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The Selling of the Spine:
Chiropractors Wangle $100 Million Windfall

Congress Ignores False Testimony, Scientific Evidence
in Approving Medicare Coverage of Manipulation

Stephen Barrett, M.D.

This article was the cover story in the December 1972 issue of New Physician, the journal of the Student American Medical Association. Although the survey it describes showed that a chiropractic leader had lied to the Senate Finance Committee, the general news media did not think "another chiropractic exposé" was newsworthy.


Despite 75 years of thorough scientific debunking, the nation's chiropractic cult has managed not only to survive, but to prosper through the artful use of political muscle. And now some 18,000 chiropractors -- declared by the Department of Health, Education, and Welfare as unfit to diagnose or treat disease-appear to have gained early success in a campaign to create a $100 million annual federal bonanza for themselves.

The first goal of the campaign was achieved Oct. 30 when President Nixon signed into law the 1972 Social Security Amendments (HR 1). The amendments contain sections that expand the definition of physicians under Medicare and Medicaid to include chiropractors, allowing chiropractic services to be reimbursable as "physician's services." Although restricting reimbursable treatments to "manual manipulation of the spine to correct a subluxation demonstrated by to exist," the amendments represent a major victory in chiropractic's fight to wangle into the multibillion-dollar national health insurance programs now being developed. The immediate effect will not be known until HEW regulations governing X-ray validations are promulgated. However, during debate over the amendments, the Senate Finance Committee estimated that chiropractic inclusion could cost the public $100 million the first year.

The chiropractic victory is particularly frightening because of the bill's history. Unlike other politically motivated legislation, some of which has become law because of lack of opposition, the chiropractic amendment was fought long and hard by several medical organizations. The opposition was well organized and scientific from the start but was not a match for chiropractic's political muscle.

The first defeat for the medical profession came in March when the Senate Finance Committee approved chiropractic inclusion under Medicare despite its knowledge that official chiropractic testimony before the Committee was an irresponsible misrepresentation. The testimony was presented before the committee by William S. Day, president of the International Chiropractors Association, one of two national organizations claiming to represent the chiropractic profession. Day was questioned closely by Sen. Russel B. Long (D-La.), chairman of the committee, who was armed with a copy of the 1968 HEW report to Congress that declared chiropractic unfit to be included under federal health-care programs. Responding to Sen. Long's questions, Day insisted that chiropractors confine their treatments to correction of "spinal subluxations" and "related disorders of the nervous system" (see accompanying article for detailed testimony). Day specifically denied that chiropractors treat migraine headaches, ulcers or hepatitis.

 Excerpts from Day's Testimony

The scope of chiropractic practice was the basis for the following exchange between U.S. Sen. Russell B. Long, chairman of the Senate Finance Committee, and William S. Day, D.C., president of the International Chiropractors Association, in September, 1970. Day was also a state senator in Washington State and chairman of the legislature's committee on medicine, dentistry, drugs, public health, air and water pollution.
 
Sen. Long: Is a chiropractor qualified to diagnose cancer?
Dr. Day: A chiropractor is qualified in the area of differential diagnosis and it is taught completely in our schools at the present time . . .
 
Long: Well, suppose it is cancer of the blood, does a chiropractor have any competence to diagnose it?
Day: A chiropractor wouldn't attempt to diagnose cancer of the blood any more than a podiatrist who was examining a foot would diagnose cancer of the blood. A chiropractor is confined to the spine and its misalignment as it relates to the nervous system. A chiropractor who goes beyond that and attempts to treat such a thing as a visceral cancer or any type of malignancy is outside the scope of his practice.
 
Long: Are there quite a number of other ailments other than cancer which are outside the competence of a chiropractor?
Day: I would say definitely yes.
 
Long: Would you name some.
Day: Fractures, pathological systemic conditions, conditions that require medications, drugs or surgery. A chiropractor is principally confined in his practice to the spine and its misalignment as it relates to the nervous system . . .
 
Long: We have reports that chiropractors are trying to treat those kinds of ailments.
Day: "We have also had reports like that. We have both chiropractic and medical disciplinary boards where the chiropractic board is empowered to stop those practices which are illegal.
 
Long: Here is an HEW report (1968) . . . Here is the percentage of chiropractors that they say are reporting to be treating these conditions: headaches. I take it you contend that a chiropractor can help a headache.
Day: First, let me state categorically that the chiropractor does not claim to be able to cure all conditions. Now as to certain types of headaches . . . In fact we are very successful on many types of headaches.
 
Long: How about migraine?
Day: No.
 
Long: High blood pressure?
Day: There again, if it is diseased blood vessels and the lumens are narrowed, that is, arteriosclerosis, chiropractic certainly does not apply. If it is due to hypertension produced by interference with nerve functions or spinal misalignments, absolutely yes. . . .
 
Long: Ulcers?
Day: "Specific adjustment which removes interference to the nerve function and that is all the chiropractor does. We do not treat ulcers.
 
Long: You don't treat ulcers?
Day: No, sir.
 
Long: Well, this report says 76% of chiropractors report that they are treating ulcers. . .
Day: I don't know where they got those figures, Senator.
 
Long: Chronic heart condition.
Day: No, sir. I believe we cannot correct the pathology by a spinal adjustment where there is permanent damage, but it is certainly true that there is a neurological control of heart functions as there is of other functions.
 
Long: What about hepatitis?
Day: "Hepatitis is an infectious disease. We would refer this to a physician.
 
Long: According to this report, 32% of chiropractors reported treating hepatitis.

Day's testimony caught the eye of the Lehigh Valley (Pa.) Committee Against Health Fraud, a 35-member lay and professional organization devoted to exposure of deception in the field of health. The committee decided to investigate the accuracy of Day's remarks, particularly when it learned that the witness was accompanied during his appearance before the Senate by a New Mexico chiropractor, John Q. Thaxton, who had once advertised publicly that he treated migraine headaches.

The committee decided the most direct way to check the accuracy of Day's testimony was to send letters, ostensibly from prospective patients, to members of the ICA to see whether their responses jibed with the testimony of their president. The committee sent 152 ICA members throughout the U.S. letters that read as follows:

I have been suffering from ulcers and sometimes migraine headaches for many years. I am going to this chiropractor near my home now and he is helping me. But I am not finished with treatments and my husband has a job near you. Do you treat these conditions? Do you think I can finish my treatments with you?"

Twenty-two of the 152 letters were returned undelivered. Of the 130 remaining, there were replies from 110 chiropractors. Fifty-eight (53%) of those replying specifically stated they treated the diseases mentioned. Some of the replies:

Yes, I have had very good success with correcting the cause of ulcers (sic) and migraine headaches.

I'd be most happy to continue chiropractic treatment with you. My practice is made up of functional diseases such as ulcers and migraine headaches plus the usual number of back problems.

I, myself, am a living example of what chiropractic can do, having suffered with migraine headaches for almost 18 years, now almost 12 years with no headaches at all.

Twenty-four (22%) did not refer in their letter to the patient's migraine headaches or ulcers but said they would be glad to continue the treatment. Twenty (19%) did not discuss the patient's specific request but expressed interest in providing chiropractic services. The rest welcomed the letter but qualified their commentary on the treatment they might offer. Two said they could not answer without more details. Two said they could be of help if there were a vertebral misalignment. Other replies included:

No, we don't treat ulcers. We do, however, look for spinal misalignment of the vertebrae, which may, by their improper position, create an irritation to the nerve, which, in turn, supplies the stomach. This is what causes the secretion of hydrochloric acid causing the ulcer.

If you would speak to your chiropractor, he will explain to you that we do not treat any disease or symptom. We correct and remove the cause of the disease or symptom. I am sure he can, explain it to you fully when you see him on your next visit.

Another 111 chiropractors were sent a similar letter with a complaint of hepatitis. Nineteen letters were returned undelivered. Of the 92 remaining, 72 (78%) generated responses. Twenty-nine (40 %) of the respondents specifically stated they would treat hepatitis. Some replies were:

Yes, I take care of cases like yours, and chiropractic offers the safest and best health care for hepatitis, as well as many other conditions.

I will be moving . . . I will recommend a chiropractor whom I feel can handle your problem very well. He has adjusting abilities and also has a diapulse instrument which is exceptionally effective in hepatitis cases.

Seventeen (24%) did not reply specifically but said they would be glad to continue the treatment. Nineteen (26 percent) just welcomed the prospective patient. Only one said no:

The laws of the Commonwealth of Kentucky as pertaining to chiropractic require that all infections or communicable disease be reported to the state or local departments of health for treatment. As your condition may fall in this classification under state law I would be unable to accept your case solely on the basis of being able to treat hepatitis.

Full details of the Pennsylvania committee's investigation were made available to the Senate Finance Committee last February. Yet, despite complete discreditation of Day's testimony, the committee voted a month later to back inclusion of chiropractic under the Medicare law.

Such a development may seem irrational and unbelievable to anyone unfamiliar with chiropractic's record of political success despite strong opposition from organized medicine, labor and consumer groups. This success is based on the reality that chiropractors have devoted all their efforts to a single issue-politics. Unburdened by any research, scientific or educational expenditures, their organizations have pounced on any effort to limit the activities-and, therefore, the income -of their members. These organizations maintain a large number of personable, full-time lobbyists. They are supported by practicing chiropractors who persuade their .patients to write letters to legislators. The principles are simple-and effective. They depend on the realization that many legislators find such grass-roots pressure much more convincing than the cold facts of scientific investigation. And the effort has paid off-for the chiropractors, of course:

These successes have not gone unnoticed by the nation's physicians, who outnumber chiropractors 20-1. But the medical profession finds itself confronted with hundreds of health problems at national, state and local levels and can't devote all of its energy to fighting chiropractic. One result of this is a tendency for organized medicine to adopt a "defensive" posture toward chiropractic. Significantly, the Utah State Medical Society recently abandoned the typical defensive policy and assessed each of its members $100 for an anti-cultist campaign, directed against ' chiropractors and naturopaths. Such aggressive action was called for last January in an editorial in American Medical News, which is published by the American Medical Association. "The fight against the cult of chiropractic must be a high-priority item for the medical profession at all levels," the editorial stated, "in the interest of high quality health care for the American people."

To counter the successes of chiropractors, the medical profession will have to wage a combined educational and political campaign. The educational campaign is necessary to increase public awareness of the dangers and scientific bankruptcy of chiropractic. This part of the campaign should be the simplest, since there is a wealth of material documenting these points. However the material will be ineffective unless there is sufficient dedication at the local level to distribute and publicize it. . . .

The educational campaign, of course, is only part of the answer. As long as scientific medicine continues to be outmaneuvered on the political front, chiropractic will continue to flourish. Physicians and other health professionals must match the dedication of chiropractors -- dollar for dollar and letter for letter. Political pressure must be brought to bear at the grass-roots level to counter chiropractic where it has enjoyed its greatest successes.

B. J. Palmer, son of the founder of chiropractic and the most successful promoter of the cult once quipped, when asked the principle functions of the spine: "To support the head, to support the ribs and to support the chiropractor." That might be funny -- if it weren't so profoundly sad that countless Americans are endangering their health and wasting hundreds of millions of their scarce dollars.

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