The greatest historical accomplishments and recent gains as the industry celebrates the 125th anniversary of that fateful day
The celebration of the 125th anniversary of chiropractic has been somewhat muted in 2020 due to the worldwide COVID-19 pandemic and travel restrictions, but the lack of physical get-togethers cannot dampen the extraordinary advances the profession has made — from the famed Wilks court decision to the aligning behind chiropractic of the U.S. government, the Centers for Disease Control, the Joint Commission and the American College of Physicians for the treatment of low-back pain and other musculoskeletal issues over the last 20 years (see the Modern Chiropractic Timeline in this issue).
Celebrating chiropractic’s beginnings
Daniel David (D.D.) Palmer in 1895 started a non-drug health care revolution in the way the musculoskeletal system and spine were viewed and cared for.1
The first chiropractic school, now known as the Palmer College of Chiropractic, soon followed, and graduates began to spread chiropractic care across the U.S. and around the world. On Sept. 18 of this year, 125 years to the day of that first adjustment, Palmer College celebrated with a 125th anniversary “virtual toast” video meeting for chiropractors around the world after their initial in-person celebration was postponed due to COVID-19.
Reflecting on the ‘5 eras of chiropractic’
In looking back over 125 years, Chiropractic Economics spoke with industry leaders during the 125th anniversary regarding some of the momentous achievements, hurdles, and what part chiropractic will, or could, play in 2021 and beyond.
Framed in the reference of J. Keith Simpson’s paper, “The Five Eras of Chiropractic & the future of chiropractic as seen through the eyes of a participant observer,” chiropractic can be broken into “five distinct and at times overlapping eras”:
The Era of Free Trade in Medicine (1860-1900)
In the “Wild West” era of medicine, no legislation governed health care and MDs’ “principal treatment methods included bloodletting, blistering, purgatives (massive doses of compounds of mercury, antimony and other mineral poisons) and tonics (arsenical compounds).”
Ironically today, when the U.S. is arguably one of the unhealthiest nations on the planet with the highest number of overweight/obese citizens per capita, during the 1800s and the birth of chiropractic and deregulation, the U.S. was one of the healthiest nations with the lowest infant mortality rate.2
The Era of Prosecution (1900-1950)
“Practically from its very origins in 1895, the chiropractic profession was in conflict with allopathic medicine,” Simpson wrote. “The relationship between political medicine and chiropractic was described by [RB] Scotton as a “holy war between the forces of good and evil.”
D.D. Palmer was charged with practicing medicine without a license in 1902-03, and jailed for the same in 1906, serving 23 days. In the first 30 years of the profession there were more than 15,000 prosecutions with roughly 3,000 doctors of chiropractic serving jail time.3
In 1913 Kansas became the first state to pass a chiropractor licensing law, according to Patrick Montgomery, DC, MS, FASA, FICC, a professor of chiropractic history. “Although the first state to issue a license from a chiropractic examining board was North Dakota,” he said. “The last state to achieve this status was Louisiana in 1974 — 61 years later!”
The Era of Persecution (1920-2000)
In the 1920s the American Medical Association (AMA) began a formal campaign against chiropractic, with regular articles in the Journal of the American Medical Association, that would last approximately 50 years.4
In 1962 the AMA launched The Iowa Plan and the Committee on Quackery to “contain and eventually eliminate the cult of chiropractic as a health hazard in the United States.”5 In 1976 the chiropractic profession struck back when five DCs, led by Chester A. Wilk, filed an antitrust lawsuit against the AMA and 14 other defendants.8
Eleven years later in 1987, a judge issued a permanent injunction order against the AMA, finding it guilty of conspiracy against chiropractors and in violation of federal antitrust laws.
The Era of Legitimation (1960-present)
During this period 18 countries, committees or commissions made inquiries into the validity of chiropractic, concluding that DCs were well-positioned to manage musculoskeletal disorders and that chiropractic education needed to improve, but that claims to affect visceral disorders were dubious and a major obstacle to health care integration.6
Chiropractic education moved into government-funded universities, research increased, and legislation governed the practice of chiropractic in 90 jurisdictions throughout the world.6
The Era of Opportunity (2000-present)
The last 20 years have seen the U.S. Department of Veterans Affairs expanding chiropractic care, along with active military health care, and indications of care for military families on the horizon. Studies have shown significant health care savings and far fewer surgeries when patients see a DC before an MD.7
The Joint Commission, the organization that accredits more than 20,000 health-care systems in the U.S. including every major hospital, recognized the value of non-drug approaches by adding care provided by doctors of chiropractic to its pain-management standard.
In 2016 the CDC recommended chiropractic as a non-drug alternative for chronic pain, and in the years following the American College of Physicians and the U.S. government included chiropractic in their guidelines for non-invasive, non-drug treatments.
Landmark decisions and advancement
Montgomery, the professor of chiropractic history, along with the licensing of chiropractors, notes the 1963 establishment of the National Board of Chiropractic Examiners (NBCE), the federal recognition of the Council on Chiropractic Education (CCE), and the successful conclusion of the Wilk v. AMA legal action as the landmark achievements over the last 125 years.
“The profession has accomplished so much over a relatively short time,” Montgomery said. “[The NBCE] helped to achieve equal and fair testing for licensing, no matter which state was issuing a license to practice. Prior to that, licenses were awarded using a wide variety of qualifications, some of which would now be considered unethical … The CCE as the sole authority for accrediting chiropractic educational institutions opened the door for federally-backed student loans, allowing educational institutions the ability to hire qualified faculty and the ability to pay them competitive salaries.”
Wilk v. AMA, Montgomery said, “halted the assault on the integrity and validity of chiropractors and chiropractic care. There are still hurdles to climb, but this landmark decision helped to put to an end to the illegal boycott and slandering of doctors of chiropractic.”
Micheala Edwards, DC, president of the American Black Chiropractic Association, puts the establishment of the Council on Chiropractic Education (CCE) at the top of her list for making government inroads and legitimizing chiropractic education.
“Forming the CCE was a vital piece to gaining acknowledgement by government entities such as the U.S. Department of Education as a profession that is backed by quality educational programs across the board,” Edwards says.
“The CCE’s efforts provided the profession with a safeguard that ensures that DC programs are effective and continuously improved to uphold the integrity of the profession as a whole. Although its inception resulted in many schools closing early on, all remaining institutions were forced to establish
stronger academic programs, thus strengthening chiropractic’s foundation. Without effective DC programs, the profession would not likely be considered among top complementary and alternative health care practices.”
The 2000s and ‘essential care’
Some consider recent years, and even 2020, as some of the most important times during the 125th anniversary of chiropractic.
“By far, the most important happening in recent history is that chiropractic was deemed ‘essential’ by the U.S. Department of Homeland Security in March 2020 in response to the COVID-19 pandemic,” says Karlos Boghosian, DC, president of the Federation of Chiropractic Licensing Boards. “This recognition affirmed the vital nature of chiropractic care, validating its necessity.… The Wilks case was a pivotal moment that demonstrated the resolve and unwavering commitment to overcome one of the many trials and tribulations that our beloved profession has endured.”
Validation by various branches of the U.S. government has been critical to chiropractic’s advancement in the 2000s.
“One of the most important occurrences in the chiropractic profession in the past 15 years is the inclusion of chiropractic within the Veterans Administration (VA) system,” said Wayne Wolfson, DC, president of NCMIC Group Inc.
“Initially this included a trial pilot program, but since 2005, chiropractors working onsite at VA hospitals has grown from 20 DCs at approximately 20 facilities to nearly 230 chiropractors at approximately 160 facilities. Additionally, during this time, growth in number of unique patients seen by chiropractors has averaged an increased utilization of 18% per year. Currently, 12 chiropractic colleges and universities work collaboratively with several VA hospitals providing clinical rotations for their students. This multidisciplinary experience in this setting is an outstanding opportunity to educate patients and staff at the hospital about the benefits of chiropractic care.”
125th anniversary: opportunity moving forward
The above Era of Opportunity was updated, as Simpson’s paper covers only up to 2012, but the author in his paper also addressed “The Way Forward.”
He noted that chiropractic would either be hindered by its divided status as an industry, or the industry would end up eventually uniting as a profession, or possibly dividing the profession into warring factions and “let each faction fend for itself” — which seems like where we are today, to the detriment of the profession.
The opportunities for the future are almost limitless due to recent achievement and recent health epidemics that chiropractic is helping to battle. Musculoskeletal disorders are among the top 3 causes of pain in most developed countries.
The opioid epidemic still rages, with patients in need of non-drug care. An aging population will provide more patients in need for musculoskeletal disorders, general wellness and a variety of ailments. In regard to wellness, many DCs provide nutritional and weight-loss advice in an era where we’re able to make little headway as a nation against unhealthy weight and obesity. This is all amidst a rapidly changing health care system in the U.S. that each year becomes more open to chiropractic care.
Despite COVID-19, 2020 has been a great time to recognize and celebrate the 125th anniversary of chiropractic, an “essential service” for health care in the U.S., and to look forward to increased cooperation both inside and outside of the profession.
“Never forget the past,” says the historian Montgomery. “Too many victories for the profession that have been won in the past should not be forgotten. Those lessons include the value of chiropractic spinal imaging, not just medical imaging; being able to run your own practice or business, and not just relying on ‘getting a job’ from the outside; how hard it is to get favorable legislation passed; why hands-on learning and hands-on treatment are so valuable for the health of our patients; and that it is OK to be different than other health professions on the mode of healing.”
RICK VACH is editor-in-chief of Chiropractic Economics.
REFERENCES
2 Mansfield C, Wilson J, Kobrinski E, Mitchell J: Premature mortality in the United States: The roles of geographic area, October status, household type, and availability of medical care. Journal of Public Health. 1999, 89 (6): 893-898.
3 Kimbrough M: Jailed Chiropractors: Those Who Blazed The Trail. Chiropractic History. 1998, 18: 79-100.
4 Donahue J: Morris Fishbein, MD: The “Medical Mussolini” and Chiropractic. Chiropractic History. 1996, 16: 39-49.
5 Simpson J Keith: The Iowa Plan and the Activities of the Committee on Quackery. Chiroprac J Aust. 1997, 27: 5-12.
6 Chapman-Smith D: The Chiropractic Profession. Its Education, Practice, Research and Future Directions. 2000, DeMoines, Iowa: NCMIC Group Inc
7 https://www.wardsuccess.com/blog/the-chiropractic-timeline-from-the-1800s-to-2018-and-beyond
