The era 1895-1925-the first thirty years-was a time of iconoclastic, militant, and revolutionary individuals. DD Palmer and his son BJ Palmer were the most chronicled in this initial period of the chiropractic profession. Their early writings were at times inflammatory and provocative with concepts and theories not yet validated. Remember, in this era, antiseptic procedures and anesthesia were just emerging, and standard medical “care” included bloodletting, tobacco enemas and leeches. The cultural status and quality of medical care at that time, placed medicine in fierce competition with homeopathy, botanical medicines, osteopathy, dentistry and nursing, as well as all other healing concepts and nostrums.
DD Palmer was a practitioner of what was called “magnetic healing”. He had a keen interest in and knowledge of anatomy. His interest in anatomy led him to consider the effect of minor derangements of the spine (which he called “subluxations”) upon the nervous system. DD also mused that there was a connection between the nervous system and the regulation of human organ systems. He theorized that manipulation of the spine (which he called spinal adjustments) could have a salutary effect on the body. This concept evolved around the end of the 19th century. In 1897 DD Palmer incorporated his magnetic healing with physical manipulation skills to create the profession of chiropractic (meaning done by hand), a moniker offered by Samuel Weed, one of DD Palmer’s early patients. In 1902, DD left Davenport Iowa as his relations with his son BJ had become hostile and estranged. In 1906, he sold his school in Davenport to his son BJ Palmer, who is credited with the development of chiropractic concepts into a healing art and profession. DD subsequently went on to start several other schools around the United States.
The next period, that of 1925-1950, could be labeled a time of maturation. It was marked by an increased public awareness of chiropractic even as public acceptance remained a challenge. Chiropractic schools proliferated, perhaps in excess of 100, most being launched by former graduates of Palmer’s school who left with a more expansive view of chiropractic than that of BJ Palmer. Chiropractic leaders, such as Budden, Cale, Cleveland, Coggins, Haynes, Janse, Nugent, Ratledge, Schultze, Watkins and Wolf, were all fierce advocates for more robust chiropractic education.
This era included pressure for advancement in education and licensure ushering in a period of political activism in the chiropractic profession. Many states had not yet granted statutory authority for the doctor of chiropractic to become licensed to practice. Intense state and national political activity by chiropractic organizations (some with competing agendas) was undertaken in efforts to legitimize the chiropractic profession by obtaining licensure and federal recognition.
In the decades of the 1960s and 1970s, increasing public awareness and acceptance emboldened chiropractic’s primary adversaries. The most formidable was the AMA, whose clandestine activities to contain and eliminate the chiropractic profession were being planned and executed in an illegal plot to destroy chiropractic. These efforts involved a formidable disparagement campaign, characterizations of chiropractic as a cult and labeling of chiropractors as charlatans.
The “contain and eliminate” campaign of the AMA had three main objectives; to prevent chiropractic from obtaining academic recognition from the US Office of Education, to prevent chiropractic from obtaining inclusion in Medicare, and to continue to prevent the profession from uniting as a single cohesive organized group. The AMA was unsuccessful in preventing either the accreditation or the Medicare inclusion efforts, but the profession even in the year 2019 still remains intransigently divided.
The single biggest event in the legal history of chiropractic was the antitrust litigation filed in 1976 by Wilk, et al. v AMA, et al., a litigation marathon which lasted 17 years! Four chiropractors, Chester Wilk, Michael Pedigo, Patricia Arthur, and James Bryden, courageously filed the anti-trust action against the AMA. In a monumental victory, the court’s final ruling was in favor of the chiropractic plaintiffs. In a 101-page opinion, U.S. District Court Judge Susan Getzendanner ruled that the AMA and the other defendants engaged in a systematic, long-term wrongdoing against the chiropractic profession and committed other acts of ‘’lawlessness” in a concerted effort to destroy the profession. The most insightful commentary from Judge Getzandanner was:
‘’I conclude that an injunction is necessary in this case,” Getzendanner wrote. ‘’There are lingering effects of the conspiracy; the AMA has never acknowledged the lawlessness of its past conduct and in fact to this day maintains that it has always been in compliance with the antitrust laws; there has never been an affirmative statement by the AMA that it is ethical to associate with chiropractors.”
During the period from 1976 (when case was filed) to 1987 (when the case was decided by the U.S. District Court), and until 1990 (when the U.S. Supreme Court denied certiorari), the medical profession was itself under scrutiny. Many of the AMA’s clandestine activities were hampered and the easing of the medical bias campaign toward chiropractic lessened. The AMA’s anti-chiropractic conspiracy had dominated major American publications from Consumer Reports to Reader’s Digest to the syndicated columns of Ann Landers. The lingering effects of the former ban against professional cooperation between medical doctors and chiropractors continued in the media, military, Veteran’s Health Affairs, Congress and Corporate America. Despite the success of the Wilk litigation, the medical bias and institutional prejudice, the lack of government funding for research and training, and the resistance of appropriate professional inclusion following Judge Getzendanner’s ruling in 1987, continued.
The decades from the 1980s through to today were a period of professional maturation and advancement. Chiropractic colleges grew into modern day educational facilities, enrollments increased and regional and specialized accreditation brought greater recognition of chiropractic by the consuming public.
It is impossible to name all the individuals who have taken part in the development, advancement, proliferation and recognition of the profession during this time period. Leaders of state and national associations, colleges and organizations dedicated time, talent and treasure to advancing the profession. Scores of individuals walked tirelessly through the halls of Congress and their respective state legislatures. Many contributed to political action committees and served as volunteers in the successful effort to gain improved recognition for the chiropractic profession. This yielded considerable inclusion of chiropractic services in workers’ compensation, personal injury and major medical insurance programs.
The development and advancement in education and training, as well as universal licensure and the profession’s credentialing process, all continued generating significant progress. The National Board of Chiropractic Examiners developed sophisticated psychometrically sound examinations that became required for professional licensure. All educational institutions demanded stronger admission qualifications to meet societal expectations. The quest for legitimacy was progressing with unwavering determination.
The Gallup Organization performed polling in three consecutive years, 2015, 2016, 2017, to better understand American perception(s) of chiropractic. Each study recognized the increased utilization and acceptance of chiropractic services, particularly for neuro-musculoskeletal disorders. Persistent and continued reluctance by segments of the public toward chiropractic care was also noted. Evidence that many individuals still harbored long-held negative opinions regarding the education and training of doctors of chiropractic reminiscent of the AMA’s charges was also demonstrated. A program to educate the general public and de-bunk the long-held myths is underway.
The Gallup polling also revealed and confirmed an important consideration for the chiropractic profession and every other non-allopathic health care system that has survived. Despite fierce opposition by organized medicine with its meticulous and illegal construct of a negative professional image of chiropractic, the lack of government grants, and the need to self-fund research, chiropractic stood the test of time for one reason…clinical results. Patients whose health needs were not being met by traditional medical care, openly or secretly sought the services of doctors of chiropractic. It is the positive outcomes in delivering healthcare services that underpinned the survival of the profession during times when survival was improbable, if not impossible. In the colorful history of chiropractic and the long struggle for survival recognition and parity, it was the PATIENT that was most important, and it was the patient that was not forgotten.
From the 1940s through the 1970s, the number of U.S. chiropractic colleges declined, and those which survived remained under the watchful review of the Council on Chiropractic Education (CCE). In August of 1974, CCE received recognition by the United States Department of Education (then the United States Office of Education). CCE required periodic self-studies and on-site evaluations for those institutions to achieve and maintain continued accreditation.
Many of the colleges and universities today have had a long and established track record, some exceeding 100 years. Current colleges are Palmer College of Chiropractic (1897), University of Western States (1904), National University of Health Sciences (1906), Texas Chiropractic College (1908), Southern California University of Health Sciences (1911), New York Chiropractic College (1919), Cleveland University-Kansas City (1922), Logan College of Chiropractic (1935), Northwestern Health Sciences University (1941), Sherman College of Chiropractic (1973), Life University (1975), Life Chiropractic-West (1976), Parker University (1982), University of Bridgeport-School of Chiropractic (1991), D’Youville School of Health Professions (2004), Keiser University College of Chiropractic Medicine (2016).
The expansion of chiropractic education around the world has progressed at an unprecedented pace for the past 25 years, and the demand comes from third world countries to long established nations. The World Federation of Chiropractic (WFC), founded in 1988, has played a major role in world-wide acceptance and recognition from working with the World Health Organization (WHO) to facilitating the licensure and acceptance of chiropractic around the globe.
A serious consideration is currently underway as we move toward 2020 for a state university in the United States to begin a chiropractic program in the near future. This milestone would be the first chiropractic program in a U.S. public university system.
The advancement of the United States chiropractic educational institutions, as well as productive legislative efforts, permitted the inclusion of the chiropractic profession in many new areas. Among these are:
The inclusion of chiropractic services within the Veterans Administration’s program. This was a major milestone for chiropractic. There were scores of individuals whose contributions were significant in this regard, most notably those of Anthony Lisi, DC.
The Journal of Manipulative and Physiologic Therapeutics (JMPT), which was the vision of Joseph Janse, President of National College. Dr. Janse understood the necessity of a scientific journal in order to advance the profession. The journal was started in 1978 and has only had three editors, Hildebrandt (1978), Lawrence (1986) and Johnson (2005), all of whom have enhanced the image and standing of this well-referenced, peer-reviewed publication.
Another important phase of the maturation of the chiropractic profession and the achievement of recognition and credibility includes the dedication and commitment to research. History will easily recall the names Scott Haldeman, John Triano, Reed Phillips, David Cassidy, Gert Bronfort, Roni Evans, Christine Goertz, Heidi Haavik and a host of other prominent researchers, which limited space will not permit to mention. These individuals and many others obtained additional degrees such as MD, PhD, MS, EdD, MBA, JD, etc., in order to advance the research and education agenda. The scientific research developed by the chiropractic profession has enhanced and modified early concepts, and while the manipulative arts have been present throughout, they have been refined and significantly developed. Many of the early simplistic ideas relating to spinal derangement and human disease have been modified, deleted, refined or enhanced based on new research evidence published.
The Foundation for Chiropractic Education and Research (FCER) (1943-1999) was active in the 1970s, 1980s, 1990s, with the support of the National Chiropractic Mutual Insurance Company (NCMIC) and other organizations in early research efforts.
In 2003, the NCMIC Foundation, a (c) (3) not for profit charitable entity, was formed and during this time essentially “kick-started” the development of chiropractic research personnel and the funding of research projects in university settings in the US and efforts with other collaborative institutions abroad. The breadth and scope of this research effort has been unprecedented.
In a publication of limited scope, to capture the names and events of what catapulted a profession from virtual obscurity to significant prominence is daunting. The profession was plagued in the early formative years by internal disputes commonly thought to be over “straights” (focused primarily on chiropractic adjustments) and “mixers” (adding various forms of therapy) to their practices. Today that division is largely without merit as most of the profession incorporates ancillary adjunctive procedures which have therapeutic value to their practices. Today’s dividing lines relate to the possible inclusion of a limited pharmaceutical role or to remain non-pharmaceutical with a greater emphasis on a vitalistic approach to health and well-being, rather than a mechanistic model. The divide continues along these lines even into the second decade of the 21st century.
Chiropractic’s next chapter as we approach the year 2020 is now being written. Only a prophet could enumerate the changes and improvements that are yet to take place. One hundred years ago, chiropractic practitioners were jailed for practicing medicine without a license. Today there are doctors of chiropractic employed in major hospital institutions across the country on a peer level with every other employed practitioner. Very few could have foreseen that development and the current state of inclusion of the chiropractic profession. The common thread throughout the history of chiropractic was a fundamental belief that there was inherent wisdom in the body and that wisdom should be listened to. Classic examples of this concept could be illustrated by the overuse of antibiotics resulting in resistant strains of microorganisms and the incorporation now of “watchful waiting” as a new approach. The overuse and abuse of opioids prescriptions in seemingly treatable musculo-skeletal conditions by conservative chiropractic approaches and the deadly result of this cavalier approach has created a deadly opioid crisis.
Healthcare and research are changing, long-held views are being altered in brain research, and technology is enhancing not only the diagnosis but more conservative measures to incorporate self-help and self-care in the process. The focus of care tomorrow will be on maintaining health and wellness, rather than attempting to treat disease after it has been diagnosed. The paradigm shift is evident and will be a major course correction in what has been a very dis-ease focused world.
Who knows what tomorrow will bring, but stay tuned…it will be an exciting ride.