OSTEOPATHS AND CHIROPRACTORS

12 May

Andrew Taylor Still (1828–1917), the founder of osteopathy, was born in Virginia, but his father, a Methodist minister, was assigned to frontier communities in the Midwest. Like the early colonial preachers, Abram Still attended to both the physical and spiritual needs of his people. Although Andrew Still later claimed that he had attended medical school in Kansas City and served as a surgeon during the Civil War, he apparently became a doctor by assisting his father and reading text- books. Following the example of Vesalius, Still furthered his knowledge of anatomy by dissecting various animals and stealing bodies from burial grounds. After three of his children died of spinal meningitis, Still became profoundly dissatisfied with orthodox medicine. Religion, expe- rience, and sectarian practitioners contributed to his belief that con- ventional drugs were dangerous and addictive. But he did not find the rationale for contemporary alternatives to orthodox medicine entirely convincing until he began to envision a connection between magnetic healing and his studies of human mechanics. The body, he concluded, was a machine through which invisible magnetic fluid flowed. Disease was the result of disturbances or obstructions that interfered with the normal healthy movement of this essential fluid. It should, therefore, be possible to cure disease by restoring the harmonious flow of magnetic fluid within the human machine. In search of a new approach to medicine, Still came to the conclusion that a just and loving God would have created the necessary remedies for human sickness and suffering. In order to be sure that rem- edies were available when needed, God would have put all the remedies that human beings would ever need within the body.

What Still then dis- covered, at least to his own satisfaction, was osteopathy—an infallible method of adjusting the mechanism of the body so that the pre-existing remedies became available. By adjusting the bones, Still could cure dis- ease without drugs. He experimented with various names for his new approach to healing before discarding Magnetic Healer, Human Engi- neer, and Lightning Bone Setter. He finally decided to call his new science of natural healing osteopathy. Some critics, however, considered his manipulations a form of faith healing or the ‘‘laying on of hands.’’ Of course, Still did not invent the idea that the human body works like a machine, but he was ingenious in linking osteopathy to the popular concept of the ‘‘human motor.’’ According to Still, osteopathy was a sys- tem for ‘‘engineering the whole machinery of life.’’ The mechanical prin- ciple of leverage—manipulating bones as levers to relieve pressure on nerves and blood vessels—was the basis of osteopathic practice. Still compared the interdependence of all bodily organs to a great labor union. The body’s parts ‘‘belong to the brotherhood of labor’’ and, when the body was healthy, they worked together perfectly and harmoniously, but if one member of the union was mistreated, the body as a whole was affected. At that point, osteopathy was needed to relieve pain and restore health by adjustments and manipulations that led to the proper inte- gration of the body’s structural components. Allopaths often described the female body as inherently weak and prone to sickness, in addition to pathological states, such as menstruation, pregnancy, labor, birth, and menopause. In contrast, osteopaths argued that the basic cause of disease was the same for men and women: mechanical displacements and the maladjustment of body parts. In 1892, Still opened the American School of Osteopathy in Kirksville, Missouri, the first school to offer courses in osteopathic manipulative techniques, in addition to traditional classes in anatomy, diagnostics, chemistry, and so forth. Of the original class of 21 students, 5 were female. According to the Osteopathic Women’s National Associ- ation, female students were welcome at osteopathic schools and female graduates practiced successfully in many states.

As osteopaths incorpo- rated bacteriology, pharmacology, and other aspects of regular medicine, divisions developed between practitioners who remained close to Andrew Still’s views and those who adopted new theories, methods, and remedies. Nevertheless, osteopaths retained a general allegiance to the founder’s doctrines and manipulative methods. Despite opposition from orthodox practitioners, osteopaths retained their independence and by the end of the 1970s had become legally eligible for unlimited practice licenses—as D.O.s—in every state. No longer in danger of being labeled quacks and cultists, osteopaths were transformed into members of a ‘‘parallel profession’’ struggling to avoid losing its unique identity. By the end of the nineteenth century, as osteopaths gained a mea- sure of professional recognition, they found themselves battling both medical doctors and ‘‘osteopathic imitators.’’ Just as regular doctors tried to prosecute osteopaths for practicing medicine without a license, osteopaths charged their competitors with practicing unlicensed oste- opathy.

The most numerous and successful competitors, who called themselves chiropractors, argued that they were not practicing medicine or osteopathy. Chiropractic was founded by Daniel David Palmer (1845–1913). Canadian-born Palmer had been an itinerant tradesman and teacher before he settled down in Davenport, Iowa. An obsessive interest in human health and disease led him to experiment with spiri- tualism, phrenology, and osteopathy before he began to practice mag- netic healing, which skeptics considered a crude form of hypnotism. Palmer became convinced that there must be one specific cause of disease and, therefore, one true method of healing. In 1895, Palmer was sure that he had discovered the key to health and healing. According to Palmer’s account of this landmark event, when he examined Harvey Lillard, who had been deaf for 17 years, he discovered a subluxated (misaligned) vertebra. By applying pressure to Lillard’s spine and adjusting the vertebral column, Palmer reduced the subluxation and restored Lillard’s hearing almost instantly. Examin- ing a patient with heart trouble, Palmer found another subluxation and successfully cured this patient by adjusting the spine. Just as displaced bones caused painful bunions and corns, Palmer reasoned, luxated bones in the spine must press against nerves, increasing vibration, cre- ating tension and heat, altering tissue, modifying nerve impulses and causing abnormal functions in the affected tissues and organs. Palmer then constructed his own anatomical charts of the relationship between spinal nerves and the organs and tissues they affected and began treat- ing a variety of problems, including heart disease, asthma, kidney problems, and cancer.

One of Palmer’s satisfied patients suggested the name chiropractic, from the Greek cheiro and praktikos, for ‘‘done by hand’’ to designate Palmer’s new system of treatment. Chiropractic theory ascribed disease to a deficiency of nerve function caused by spinal misalignment or sub- luxation. The line of reasoning developed by Palmer was remarkably similar to that recounted by Andrew Taylor Still, the founder of osteo- pathy. Palmer reasoned that the body had its own supply of natural healing power and that this power was transmitted throughout the body by the nervous system. If a specific organ did not receive its proper nerve supply, it would become sick. Like osteopathy, chiropractic was a way of providing relief and healing through physical manipulation of the spinal column and other body structures. Palmer provided very specific details about his theory of disease and the effects of chiropractic manipulation, but many modern practi- tioners prefer to avoid scientific arguments and simply say that there is empirical evidence that chiropractic works, although understanding the physiological effects of spinal manipulation requires more research. One all-purpose explanation that is used to explain a myriad of thera- pies, conventional and unconventional, is that treatment may affect the release of chemicals that influence pain and pleasure sensations, such as substance P and endorphins. In 1906, Palmer and several colleagues were jailed and fined for practicing medicine without a license. A year later, one of Palmer’s for- mer students was arrested in Wisconsin for practicing medicine, surgery, and osteopathy without a license, but the judge and jury agreed that he was not practicing medicine, surgery, and osteopathy—he was practi- cing chiropractic. Chiropractors fought hard, state by state, to secure limited medical practice licensing. Although practitioners with such licenses are called ‘‘doctor,’’ the scope of their practice does not include the whole range of functions and activities granted to medical doctors. Podiatrists, for example, have limited practice licensing by virtue of their scope of practice, not their fundamental philosophy. A license that prohibits prescribing drugs or performing surgery is not a troublesome restriction for chiropractors, because these activities are not part of chiropractic. In 1913, Kansas became the first state to license chiroprac- tors. Currently, all 50 states have statutes recognizing and regulating the practice of chiropractic. In 1897, Daniel David Palmer offered the first classes in chiroprac- tic medicine at the Palmer School and Cure, later known as the Palmer Infirmary and Chiropractic Institute. Palmer’s son, Bartlett Joshua Palmer (1881–1961), was one of the school’s first students and instruc- tors.

Many rival schools opened and closed, but none could compete with ‘‘the Fountainhead ’’ established by the Palmers. Although Bartlett Joshua always claimed total confidence in the theory and efficacy of chiropractic, his critics noted that he went to medical doctors when he was sick and X-rays of his spine allegedly revealed ‘‘advanced degenerative arthritis with marked curvature.’’ In chiropractic tradition, D. D. Palmer is known as ‘‘The Discoverer,’’ Bartlett Joshua as ‘‘The Developer,’’ and David D. Palmer (1906–1978) as ‘‘The Educator.’’ Bartlett Joshua was a successful businessman and the school, which he described as a business that ‘‘manufactured chiropractors,’’ flourished under his administration. Bartlett Joshua’s wife, Mabel Heath Palmer (1881–1949), another Palmer graduate, taught anatomy and served as the treasurer of the School. Bartlett Joshua was particularly interested in the mysterious X-rays that had been discovered in 1895, the year in which his father discovered chiropractic adjustment. Chiropractors were soon using X-ray machines to create pictures of the spine as part of the search for subluxations. Since chiropractic became successful, there have been ideological divisions within the field. Chiropractors who objected to any methods other than spinal adjustments were called ‘‘straights.’’ Those who employ additional methods—such as nutritional therapy, massage, colonic irrigation, and even drugs—were called ‘‘mixers.’’ In reality, however, chiropractors have embraced a spectrum of beliefs rather than two separate and distinct schools of thought. Many chiropractors give advice on diet, nutrition, and exercise. Most visits to chiropractors are for musculoskeletal complaints, and almost half are for back pain. Diagnostic procedures such as X-ray, computed tomography, magnetic resonance imaging, and thermography may be used, followed by treat- ment with ice packs, heat packs, massage, guided movement, friction, traction, electrical current, ultrasound therapy, and Rolfing. Not all practitioners of Rolfing (also known as structural integration or somatic ontology), the technique developed by Ida P. Rolf (1896–1979), are chi- ropractors, but Rolfers also believe that health problems are caused by misalignments.

Rolf earned a Ph.D. in Biological Chemistry from Columbia Univer- sity, New York, in 1920. After 12 years at the Rockefeller Institute, Rolf went to Europe where she studied homeopathic medicine. Disillusioned by orthodox medicine, Rolf experimented with osteopathy, chiropractic, yoga, and other healing techniques before developing her own approach, which she called structural integration. According to Rolf, stiffness and thickening of the tissues surrounding the muscles lead to musculoskeletal dysfunction and misalignment of the body. Rolfing involves deep tissue massage, which is supposed to relieve stress and improve mobility, posture, balance, muscle function and efficiency, energy, and overall well being. According to chiropractors, since D. D. Palmer opened his first school, the AMA selected chiropractic as a prime target of ridicule and harassment. Despite attempts by the medical profession to portray chiropractic theory as ‘‘voodoo or witchcraft’’ or a ‘‘scientific fairy tale’’ and the profession as a form of ‘‘licensed medical superstition,’’ chiro- practors have enjoyed considerable success in the healthcare market- place. Some chiropractors have attempted to provide scientific evidence that spinal adjustment is effective in the treatment of various conditions, but, for the most part, support for chiropractic has come from testimo- nials rather than controlled clinical trials or animal experiments. Chiro- practors have reported treating migraine and tension headaches, low back pain, herniated lumbar disks, neck pain, asthma, carpal tunnel syndrome, ulcers, fibromyalgia, colic, jet lag, bed-wetting, AIDS-HIV, whiplash, and so forth, but the results of clinical studies have been ambi- guous. Outside the chiropractic community, the safety, as well as the effectiveness of spinal manipulative therapy remains controversial. Critics warn of increased risk of stroke, bleeding, and blood clots in the spine, fractures, nerve damage, muscle strains, sprains, spasms, and the risks of postponing conventional treatment for life-threatening diseases. Skeptics note that chiropractors are unlikely to win support from scien- tists and physicians when they insist that even cancer is caused by nerve blockage, or that manipulation affects ‘‘bio-energetic synchronization’’ or the flow of the ‘‘life forces’’ that heal the body, and that germ theory is wrong or irrelevant. When Congress passed the Medicare Act in 1967, it asked the Secretary of the Department of Health Education and Welfare (HEW) to study the question of whether certain types of practitioners who were not medical doctors should be included in the program. HEW’s report, entitled ‘‘Independent Practitioners Under Medicare,’’ recommended against the inclusion of chiropractors and naturopaths. In 1971, the Director of the AMA Department of Investigation and the Secretary of its Committee on Quackery (COQ), submitted a memo to the AMA Board of Trustees stating that the Committee’s prime mission was to contain the cult of chiropractic and, ultimately, to eliminate it. The AMA fought coverage of chiropractic under Medicare law, and the recognition of any chiropractic accrediting agency by the U.S. Office of Education. The Council on Chiropractic Education (CCE) adopted national standards in 1974, which are now recognized by the U.S. Department of Education. Since 1975, the CCE has accredited all U.S. chiropractic colleges and Medicare has reimbursed for chiropractic since 1972. After chiropractors filed and won a series of antitrust lawsuits against the AMA from the 1970s to the 1980s, the AMA has generally censored its references to chiropractic, at least in public. A lawsuit initiated in 1976 against the AMA, the American College of Radiology, the American College of Surgeons, and other critics, charged the defen- dants with conspiring to destroy chiropractic and illegally depriving chiropractors of access to laboratory, X-ray, and hospital facilities. In 1987, a federal court judge ruled that the AMA had engaged in an illegal boycott. Chiropractors claimed that the decision was a triumph for chiro- practic therapy, but the trial was decided primarily in response to evi- dence that the AMA had attempted to eliminate chiropractic as a competitor in the health care system.

The AMA was, therefore, guilty of engaging both ‘‘overtly and covertly’’ in a conspiracy ‘‘to contain and eliminate the chiropractic profession,’’ in violation of the Sherman Antitrust Act. The judge ordered a permanent injunction against the AMA to prevent such behavior in the future. In addition, the AMA was forced to publish the judge’s decision in the Journal of the American Medical Association. During the 1990s, several attempts by the AMA to overturn the injunction were unsuccessful. Continuing the litigious approach into the twenty-first century, chiropractic associations filed lawsuits against Blue Cross and Blue Shield for discriminating against chiropractors by limiting reimbursements for chiropractic procedures. In filing lawsuits against medical insurance companies, chiropractors demanded a ‘‘level playing field’’ with medical doctors and osteopaths.

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