CAMLAW: Complementary and Alternative Medicine Law Blog

Medical Doctors vs. Chiropractors: History Repeats Itself

The dark legacy of MDs vs. DCs is repeating itself, with an assault by medical school professors at Florida State's new medical college against a proposed chiropractic school.

The Chronicle of Higher Education reported the opposition in a story with the ugly title, "Doctors at Florida State's new medical college say a proposed chiropractic school would be a pain in the neck."

For patients who have neck pain and for their caregivers, the attempt at humor is probably less than amusing. So, too, the political storm.

According to the article, about 70 medical professors "reportedly signed petitions against the school, and eight part-time medical professors have threatened to quit if it opens. The controversy has opened an angry debate between chiropractors and more-traditional doctors and raised questions about the way higher-education decisions are made in Florida. Ultimately, the battle is about legitimacy."

The debate over legitimacy is not new, and indeed, has for some time been resolved, at least in law, regulation, ethics,and policy. The landmark case of Wilk v. AMA established that the American Medical Association had engaged in a conspiracy to eliminate chiropractic, a licensed profession. That conspiracy was illegal.

Now the conspiracy has morphed into a more localized, open spectacle.

Last year the state Legislature, "led by a well-connected chiropractor," inserts the Chronicle, "approved $9-million a year for the chiropractic college before either the university or the state's Board of Governors had determined it was needed....Now professors who view chiropractic medicine as 'pseudoscience' are feeling manipulated, and they're fighting back."

It seems the old labels -- quackery, psuedoscience -- are back; war of epithets, I called it in Future Medicine. Instead of trial by jury: a dispassionate analysis of the evidence.

In keeping with its earlier attempt at humor, the Chronicle article includes a subtitle within the article: "Alien Studies Next?" Citing critics, the piece notes some have suggested "that schools of extraterrestrial or past-life studies might come next."

Indeed, why not? And why would that be so laughable? These phenomena are intensively studied and subject to rigorous scholarly debate; and, although the RCT methodology may not fit the subject, investigation of even a more mainstream mind-body therapy, such as hypnosis, suggests that consciousness is far more complex than reductionistic thinking can possibly hope to authoritatively assert.

But this question of time, inside the mind and beyond, is for another time.

Focusing on the dispute at hand, chiropractors would no doubt argue the comparison to alien studies is unfair and prejudicial, in light of medical evidence and clinical practice supporting chiropractic.

That may be. The point here is that derision-by-association is a remarkably low rhetorical strategy. So, too, is the arrogant presumption that a closed system of thinking can understand and reduce everything to readily digestible categories; that one epistemology fits all; and that current, scientific truth in narrowly defined methodological categories dictates the beginning and end of all knowledge.

"Professors at the four-year-old College of Medicine -- the nation's youngest -- are particularly sensitive about the addition of an alternative-health-care college at a university whose provisionally accredited medical school is still awaiting full accreditation. The two colleges would be separate, but medical professors who oppose the chiropractic school argue that it would taint the reputation of the entire university."

And there, perhaps is the rub? The old economic rivalry between one "sect" of doctors and another -- which reaches back to the earliest emergence of professional health care in this country. The history of medicine--and its regulation--is rife with rivalries, economic and ideological, played out in the battlegrounds of legislatures and courts, shaping the legal boundaries of who can practice what the law defines as "medicine."

Yet, with chiropractic licensed in every state, and the development of mature professional bodies for education, accreditation, and credentialing, the profession of chiropractic, circa 2005, is here to stay. And, the chiropractic profession itself takes advantage of medical research to study the safety and efficacy of different chiropractic therapies. Chiropractic's research efforts are aimed at continually accelerating the historic move, to borrow colleague Mary Ruggie's phrase, from marginal to mainstream.

"At Florida State, supporters counter that doctors and medical professors are feeling threatened by a practice that is growing in popularity and could cut into their business." So there it is. "Lawmakers who approved the money for the college say it could attract millions of dollars in federal support for alternative medicine and be the nation's pre-eminent chiropractic college."

The article continues with remarkable quotations that hark back to the pre-Wilk days.

It is easy for speculation, fantasy, projection, and plain old bias to substitute for facts.

"'Most of the faculty I speak to are saying this is absolutely ludicrous and we'd be the laughingstock of the academic world,'" says Raymond E. Bellamy, an orthopedic surgeon and assistant professor of medicine who is leading the charge against the proposal. "'Chiropractic is not science-based. Not one major university in North America has a connection with a chiropractic school. There's a reason for that.'"

Shame on you.

Let's hear from the other side.

"'I have no problem with these people quitting,'" says Senator Jones, a Treasure Island Republican, referring to the eight part-time Florida State professors. "'If they're spreading professional bigotry, they shouldn't be teaching students anyway.' Despite opponents' claims that manipulating necks and spines can injure patients, he argues that chiropractic care is safer than other forms of medicine, in part because it allows some patients to avoid risky surgery or potentially debilitating medications.

He points out that chiropractors are provided on 44 military bases in the United States, as well as in a growing number of Veterans Affairs hospitals. Some 15 million people in the country regularly visit chiropractors, according to the National Institutes of Health's Center for Complementary and Alternative Medicine."

Aren't chiropractors working alongside medical doctors to help patients heal in a variety of clinical settings, included ones in mainstream hospitals? (Note: For those interested in case studies, here's a recent reference from my work: Cohen MH, Ruggie M. Integrating complementary and alternative medical therapies in conventional medical settings: legal quandaries and potential policy models. Cinn L Rev 2004; 72:2:671-729, and Cohen MH, Ruggie M. Overcoming legal and social barriers to integrative medicine. Medical Law Intl 2004:6:339-393).

You'd think the critics never heard of "integrative medicine," an idea pioneered in numerous academic and other medical centers, described in the medical literature by luminaries such as Ralph Snyderman, MD, Duke University Medical Center's dean, and cogently explored by the Institute of Medicine's Report on Complementary and Alternative Medicine in the United States.

The local reaction to chiropractic education would be akin to one state deciding it didn't like Brown v. Board of Education and then returning to segregation.

"'This isn't a turf battle,'" one critic is quoted as saying. "'I was leaving well enough alone until they wanted to bring a school on my campus, and that's where I draw the line.'"

The segregation analogy perhaps is not so far afield after all.

In addition to the well-used phrase, "physician, heal thyself," it seems the healing professions, too, need healing. It's time to go beyond "conventional" and "alternative:" rather than recreating the dark, sectarian rivalries of the late-nineteenth century, the licensed professions need to move on and learn how to draw on the best of planetary knowledge to help people find wholeness at all levels of being.

****

Reported a colleague and friend the day this was posted: "Michael, thank you I am in Florida as I write this just coming back from the Board of Governors meeting where the FSU progam was defeated. It is truly a sad day for science....for fairness, for logic and for the ultimate good of the population that health care is supposed to serve."

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173