard of. The AMA repeatedly argued that this was a class action suit disguised as a simple anti‑trust suit, and asked the judge to throw it out of court. That was a concern we repeatedly faced, but the judge did not buy their argument.

When the Wilk case is viewed in its proper context of being an anti‑trust case, and when comparing the way things were before the suit to the way they are now, it is clear that this suit has had -- and is continuing to have -- a major positive impact on our profession. The evidence to support that statement is easy to find and readily available to anyone wishing to research the topic.

To understand what Wilk has accomplished thus far requires a comparison to pre‑Wilk (before 19976). A significant percent of today's chiropractors, possibly over 50%, were not in practice then. They must rely on recorded history. That is why it is important to set the record straight. To leave the article in question unchallenged would be a disservice to history.

In the early '60s, the AMA had become concerned about the increasing interprofessional cooperation between M.D.s and D.C.s so they created the Committee on Quackery with its "prime mission to be, first, the containment of chiropractic and ultimately, the elimination of chiropractic."

They created an ethical ban against any association by medical doctors with chiropractors in order to give them clout against those M.D.s that wanted to associate with chiropractors.

"It is the position of the medical profession that chiropractic is an unscientific cult ... The Principles of Medical Ethics proscribe [prohibit, forbid] all voluntary professional associations between doctors of medicine and sectarian or cult practitioners."

Compare that position to today's:

AMA's NEW STATEMENT ON CHIROPRACTIC, printed in the American Medical News, January 13, 1992.

"Revised opinion on chiropractors -- Revised Paragraph 3.08 of the Current Opinions of the Council on Ethical and Judicial Affairs:

"CHIROPRACTIC. It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic service to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic."

Not long after we filed the lawsuit, the AMA lifted the ethical ban against chiropractors, however, they used "weasel words" in doing so with an obvious attempt to dilute the lawsuit. Judge Getzendanner said "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 chiropractic..."

None the less, it had a positive effect on interprofessional cooperation. At a grass‑roots level more and more M.D.s began to accept and make referrals to D.C.s. A few hospitals also opened their doors. M.D.s began to accept invitations to speak at chiropractic colleges and association meetings. Some M.D.s became faculty members at chiropractic colleges. Others began to do joint D.C./M.D. research.

The AMA finally changed its official position on chiropractic to a positive, clear statement. The Jan. 13, 1992 issue of AMA News was the first time their new position was made public (see above quote).

It is hard to comprehend how massive the AMA's anti‑chiropractic campaign was prior to Wilk.

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; conduct a massive disinformation campaign to discredit and de‑stabilize the chiropractic profession; and engage in numerous other activities to maintain a medical physician monopoly over health care in this country.

They went around the country telling M.D.s and medical students that chiropractors were "killers and rabid dogs." They brainwashed every segment of society that they had influence with. In those days the AMA was considered "Godlike" by many. "If they said it, then it must be true!"

Before Wilk, every chiropractor strongly felt the effects of the boycott. Patients were afraid to tell their M.D. they were seeing a D.C. for fear of ridicule, or being dismissed as a patient. Those that were brave enough to speak up were told not to go to "quack" chiropractors, "they will kill you."

Today, that is much less likely to occur. Frequently, M.D.s instruct the patient to continue if it's helping. More and more M.D.s are referring patients to D.C.s.

Of course, there are many M.D.s that still bad‑mouth D.C.s and many people that will never go to a chiropractor. The AMA's brainwashing was very effective. Once people get set in their ways it is difficult to change that belief system. That is why we need a massive PR program. The point is things are improving. It started slowly in 1976, but has gradually increased. In the past year interprofessional cooperation has dramatically accelerated in much of this country.

This lawsuit has become known as Wilk v AMA, but let's not forget the suit was filed against the AMA and 14 other medical associations and individuals which resulted in significant settlements and positive results. They were: the American Hospital Association; the American College of Surgeons; the American College of Physicians; the Joint Commission on Accreditation of Hospitals; the American College of Radiology; the American Academy of Orthopedic Surgeons; the American Osteopathic Association; the American Academy of Physical Medicine and Rehabilitation; the Illinois State Medical Society; the Chicago Medical Society; the Medical Society of Cook County; H. Doyl Taylor; Dr. Joseph Sabatier, Jr.; Dr. Thomas Ballantine; and Dr. James Sammons.

Our profession has had more positive media coverage since Wilk than in its entire history prior to Wilk. A few examples:

The American Medical News, January 13, 1992 carried a 2,000‑word article written by our attorney George P. McAndrews. This article has stimulated calls and letters from M.D.s all over the country requesting more information. Many have stated that they were unaware that there was any valid research to support chiropractic care. Some have expressed interest in joint research.

The Illinois Medical Journal, April, 1985, Vol. 167:4 published the following:

"STATEMENT ON INTERPROFESSIONAL RELATIONS WITH DOCTORS OF CHIROPRACTIC

"The Illinois State Medical Society [ISMS] declares that, except as provided by law (statute or final judicial opinion), there are and should be no ethical or collective impediments to full professional association and cooperation between doctors of chiropractic and medical physicians. Individual choice by a medical physician voluntarily to associate professionally or otherwise cooperate with a doctor of chiropractic should be governed only by legal restrictions, if any, and by the individual medical physician's personal judgment as to what is in the best interest of a patient or patients.

"Professional association and cooperation, as referred to above, includes, but is not limited to: referrals, consultations, group practice in partnerships. HMOs, PPOs, and other alternative health care delivery systems; the provision of treatment privileges and diagnostic services (including radiological and other laboratory facilities) in or through hospital facilities; working with and cooperating with doctors of chiropractic in hospital settings where the hospital's governing board, acting in accordance with applicable law and that hospital's standards, elects to provide privileges or services to doctors of chiropractic; association and cooperation in hospital training programs for students in chiropractic colleges under suitable guidelines arrived at by the hospital and chiropractic college authorities; participation in student exchange programs between chiropractic and medical colleges; cooperation in research programs and the publication of research material in appropriate journals in accordance with established editorial policy of said journals; participation in health care seminars, health fairs or continuing education programs; and any other association or cooperation designed to foster better health care of patients of medical physicians, doctors of chiropractic, or both."

This statement was the result of our settlement agreement with the Illinois Medical Society and resulted in a few hospitals opening their doors, increased M.D.s and D.C.s referring patients to each other and some practice partnerships between chiropractors and medical doctors.

September 24, 1987 we settled with the American College of Radiology (ACR) which resulted in a similar statement as the one by the ISMS quoted above. This opened the door to radiological labs and MRI centers across the country. Pre‑Wilk we had no access to those facilities. Today they solicit our business.

The San Francisco Examiner, Sept. 1, 1990, reported in a syndicated column by Eugene Robin, M.D.: "I have had an arrogant and condescending attitude toward chiropractors and their treatment of various illnesses, including low back pain.

A recently published, extensive study conducted in England over a 16‑year period has demonstrated that in the treatment of low back pain, physician arrogance toward chiropractic is unjustified."

Newspaper articles have positively reported the lawsuit and chiropractic all across the country with headlines such as;

"80s chiropractors in sync with demand" (Oakland Tribune, Jan. 10, 1988); "U.S. Judge Finds Medical Group Conspired Against Chiropractors" (New York Times, Aug. 1987); and "Judge hits AMA on chiropractors" (Chicago Sun Times, Aug. 29, 1987). "Hospital Allows Chiropractors to Treat Out‑patients on Physicians' Turf" (Los Angeles Times, June 18, 1989); and "Chiropractor a hero after taking on AMA: (Hayward Daily Review, Fed. 14, 1991).

More: "Chiropractors Cite Progress in Bid for Place in Medicine" (Medical World News, Sept. 12, 1988); and "Should chiropractors be granted hospital privileges" (Physician's Weekly, Aug. 31, 1987). "Physicians working with chiropractors: A growing trend" (Back Pain Monitor, March, 1988); "What Happens When Chiros Get Hospital Privileges" (Medical Economics, Jan. 4, 1988); and "Joint Effort by M.D.s, D.C.s Praised at Trial" (American Medical News, June 26, 1987).

Still more: "Chiropractors find judge with backbone" (San Francisco Examiner, Aug. 29, 1987: "AMA guilty of antitrust plot to 'eliminate' chiropractors" (Fresno Bee, Aug. 29, 1987); "Boycott of Chiropractors by the AMA, Others Broke Antitrust Law, Judge Rules" (Wall Street Journal, Aug. 31, 1987); and "Chiropractors win antitrust action against AMA boycott, mudslinging (Arizona Daily Star, Aug. 29, 1987).

That is just a small sampling of print media coverage. Chiropractic has also been receiving positive radio and TV coverage. Chiropractors have been on talk shows all over the country.

The "NBC News Today" show with Bryant Gumbel and Deborah Norville did a very pro‑chiropractic story on July 23, 1987 with guests Sharon Ives, one of Dr. Wilk's patients who was relieved of severe headaches by Dr. Wilk after medical treatment failures; Dr. Freid, a D.C. and M.D.; and Dr. White, the orthopedic surgeon that operated on Joe Montana's back.

Gumble said, "If we're talking about alignment, Dr. White, why can't a spine surgeon or a medical doctor do that? White replied, "We do, surgically. I align spines surgically, he [the chiropractor] aligns spines with his hands. That takes years of learning how to use your hands to make spines straight. I don't have that talent. But it also takes years to learn how to do surgery, he doesn't have that talent."

Before Wilk, Dr. White would not have been permitted to make such statements about chiropractic, nor would he have been allowed to have a chiropractor on his staff as he currently does.

The Canada Family Physician, March 31, 1985 reported a research project done by Kirkaldy‑Willis, M.D., and David Cassidy, D.C. where 283 patients had severe chronic pain for eight years and medical treatment had failed. They were treated with chiropractic adjustments, and 70 to 80% were greatly improved or pain‑free in a short period of time.

The Western Journal of Medicine, March 1989 reported "Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66%) versus 22%) respectively." This kind of reporting in medical journals would never have been allowed before Wilk.

Spine, Volume 16, November 10, 1991 reported the North American Spine Society's Ad Hoc Committee on Diagnostic and Therapeutic Procedures ratings for various therapeutic procedures. The ratings went from "I, Generally accepted well established, and widely used," to "VI. Of no proven value."

Here is how Manual Therapy was rated:

"Procedure Category: I [The highest rating] ‑ Joint manipulation, soft tissue mobilization, therapeutic massage, and chiropractic adjustments are modalities included in this category."

Has anything really changed since Wilk? You bet! Before Wilk, chiropractic would not have even been mentioned in a prestigious medical journal like Spine and a prestigious medical society like the North American Spine Society would have rated it a VI., "of no proven value," if at all. They certainly would not have specified "chiropractic adjustment." They would have left it generic as "joint manipulation."

As a general rule, all forms of media coverage have been much more positive than pre‑Wilk. Pre‑Wilk the media frequently blasted chiropractic as a cult and quackery. Certainly the media does not give chiropractic all cheers and praise, but they don't do that for the medical profession anymore either. The trend is to present pro and con about chiropractic, which is much better than all con. Most coverage is more pro than con these days.

The article "...has anything really changed?" states that "A comparison to current coverage of chiropractic with that of pre‑Wilk era shows very little difference." That just is not true. Of course there is room for improvement, and there are unwarranted and mean spirited attacks on our profession, but overall, the difference between pre‑Wilk and now is like the difference between day and night!

The most recent example was the Feb. 21, 1992 TV program of "20/20." While the program dealt with a very limited part of chiropractic, it was overall very positive.

When they cut to a neurosurgeon that bad‑mouthed chiropractic, they discredit him by going to Paul Shekelle, M.D. of RAND who counters with a statement about how there are more research studies showing chiropractic is effective for low back pain than many of the things M.D.s routinely do to patients. That was a major shift in reporting from times past. In the past, it was common practice to have a chiropractor make a statement and then have an M.D. follow with a counter statement. Yes, things are changing.

I frequently hear chiropractors complaining about media coverage or medical reports that limit chiropractic's effectiveness to just treating low back pain and criticizing our profession for making claims of broad scope health care.

Wilk v AMA did not stop free speech and it did not cause society to suddenly believe every claim every D.C. makes. What it did was to stop the illegal boycott and kick wide open the doors of opportunity for professional advancement. It is up to the profession to convince society that we have something to offer them and the value of our services. That effort is helped by solid research and hurt by unsubstantiated claims and unprofessional advertising and gimmicks. What a challenge. Let's get on with the research. The problem is now one that we can and must solve.

Most of the recent positive media reports were stimulated by two things: the Wilk victory, and research studies mostly relating to low back. If this profession does not want its members to be labeled just low back doctors, then it had better start doing research to prove otherwise. In the meantime, the low back research showing chiropractic is more effective than medical treatment has resulted in major positive press for our profession.

One example is the British Medical Journal's June 2, 1990 report (the Meade study) about chiropractic care being much more effective than medical care -- both short and long term -- for low back pain. The report has received media coverage all over the world. Even the Sept. 11, 1990 "Harvard Medical School Health Letter" reported, "British researchers found support for chiropractic treatment, and an American team has pulled the plug on transcutaneous electric nerve stimulation (TENS)." Can you imagine Harvard Medical School printing such a story in pre‑Wilk days?

A recent research project was conducted in England to see what impact the Meade study had on the practices of chiropractors in England after the study received wide spread media coverage. The European Journal of Chiropractic, 7, 1991, 39, 59‑63 reported, "Although there was an increase in new patient numbers which was to some extent sustained, there was a more noticeable increase in medical referrals."

Scientifically valid research is critical for this profession if we are to be included in the coming national health program, etc.

Before I close, I want to share one more example of how things have changed from the days of pre‑Wilk when M.C.s were forbidden to associate with chiropractors. The following quote is from a Nov. 23, 1990 letter by Dr. Haldeman to a Medical doctor that was upset about the American Back Society having chiropractors on the program.

"I assume you have similar concerns about the North American Spine Society which is made up of 85% spine surgeons as they had three chiropractors presenting papers at their last meeting in Monterey. I assume you also have similar concerns about the International Society for the Study of the Lumbar spine which has had at least half a dozen papers presented by chiropractors on their program.

"As a matter of fact, the next American Academy of Orthopedic Surgery has a symposium on manipulation which will be primarily a discussion of chiropractic as they provide the majority of manipulative treatment in North America. One of the speakers in that program happens to have a chiropractic degree.

"It appears to me that if you maintain your current unwillingness to participate in a program that includes chiropractic speakers that you would be virtually eliminating your attendance at any scientific spine meeting in North America."

The evidence I have presented here is just a drop in the bucket as to what is available to prove that there have been major changes because of the Wilk v AMA anti‑trust lawsuit. The door has been kicked wide open. How is this profession going to use its golden opportunity?

Will we come together as a profession or will we remain divided? Will we do the needed research to prove the full value of our profession, or will we cry that the scientific community won't accept all chiropractors' claims just because we say it's so? Will we cry foul every time someone criticized the profession, or will we accept the challenges before us?

It's up to us!

-----

We're still being ignored, bad‑mouthed & pigeon‑holed by Dr. Terry A. Rondberg

The article "Five years after Wilk..." was a particularly important one for the profession and I am glad to see that it has generated so much interest throughout the country. I'd like to take this opportunity to respond to some of the points Dr. Pedigo makes.

First, it should be noted that most staff‑written pieces reflect the ideas and research of more than one person and -- as is the policy of most major newspapers -- do not carry a byline.

Contrary to what he states, the article was NOT based on incomplete data and incorrect assumptions about the lawsuit. It was a review of some of the current media coverage of chiropractic. Excerpts from actual print and broadcast pieces were used to illustrate the point that, when it comes to the way chiropractic is treated by most of the media, little has changed since Wilk v AMA.

I'd like to emphasize from the start that we did not criticize the accomplishments of the case, or its plaintiffs. In fact, The Chiropractic Journal was consistently a strong supported of Dr. Wilk and continually ran his articles and find raising appeals. We reported each step of the case's progress and have always applauded the courage and conviction of the men and women involved in that lengthy and difficult suit.

Nor did the article say that Wilk v AMA was supposed to automatically change the way everyone thinks about chiropractic.

Yet, for years the entire profession was called upon to support and contribute money to this worthy cause. Thousands, if not millions, of dollars were collected to finance it. A victory, we were told, would affect each one of us. I suppose it was only natural that doctors trusted the ramifications of this landmark case would quickly be felt outside the law offices and courtrooms.

We had hoped that the general attitude of the public, and the media, would change significantly once the startling evidence of widespread medical conspiracy was revealed.

Now, Dr. Pedigo points out to us that Wilk v AMA was a "simple anti‑trust lawsuit."

Even given the heightened expectations, no one ever thought (and the article never claimed) that the Wilk case decision would "force" medical doctors into befriending their local chiropractor -- or even stop them from calling us quacks. No one is holding the case, or the plaintiffs, responsible for the fact that the same lies are still being told, although perhaps couched in wording that's just a bit more subtle.

Actually, the article we ran in The Chiropractic Journal wasn't about the Wilk case at all! Let's not be distracted by red herrings. The subject examined in the "Five years after Wilk ..." article was the way that chiropractic is being covered in the media, not the Wilk case itself.

The article clearly and accurately showed that not much has changed since the case was decided. Obviously, the official AMA policy on chiropractic is different today (although, as Dr. Pedigo pointed out, the ethical ban against D.C.s was lifter "not long after" the lawsuit was filed in 1976). This past January, the AMA did print the court order in its weekly publication the American Medical News, along with an article by George McAndrews.

BUT ... in a subsequent issue, it published several letters to the editor blasting McAndrews' article.

One of them said: "I read, with a sick feeling in the pit of my stomach, the apologia of George P. McAndrews... (whose) arguments for the legitimacy of chiropractic and the inclusion of chiropractors in the allopathic medical community are based on the same tired arguments to which we have been subjected for so many years."

Another read: "Having read McAndrews' ludicrous argument concerning the validity of chiropractic treatments. I can only shake my head in disbelief..."

Still another compared chiropractic care to silicone breast implants, asking: "Will McAndrews and his clients be willing to place cervical manipulation on hold as a method of relieving neck pain until the chiropractic profession proves it is safe?"

A Detroit M.D. wrote: "I have encountered many patients who have been victimized by chiropractors. I was  therefore pleased to discover, although belatedly, that my professional organization did make a valiant, even through unsuccessful effort to curtail these practices."

A Vermont D.O. offered his opinion, saying, "I have heard too many questionable occurrences with chiropractors to accept them as equals on the health care team."

Granted, the AMA news printed a couple of positive responses -- but only after all the D.C.‑bashers had had their say.

Clearly, having the AMA officially say it's okay to associate with D.C.s (although it clearly tells members they are under no compulsion to do so), is a hollow victory if the message doesn't get through to most of the membership.

Dr. Pedigo also reminds us that "before Wilk, every chiropractor strongly felt the effects of the boycott. Patients were afraid to tell their M.D.s they were seeing a D.C. for fear of ridicule or being dismissed as a patient." Unfortunately, that, too, has not changed to the extent many of us had anticipated. Many M.D.s -- including those with prominent media connections -- continue to warn the public against "dangerous" chiropractic manipulations.

Undeniably, things HAVE changed somewhat, and many chiropractors are establishing productive relationships with medical doctors. But as long as D.C.s are still being boycotted, harassed, and discriminated against, it's far too early to start ringing the victory bell.

Dr. Pedigo also notes that "our profession has had more positive media coverage since Wilk than in its entire history prior to Wilk." As examples, he cites the court order and McAndrews' address in American Medical News, and articles in the Illinois Medical Journal, Medical Economics, Medical World News, Physician's Weekly, and The Western Journal of Medicine.

These must be counted as pluses -- though many of them are, at best, cautious in their approval manipulations. Yet, how many of our present and prospective patients read these publications? So, while a few medical doctors are being convinced, the effect is not yet visible in the "real" world.

Dr. Pedigo also lists articles in several mainstream newspapers which have given the nod to chiropractic. They, too, are encouraging signs that progress is occurring. It's gratifying to see that some publications are including us. Whenever I see a really positive article about chiropractic, I celebrate and try to write to the publication expressing my thanks.

But, let's not get carried away. Most pieces dealing with chiropractic -- as pointed out in the Journal article -- contain the obligatory qualification that "medical doctors still are skeptical" or similar wording. Some, like last year's Time magazine piece, quote numerous medical doctors and feature few, if any, comments by chiropractors.

A couple of recent examples (not included in the "Five years after Wilk..." article) include:

*** Consumer Reports on Health, February 1992: "See your (medical) physician first... to rule out underlying problems that manipulation...could make worse. If you do choose a chiropractor to manipulate your back, look for a member of the National Association for Chiropractic Medicine, which disavows the theory of subluxations and endorses only treatment of musculoskeletal disorders."

*** American Health, April 1992: "While the (RAND study) panel addressed spinal manipulation, it did not evaluate the validity of chiropractic theory. 'I don't for a second believe in what chiropractors call subluxations,' Shekelle says." (Note: Paul Shekelle, M.D., was the lead researcher for the RAND study).

In addition, a recent rash of articles on back pain in other consumer magazines (including Living Well, the new joint AMA‑Good Housekeeping publication) have totally ignored chiropractic!

One major problem is that we are often so thankful to be mentioned in an article or on a news show, that we are not too concerned about either the coverage's context or content.

A good case in point is the recent "20/20" television report which clearly gave the wrong impression that the only thing chiropractic might be effective for in some cases is low back pain.

Further, the implication was that people should go to a chiropractor only after drugs and medical treatment failed and only with a referral from a medical doctor! As the kicker, the medical editor of the piece noted that the RAND study wasn't referring to chiropractors at all, but to manipulation, which can be performed by medical doctors and physical therapists.

It's hard to believe anyone in the profession could consider THAT, as Dr. Pedigo puts it, "overall very positive." True, they didn't come out and say we were quacks, but neither did they clearly allow the mantle of legitimacy to rest on chiropractic's broad shoulders.

I agree wholeheartedly with him that we should support research to prove the full value of our profession and meet the challenges before us. I also think we need to stop kidding ourselves about how rosy things are right now and how much the medical establishment is changing in its attitude toward us. We must look critically at media coverage of chiropractic and try to generate truly positive analyses of the profession, rather than stay content with what we've been getting.

I also agree that chiropractic must come together in order to accomplish anything of lasting value. A good start in that direction would be to stop the typical knee‑jerk attack response within the profession of "just because so‑and‑so did, said or printed it, it must be wrong."

Let's start offering constructive criticism rather than continue to dump unfounded accusations on those we don't agree with, are jealous of, or just plain don't like. Let's quit playing the old cold war game of trying to pit one side against the other (the old "do what I want, or I'll go to the Soviets/Americans and then you'll be sorry"). Let's stop the barrage of insults and promise ourselves that we'll do all we can to support each other.

After all, if we don't respect one another, how in the world can we possibly expect others to do the same?