The American Medical Association (AMA) systematically worked to marginalize chiropractic care from mainstream healthcare throughout the 20th century. Here’s how they did it:
- Public Campaigns: The AMA labeled chiropractic as an "unscientific cult" and used media, including TV, newspapers, and medical journals, to discredit the profession.
- Institutional Barriers: Chiropractors were denied hospital access, referrals from medical doctors, and insurance coverage.
- Committee on Quackery: In 1963, the AMA established this group to “contain and eliminate” chiropractic care.
- Legal and Policy Actions: The AMA influenced laws and accreditation standards to restrict chiropractic practice and access to resources.
- Wilk v. AMA Lawsuit: In 1987, a court ruled the AMA violated antitrust laws by attempting to destroy chiropractic as a profession. This led to reforms, but barriers still exist today.
Quick Overview
| Tactic | Impact |
|---|---|
| Public Campaigns | Shaped public perception against chiropractic care |
| Hospital and Insurance Limits | Restricted access to resources and patient referrals |
| Committee on Quackery | Coordinated efforts to isolate chiropractic care from healthcare systems |
| Legal Ruling (Wilk v. AMA) | Exposed and ended discriminatory practices, but challenges remain |
Despite these efforts, chiropractic care has persisted and grown, with approximately 9-15% of Americans using it today. However, insurance barriers and limited system integration still pose challenges for patients and practitioners.
WILK VS THE AMA – CHIROPRACTIC HISTORY BRIEF
AMA’s Early Control of Healthcare
The American Medical Association (AMA) began shaping the medical field in 1847 by establishing standards for medical education and licensing. Through persistent lobbying, the AMA convinced state legislators to support its educational initiatives and limit "irregular" medical practices [2]. A major milestone in this effort was the 1910 Flexner Report, which fundamentally transformed medical education.
The 1910 Flexner Report’s Impact
The 1910 Flexner Report, commissioned by the Carnegie Foundation at the AMA’s request, marked a turning point in the AMA’s consolidation of influence [6]. This detailed examination of medical education revealed significant shortcomings in the system:
"Each day students were subjected to interminable lectures and recitations… they observed more than participated." – Abraham Flexner [6]
The report led to sweeping reforms in medical education, as shown in the following comparison:
| Impact Area | Pre-Flexner (1904) | Post-Flexner (1920) |
|---|---|---|
| Medical Schools | 160 institutions | 85 institutions |
| Student Enrollment | 28,000 | 13,800 |
| University Education Requirement | 16 schools (10%) | 78 schools (92%) |
By adopting the Johns Hopkins School of Medicine model, which focused on laboratory science and clinical training, the Flexner Report standardized medical education [6]. These changes not only improved training but also laid the groundwork for the AMA to challenge alternative medical practices.
Growth of Chiropractic Medicine
Despite the AMA’s growing dominance, chiropractic care gained traction and legitimacy. By the late 1920s, more than half of the U.S. states had legally recognized chiropractic practice [2]. This rise in acceptance posed a direct challenge to the AMA’s authority, prompting a forceful response.
"Judge Susan Getzendanner noted, ‘The AMA decided to contain and eliminate chiropractic as a profession,’ reflecting its intent to destroy a competitor." [2]
The AMA’s transformation of medicine into a profession marked by "sovereignty, power, and financial affluence" [2] came at the expense of medical diversity. Its calculated control over education, practice standards, and professional dynamics set the stage for more aggressive actions against the chiropractic field in the decades that followed.
AMA’s Anti-Chiropractic Actions
The American Medical Association (AMA) spearheaded a deliberate campaign in the 1960s aimed at discrediting and restricting chiropractic care. This movement not only influenced public perception but also left a lasting impact on how chiropractic care is practiced in the United States.
The Committee on Quackery’s Goals
In November 1963, the AMA intensified its efforts by creating the Committee on Quackery (CoQ). The committee’s mission was clear, as articulated by its chairman, Dr. Joseph A. Sabatier Jr.:
"OVERALL GOAL To contain and eventually eliminate the cult of chiropractic as a health hazard in the United States." [8]
One of the committee’s key strategies was the "Iowa Plan", named after Iowa’s unusually high ratio of chiropractors to medical doctors – about one chiropractor for every four medical doctors during the 1950s. The plan aimed to isolate chiropractic care from mainstream healthcare systems systematically [8].
Public Relations Campaign Effects
The AMA also launched a far-reaching media campaign to shape public opinion against chiropractic care. This included:
- Writing television and movie scripts that portrayed chiropractic negatively
- Collaborating with prominent newspaper columnists like Ann Landers
- Distributing materials to school guidance counselors
- Publishing articles in medical journals to reinforce their narrative
These efforts painted chiropractic care as illegitimate and unscientific. Doyl Taylor’s statement encapsulated the AMA’s stance:
"Since the birth of chiropractic in 1895, the AMA has considered chiropractic an unscientific cult whose practitioners are not qualified to diagnose and treat human illness. That chiropractic is an unscientific cult is an established fact." [8]
This public relations push was further reinforced by institutional barriers that restricted chiropractors’ ability to practice.
Insurance and Hospital Limitations
The AMA’s campaign extended beyond public relations into concrete restrictions. Chiropractors faced significant barriers, including:
- Being denied access to hospital facilities, diagnostic tools, and referrals from medical doctors
- Prohibiting medical doctors from interpreting test results for chiropractors
- Severely limiting insurance coverage for chiropractic care
In 1973, the AMA formalized these restrictions by introducing Standard X through the Joint Commission on Accreditation of Hospitals (JCAH), effectively barring chiropractors from practicing in hospitals [5]. By 1987, only 15 hospitals nationwide allowed chiropractors privileges [10].
The AMA also worked to exclude chiropractic care from government programs. For instance, when HR 3246 proposed adding chiropractic services to VA facilities, the AMA’s executive vice president argued that such a move would drain resources meant for medical education at the VA [3].
These combined efforts significantly hindered chiropractic care’s integration into mainstream healthcare systems.
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Wilk v. AMA Lawsuit Analysis
Evidence Against the AMA
The 1976 Wilk v. AMA lawsuit brought to light the AMA’s systematic efforts to undermine chiropractic care [7]. The evidence presented in court highlighted several key actions:
- Hospital Access Restrictions
In 1975, Dr. Patricia Arthur faced significant barriers at Estes Park’s local hospital. Denied access to X-rays and lab testing due to AMA-influenced accreditation standards, she had no choice but to relocate her practice [1]. - Professional Isolation
In Sedalia, Missouri, Dr. James Bryden’s professional relationship with Dr. Jerome Block was abruptly severed. The hospital ethics board, adhering to AMA guidelines, prohibited collaboration between medical doctors and chiropractors [1]. - Media Manipulation
Internal AMA documents revealed a deliberate media strategy designed to marginalize chiropractic care, echoing earlier public relations campaigns [12].
These examples painted a clear picture of the AMA’s calculated efforts to isolate and discredit the chiropractic profession, laying the groundwork for legal action.
Legal Decision and Results
The court found the AMA’s actions to be in violation of antitrust laws. In 1987, U.S. District Judge Susan Getzendanner ruled that the AMA had breached Section 1 of the Sherman Antitrust Act [2].
"The AMA decided to contain and eliminate chiropractic as a profession" and that it was the AMA’s intent "to destroy a competitor" [2].
The court issued several remedies to address the AMA’s misconduct:
- Permanent Injunction: The AMA was prohibited from imposing restrictions that prevented members from working with chiropractors [9].
- Public Notification: The court order was published in the Journal of the American Medical Association and distributed to all AMA members [9].
These measures resulted in significant changes within the medical community:
- The AMA eliminated Principle 3, which had previously barred collaboration with "unscientific practitioners" [7].
- Medical doctors were allowed to refer patients to chiropractors [7].
- Chiropractors gained access to hospital diagnostic facilities and staff privileges.
"The current collaborative relationship between the AMA and chiropractic profession is far removed from the history of 60 or 70 years ago and has long reflected that physicians and chiropractors work side-by-side as members of the patient care team." – American Medical Association [11]
The 1990 affirmation of this decision by the Court of Appeals [3] reinforced the ruling and marked a turning point in fostering cooperation between medical doctors and chiropractors [4].
Current Impact on Chiropractic Care
Healthcare System Restrictions
Even after the landmark Wilk v. AMA case, chiropractors still face hurdles when it comes to full integration into the healthcare system. One key issue is the AMA’s influence on defining "physician" in statutory language. This definition often includes only MDs, DOs, and dentists, leaving chiropractors out of the equation [9], but Oklahoma law recognizes chiropractors as physicians [17], and also, it is the only chiropractic board in the nation that recognizes Croft Guidelines for Whiplash Associated Disorders (WAD)[18]. It was patient testimony that eventually saved chiropractic from its demise.
Insurance claim denials further highlight these challenges. For example, major commercial insurance providers report denial rates ranging from 1.63% to 9.6%, while Medicare denial rates can climb as high as 23% [13].
| Insurance Type | Claim Denial Rate |
|---|---|
| Commercial Payers | 1.63% – 9.6% |
| Medicare | Up to 23% |
Changes in Public Opinion
Despite institutional barriers, public perception of chiropractic care has improved over time. Today, between 9% and 15% of Americans utilize chiropractic services, with chiropractors conducting approximately 190 million office visits annually [16].
"A persistent bias still influences patient prioritization." [9]
The growing acceptance of chiropractic care is reflected in its market growth, with the U.S. chiropractic market expected to reach $2.87 billion by 2030 [13].
Patient Access Today
Access to chiropractic care remains a challenge for many patients. As Dr. Overland points out:
"Once they were found guilty of trying to crush our profession, they went underground, and used payment mechanisms to try and prevent patients from having equal access to our care." [9]
Several modern obstacles continue to limit patient access:
- Limited System Integration: Chiropractic care remains on the fringes of many healthcare systems [14].
- Insurance Barriers: Complex coding requirements and inconsistent coverage policies hinder access.
- Institutional Resistance: Many hospitals and medical centers still enforce restrictive policies regarding chiropractic services [15].
To navigate these challenges, chiropractors are adopting new strategies. These include streamlining administrative workflows, leveraging social media to reach patients, and focusing on patient education [13]. While progress is being made, these ongoing struggles underscore the lasting influence of past policies on chiropractic care today.
Conclusion
The American Medical Association’s (AMA) campaign against chiropractic care has left a lasting mark on the U.S. healthcare system. Starting in 1963, the AMA actively sought to undermine the chiropractic profession, using tactics like discouraging collaboration between medical doctors and chiropractors and creating institutional barriers [9].
A major turning point came with the creation of the Committee on Quackery in the 1960s. This group spearheaded efforts to discredit chiropractic care, culminating in the landmark Wilk v. AMA lawsuit in 1987. The case revealed the AMA’s discriminatory practices and led to a legal victory that reshaped the relationship between chiropractors and medical doctors [9].
However, as Dr. Keith Overland, former president of the American Chiropractic Association (ACA), explained:
"Once they were found guilty of trying to crush our profession, they went underground, and used payment mechanisms to try and prevent patients from having equal access to our care." [9]
This highlights the ongoing challenges chiropractors face. Despite the lawsuit’s outcome, insurance policies and institutional resistance still limit patient access. For example, chiropractors remain excluded from the legal definition of "physician" in many contexts, which complicates referrals and reimbursement processes [9].
Even with these obstacles, the chiropractic profession has demonstrated remarkable perseverance. By 1974, chiropractic care was licensed in all 50 states, and services became covered under Medicare, Medicaid, and most private insurance plans [9]. These milestones reflect both the enduring effects of past struggles and the gradual transformation of healthcare in the United States.
FAQs
How did the American Medical Association work to exclude chiropractic care from mainstream healthcare?
The American Medical Association (AMA) employed a range of tactics to sideline chiropractic care and block its integration into mainstream healthcare. One of the most prominent actions was an organized boycott aimed at discrediting chiropractors and preventing collaboration between them and medical professionals. This effort was ultimately deemed illegal in the landmark Wilk v. AMA case, which revealed the AMA’s attempts to suppress chiropractic care as a competing profession.
Beyond the boycott, the AMA shaped public opinion by launching campaigns that painted chiropractic care in a negative light. It also influenced medical education and professional standards to exclude chiropractors, creating further barriers for the profession. These actions left a lasting mark on how chiropractic care is perceived and its role within the broader healthcare system.
What impact did the Wilk v. AMA lawsuit have on the relationship between chiropractors and the medical community?
The Wilk v. AMA lawsuit significantly shaped the dynamics between chiropractors and the broader medical community. The court ruled that the American Medical Association (AMA) had unlawfully attempted to undermine and marginalize chiropractic care. Following this decision, the AMA was barred from enforcing policies that prevented its members from collaborating with chiropractors.
This case became a turning point, opening doors for chiropractic care to gain more recognition within mainstream healthcare. It encouraged greater cooperation between chiropractors and medical professionals, offering patients expanded access to alternative and complementary healthcare options.
What challenges do chiropractors face in becoming fully integrated into mainstream healthcare in the U.S.?
Chiropractors often grapple with challenges in being fully embraced by mainstream healthcare. A key hurdle is the skepticism from certain medical professionals, which can result in limited collaboration and fewer patient referrals. Much of this doubt is rooted in outdated views about chiropractic care that persist despite advancements in the field.
On top of that, chiropractors face regulatory and reimbursement issues, particularly with programs like Medicare and Medicaid. These programs often restrict the types of services chiropractors can provide, making it difficult for their care to be seen as an integral part of a broader healthcare approach. Addressing these challenges is crucial to fostering better collaboration and ensuring patients can access a wider range of treatment options.
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