The intensity of their refusal to accept things as they are, and the way they demand of both themselves and others a willingness to explore unorthodox alternative healing methods, are precisely the factors that have enabled chiropractic and other natural healing arts to survive and even thrive in the face of determined opposition from organized medicine.

In 1991, after well over a decade of litigation, the United States Supreme Court affirmed a lower court ruling declaring the American Medical Association et. al. guilty of anti-trust violations that were part of an ongoing conspiracy to "contain and eliminate" (the AMA's own words) the chiropractic profession. As a result of the Wilk v. AMA suit, the medical profession reversed its longstanding ban on inter-professional cooperation between medical doctors and chiropractors, agreed to publish the full findings of the court in the Journal of the American Medical Association, and paid a large sum of money which is now being used for chiropractic research.

This has not undone the effects of a well-organized anti-chiropractic campaign by organized medicine (which at one point even included attempting to rig in advance a federally mandated study on chiropractic!),[1] but it certainly points to the dawning of a new day.

Chiropractic Research: Clinical Studies and the "Outcomes Revolution"
Spinal manual therapy, of which chiropractors are the primary providers, has now been shown by reputable researchers to be the most demonstrably effective healing method for the most common kinds of lower back pain. Each year brings the publication of more studies (published in both medical and chiropractic journals), gradually expanding the range of conditions for which chiropractic should be considered a treatment of choice.

This was not always so. For years, chiropractors were criticized for offering only anecdotal evidence (stories of people who got well under chiropractic care) in support of their methods. Despite the fact that only an estimated 15 percent of orthodox medical interventions are validated by rigorous scientific research,[2] chiropractic was repeatedly attacked as unscientific, in contrast to the presumably altogether scientific medical profession.

Two things have changed. First, as you will see in this chapter, there is now a substantial body of chiropractic research, performed under accepted scientific protocols, which even the most die-hard skeptics cannot refute. Second, there has been an increased emphasis, largely driven by governmental and economic pressures, given to what is now called "outcomes research," which in part involves asking patients to rate their degree of pain relief, return to proper function in daily activities, satisfaction with treatment, and other related factors. Outcomes research has a strong subjective component, but has risen in stature because it has the overriding virtue of including what, after all, is the whole purpose of the healing arts to bring improved health, and relief from pain and suffering, as judged by the patients themselves.

The full effects of the outcomes research revolution are yet to be felt. But one thing is clear already: patients are growing very impatient with many orthodox medical therapies, and are "voting with their feet." They are flocking in droves to alternative practitioners of all sorts,[3] some of whose approaches already have significant scientific validation (chiropractic being most prominent example), and others whose methods have yet to face the scrutiny of rigorous research. This trend, unprecedented in its magnitude and probably nowhere near the peak of the curve as yet, portends a significant realignment in the healing arts as we know them, probably within the next generation. While it is still possible that the forces of orthodoxy may wage temporarily successful rearguard actions in some countries, blocking valid alternative methods from attaining equal status in terms of licensure and insurance reimbursement, it appears that a critical mass has already been reached, and that major changes will continue at an accelerating pace. The chiropractic profession is in the unusual, and perhaps unique, position of having one foot inside the establishment (with licensure, insurance reimbursement, accredited training institutions, and an increasingly broad scientific research base), while the other is firmly in the alternative camp (with a philosophy of natural healing that in most cases relegates drug therapy to a position of last resort, rather than first).

As such, chiropractic provides a rare modern example of how a healing art, born in rebellion against the status quo, enters the mainstream. The history of chiropractic is for the most part an inspiring story of the triumph of the underdog, but it also contains a travelerâs advisory as to the perils of the journey.

Historical Roots
Spinal manipulation has existed in one form or another for millennia. Accounts of manipulative therapies go as far back as 2700 B.C. in China, and a similar legacy has been bequeathed to us by ancient civilizations from Babylonia to Central America to Tibet.

Hippocrates (460 B.C.) was an early practitioner of spinal manipulation and according to some scholars, the Father of Medicine used manipulation "not only to reposition vertebrae, but also thereby to cure a wide variety of dysfunctions.[4] The Hippocratic Corpus, recorded by physician-scholars in Alexandria, Egypt, when that city was the cultural center of Western civilization, includes detailed descriptions of manipulative methods.

Galen, Greek-born Roman physician who lived in the Second Century A.D., and whose approach to healing set the officially recognized standard in Western medicine for 1,500 years after his death, also utilized spinal manipulation, and reported successfully resolving a patientâs hand weakness and numbness by manipulating the seventh cervical vertebra.[5]

As Europe endured what later would be known as the Dark Ages, these healing traditions were preserved in the learning centers of the Middle East by the ascendant Arabic civilization. Later, this body of knowledge returned to Europe, and the works of Hippocrates and Galen formed the foundation of Renaissance medicine. Ambroise ParŽ, sometimes called the Father of Surgery, used manipulation to treat French vineyard workers in the Sixteenth Century.[6]

During the centuries that followed, up to the beginning of the modern era, manipulative techniques were passed down from generation to generation within families. These "bonesetting" methods, which were transmitted not only from father to son but often from mother to daughter, played an important role in the history of non-medical healing in Great Britain and similar methods are common in the folk medicine of many nations.

Birth of the Modern Professions
In the second half of the Nineteenth Century, the United States was a crucible of natural healing theory and practice. Two manipulation-based healing arts, osteopathy and chiropractic, trace their origins to that era. Both began in the American Midwest.

Neither emerged in a vacuum. A medical physician, Dr. J. Evans Riadore, wrote in 1843 in Irritation of the Spinal Nerves that "if any organ is deficiently supplied with nervous energy or of blood, its functions immediately, and sooner or later its structure, become deranged." Robert Leach, D.C., in The Chiropractic Theories: A Synopsis of Scientific Research, says of this, "Apparently Riadore concluded that irritation of the spinal nerve roots resulted in diseases; he even advised manipulation to treat this disorder.[7]

Dr. Riadore's work predated by decades the development of osteopathy by Andrew Taylor Still, in the 1870s, and the introduction of chiropractic by Daniel David Palmer in the 1890s. Whether or not Still and Palmer were personally aware of Riadoreâs work, and it seems likely that they were, their pioneering efforts certainly occurred in a context where work such as Riadoreâs was in the public domain.

Interestingly, Riadoreâs statement about deficiency "of nervous energy or of blood" summarizes in one phrase the respective founding principles of chiropractic and osteopathy. Since its beginnings, chiropractic has attributed the central role in health to the nervous system. Osteopathy is founded on the Law of the Artery, with which Dr. Still asserted the primacy of the circulatory system.

Both Still and Palmer formulated their hypotheses and built their new professions against a backdrop of medical orthodoxy which they found to be frequently ineffective, and sometimes barbaric. Dr. Still, a Missouri country doctor, had lost three of his children to spinal meningitis. The standard treatment of the era was cauterization (burning through the skin with a hot iron), followed by the application of bloodsucking leeches to the raw exposed tissues of the spinal area. After the death of his children, like the Biblical Job, Still cried out in his pain for understanding. He spent the remainder of his life developing the natural healing art he called osteopathy.

Chiropractic: Then and Now
D.D. Palmer founded chiropractic on the premise that the vertebral subluxation was the cause of virtually all disease, and the chiropractic adjustment its cure. This "one cause-one cure" philosophy has played a central role in chiropractic history first as a guiding principle, and later as an historical remnant, a bulls-eye at which the slings and arrows of organized medicine have repeatedly been hurled.

While few contemporary chiropractors would endorse such a simplistic formulation, it nonetheless remains true that the raison dâtre of the chiropractic profession is the detection and correction of spinal subluxations. Chiropractors may, in fact, do much more, but it is our ability to do this one thing well that has allowed us to survive for a century under a constant barrage of medical opposition, some of it justified, most of it not.

The "one cause-one cure" adherents among the early chiropractors had two major political effects on the development of the profession. First, their deep faith in the truth of their message, combined with the sometimes stunningly positive results of chiropractic adjustments, created a strong and steadily growing activist constituency of chiropractic supporters. In their zeal, they forged a grassroots movement which assured the survival of the profession through some very stormy years in the first half of the Twentieth Century. But at the same time, by sometimes making inflated claims, and failing to back those up with hard evidence, some early chiropractors also managed to convince most medical physicians and, through them, a substantial portion of the general public that chiropractors were not to be trusted.

In this conflict, the medical profession was by no means a disinterested party solely seeking to protect the public well-being. It faced in chiropractic an intrepid economic competitor with a competing philosophy that raised the possibility of healing without drugs, which were, and still are, the medical professionâs primary healing tool.

The Wilk v. AMA suit brought to light a decades-long pattern of conspiracy, lies and political intrigue which exposed the AMA for what it was: a trade association whose principal loyalty was to the self-interest of its membership. The American judicial system may sometimes seem to move interminably slowly, but in this case justice finally prevailed.

A Complex Legacy
Contemporary chiropractors have inherited both the positive and negative aspects of this complex legacy. We look back at our professional forebears, and honor the level of sacrifice their commitment called forth, while at the same time seeking to adapt to the needs of a new era. Our task is in many ways easier than theirs. Starting with D.D. Palmer, thousands of chiropractors were charged with practicing medicine without a license. Hundreds, including Palmer himself, went to jail.[8] Civil disobedience was an integral part of the early development of the chiropractic profession, as it would later become in the civil rights movement. When Dr. Palmer was jailed in 1906, he said, "I have never considered it beneath my dignity to do anything to relieve human suffering." Like Thoreau before him and Martin Luther King later, Palmer understood that the defense of basic rights sometimes requires time behind bars.