November 2006

Boiled frogs ‑‑ and the movement to 'contain and eliminate' chiropractic

by Dr. Christopher Kent

In its eleven decades of existence, the chiropractic profession has faced formidable challenges. From the jailing of founder D.D. Palmer, to the vicious attacks by the AMA, only the resolve of courageous practitioners and the patients they served carried the day.

On November 2, 1963, the AMA created a "Committee on Quackery" with the goal of first containing, and then eliminating chiropractic. Doyle Taylor, the director of the AMA Department of Investigation served as Secretary of the Committee on Quackery.

The House of Delegates, governing body of the American Medical Association, had said formally:

"Either the theories and practices of scientific medicine are right and those of the cultists are wrong, or the theories and practices of the cultists are right and those of scientific medicine are wrong." [1]

Before 1980, Principle 3 of the AMA Principles of Medical Ethics stated:

"A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." [2]

Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner", and labeled chiropractic "an unscientific cult." [1,2]

As a result, an antitrust suit was brought against the AMA and other medical associations in 1976 ‑‑ Wilk et al. vs AMA et al. The landmark lawsuit ended in 1987 when the Federal Appeals Court upheld the District Court decision finding that the AMA had engaged in conspiracy and restraint of trade. The judge in the Wilk case said:

"Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country." [3]

Today, many chiropractors feel that the battle is over, and that the campaign to contain and eliminate chiropractic is a thing of the past. Nothing could be farther from the truth. Instead of direct confrontation, our adversaries have adopted a "boiled frog" approach:

"They say that if you put a frog into a pot of boiling water, it will leap out right away to escape the danger.

But, if you put a frog in a kettle that is filled with water that is cool and pleasant, and then you gradually heat the kettle until it starts boiling, the frog will not become aware of the threat until it is too late. The frog's survival instincts are geared towards detecting sudden changes." [4]

I urge you to examine the following post‑Wilk developments. Our profession is now being subjected to a "boiled frog" approach. It should be obvious to any casual observer that chiropractic, as we know it, is still under siege, often with the cooperation of some of our professional organizations. We now have the following federal precedents regarding chiropractic:

1. Access to chiropractic care by medical referral only in the Veteran's Administration (VA) and Department of Defense (DoD).

2. Patients must have a musculoskeletal complaint to get Medicare reimbursement.

3. An Office of the Inspector General suggests that we're crooks providing services that aren't "medically necessary," such as maintenance care.

4. Chiropractic is classified as a "Body‑Based and Manipulative Method" along with massage, rather than an "Alternative Medicine System" such as acupuncture, naturopathy, and homeopathy by the National Center for Complementary and Alternative Medicine.

Turning chiropractic from a separate and distinct system within the healing arts to a mere therapy, lumped in with massage, for a narrow spectrum of musculoskeletal pain syndromes is no small feat. It can be accomplished only with the complicity of educational and reimbursement systems, and what Ayn Rand called "the sanction of the victims." For those of you who haven't yet felt the rising heat of the water, here's what else has been going on:

***  Third party payers (including Medicare) will generally reimburse only for treatment of patients suffering from symptomatic musculoskeletal disorders.

***  Like the VA and DoD (with the tacit approval of chiropractic politicians), access to chiropractic care is being limited in some managed care plans by requiring medical referral.

***  Vertebral subluxation, as a term and concept, is being downplayed at best, and vilified at worst, within the profession. The WFC identity statement does not include the term, and the WFC "Secretary General" discourages its use outside the profession..

***  Doctors of Physical Therapy (DPTs) are being positioned as the providers of musculoskeletal care, including diagnosis and manipulation. If DCs agree to be limited to caring for patients with musculoskeletal disorders, they can anticipate having the rug pulled out from under them by DPTs.

***  Third party payers and politicians within chiropractic are seeking to strip DCs of the tools needed to objectively assess vertebral subluxation and its effects, such as x‑ray spinography and instrumentation. Instead, they promote care based merely upon symptomatic response and questionable orthopedic tests.

***  Medicine is seeking legislation to limit the use of titles and designations by those who are not MDs, DOs, or DDSs. Will DCs remain "doctors?"

***  "Best Practices" are being drafted that restrict chiropractic to this narrow model.

***  Safety, one of chiropractic's greatest strengths, is being turned upside down with negative publicity. Patients are being discouraged from seeing DCs for anything but low back pain. The public is being sold the notion that cervical adjustments are dangerous.

If all this is happening, how can I say that chiropractic faces a glorious future? For one reason only. The truth will survive. The public is seeking leadership in wellness. They want strategies that will preserve and advance their quality‑of‑life. Science is moving in our direction with the "New Biology" as described by Lipton [5] and others, and further insights into the functions of the nervous system. We're poised to turn the health care system around.

The question is not, "Will chiropractic principles and practices survive?" The question is whether the chiropractic profession will be the one to apply them. Reggie Gold once asked, "If you were the last chiropractor on earth, would chiropractic survive?" Look in the mirror, and answer the question.

REFERENCES

1. "Chiropractic: the unscientific cult." AMA Department of Investigation. 1966.

2. Wikipedia. Chiropractic.

3. Summary of the Wilk case. http://www.chiro.org/abstracts/amavschiro.pdf

4. http://allaboutfrogs.org/stories/boiled.html

5. http://www.brucelipton.com

(Dr. Christopher Kent, president of the Council on Chiropractic Practice, is a 1973 graduate of Palmer College of Chiropractic. The WCA's "Chiropractic Researcher of the Year" in 1994, and recipient of that honor from the ICA in 1991, he was also named ICA "Chiropractor of the Year" in 1998. He is director of research and a co‑founder of Chiropractic Leadership Alliance. An attorney as well as a chiropractor, Dr. Kent is a member of the California bar. With Dr. Patrick Gentempo, Jr., Dr. Kent produces a monthly audio series, "On Purpose," covering current events in science, politics and philosophy of vital interest to the practicing chiropractor. For subscription information call 800‑892‑6463.)