From Marginally Acceptable to the Acceptable Margin: The 1960s through the 1980s
The 1950s and 1960s were a golden age for medicine. Federal support for biomedical science expanded enormously after World War II, and impressive diagnostic and therapeutic advances aided medicine’s emergence as the most highly regarded profession in the United States.
Federal subsidies for hospital construction helped create an enormous health care industry.Simultaneously, chiropractic seemed to stagnate. It received no significant federal support, and indirect subsidies, in the form of support to veterans under the G.I. bill to finance their chiropractic education, were small indeed in comparison with the massive investment in orthodox medicine. Perhaps more than ever before, medicine dwarfed chiropractic, and in the early 1960s the AMA set out to destroy it. The motives for its assault ranged from concern that chiropractic was gradually achieving acceptance to the conviction that chiropractors were unscientific cultists who were detrimental to the public health. The assault was launched by the AMA Committee on Quackery, created in 1963.
The committee mounted an intensive campaign. Under its direction, the AMA adopted a resolution calling chiropractic an unscientific cult, distributed publications critical of its practice, and discouraged medical organizations from condoning interactions between physicians and chiropractors, even declaring consultation with chiropractors unethical.
Despite this remarkable onslaught, chiropractic not only survived but thrived. During the tenure of the committee (1963-74), chiropractic greatly expanded as schools opened, the number of chiropractors grew, and licensing was granted in the few states that had withheld it. Chiropractic achieved federal recognition when it became incorporated into the Medicare and Medicaid programs.
The ability of chiropractic to resist AMA’s assault rested on four important developments: (1) a new social climate, (2) improved intraprofessional cohesion, (3) shrewd political maneuvering, and (4) jettisoning of its one cause-one cure hypothesis.
A new social climate had come about with the extraordinary upheavals of the 1960s. The civil rights movement, the women’s movement, the antiwar movement, and the environment movement, among others, rejected the status quo. What had previously been held to be authoritative was now condemned as authoritarian. Science and technology were no longer accepted as unalloyed good, critics argued that physicians had lost touch with the art of medicine, and conventional health care came to be viewed as impersonal, costly, and inefficient. Long critical of organized medicine, chiropractors began to find an increasingly receptive audience as tolerance for, and interest in, alternative medicine expanded enormously. Chiropractic benefited greatly from this new openness and yet, as a well- established profession, simultaneously avoided the appearance of being a fad. The criticism that medicine was too reliant on technology led chiropractors to reemphasize their reliance on “natural” healing. (Ironically, the use of technologies like diathermy again became controversial in chiropractic, and a new “superstraight” faction emerged that eschewed nearly all machinery.) The AMA’s antichiropractic efforts may have paradoxically created new support for this system of healing.Chiropractic witnessed much more cohesion among its practitioners, for efforts by the medical profession to eradicate it had the effect, despite the persistent argument between mixers and straights, of unifying chiropractors. Certainly, the tangible manifestation of chiropractic unity was adept political maneuvering. From their earliest struggles to obtain state licensure at the beginning of the twentieth century, chiropractors have demonstrated a considerable mastery of the U.S. political process and thus, despite opposition from the vaunted AMA lobby, they have shrewdly combined personal appeals, mass mailings, and the efforts of paid lobbyists to promote their goals.
Finally, chiropractic began explicitly to limit its claim of effectiveness and increasingly emphasized its role in the management of musculoskeletal disorders.
In 1969 both major chiropractic associations rejected the “one cause-one cure” tenet of chiropractic. This freed chiropractors from having to respond to medical hecklers who ridiculed them for believing that cancer, diabetes, and other ills were caused by spinal subluxations. Growing evidence supported chiropractic’s contention that it was an effective therapeutic modality for low back pain. The prevalence of this condition combined with orthodox medicine’s paucity of effective treatments for back problems helped chiropractors define a niche for themselves in the U.S. health care system.By the mid-1970s chiropractic occupied a new and greatly strengthened position. In the face of a changing social climate and numerous antitrust lawsuits instituted by chiropractors, opposition from organized medicine began to abate. The AMA and other medical organizations grudgingly recognized that there might be some benefits from spinal manipulation, and of course the inclusion of chiropractic in the Medicare and Medicaid programs helped legitimize the profession. In 1979 a conference sponsored by the National Institute of Neurological and Communicative Disorders and Stroke of the National Institutes of Health addressed the research status of spinal manipulative therapy. At this meeting, medical doctors, osteopaths, scientists, and chiropractors exchanged information. Although the scientific basis for manipulative therapy remained a subject of debate, a consensus emerged that this therapy was of clinical value in the treatment of back pain. The fact that chiropractic was seriously discussed by a branch of the National Institutes of Health - one of the cathedrals of scientific medicine - symbolizes how far chiropractic had traveled.
Although, as this essay has shown, chiropractic has become more acceptable to the mainstream of U.S. society, it has not become widely accepted as a conventional therapy. The majority of Americans have never visited a chiropractor, and considerable confusion exists about what chiropractors do. However, the number of people who have been treated by a chiropractor is gradually increasing, and chiropractic’s public image is improving. The periphery of the U.S. health care system is perhaps the ideal position for chiropractic. It provides legitimacy while allowing for the distance from conventional medicine that is fundamental to chiropractic’s identity.
Steuen C. Martin