Medical monopoly: the game nobody wins - excerpt from 'Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing'

WHILE DISCUSSING THE course of health care in the United States, the noted Princeton medical economist Uwe E. Reinhardt once said: "What the head of the American Medical Association thinks in the shower in the morning is much more important than the aspirations of millions of Americans."

The American Medical Association (AMA) is indeed the most powerful medical organization on the planet. The Journal of the American Medical Association has a circulation of 700,000, making it the world's largest medical journal. The AMA also publishes 10 medical specialty publications, numerous books on health for the public, as well as its weekly newspaper, the American Medical News. Each week, its public relations department sends news releases to 4,000 medical and science journalists and dispatches video news releases via satellite to 340 TV outlets. Every day, the AMA sends one-minute medical reports to 5,000 radio stations. The information it dispenses is presented to the public by the major networks, newspapers and magazines as objective and reliable and is often incorporated verbatim into news stories or presented to the public as the news.

The AMA has enormous influence over what's taught in medical schools, over physicians' continuing education and indeed over every aspect of the practice of medicine today. When it comes to treating patients, the AMA has never been a fan of alternatives to drugs or surgery. At the AMA's founding, for example, a clause was placed in its code of ethics that stated any AMA member would be kicked out if he ever so much as "consulted" with a homeopath. One of the AMA's top physicians eventually acknowledged the organization's motives: "We never fought the homeopaths on matters of principle; we fought them because they got our business."

The history of the AMA is resplendent with a long, illustrious, and unbroken tradition of trying to do away with its competition. In each case, the AMA appears to have been motivated more by the desire to monopolize the medical market than by wanting to help people or protect them from frauds. How else, for example, can we explain the organization's war on chiropractic?

THE AMA DECIDES TO DO AWAY WITH CHIROPRACTIC

IN 1963, THE AMA HIRED Robert B. Throckmorton as its general counsel. Throckmorton was an Iowa attorney who had caught the eye of the AMA a few months before at a meeting of medical societies in Minneapolis, where he had given a rousing speech calling for an end to "the menace of chiropractic." The public, he proclaimed, looks "to the medical profession for unbiased and authoritative information on the subject." The medical profession, he demanded, should oppose chiropractic efforts to be covered by health insurance and worker's compensation, oppose chiropractic efforts to get hospital privileges and encourage complaints against chiropractors.

The hiring of Throckmorton was the beginning of a remarkable saga, ably recounted in a book called The Serpent on the Staff, by Howard Wolinsky and Tom Brune, and in Chiropractic Speaks Out: A Reply to Medical Propaganda, Bigotry, and Ignorance, a book penned by a Chicago chiropractor named Chester A. Wilk. Throckmorton was aware that it would not look good if the public became aware that the AMA was behind a campaign to destroy its competition. He repeatedly emphasized that "action taken by the medical profession should be...behind the scenes whenever possible." Throckmorton proposed forming a Committee on Chiropractic to organize and oversee the campaign.

In November 1963, the AMA Board agreed. They made one change, however--they thought that a focus specific to chiropractic was too limited in scope. The board renamed the panel the Committee on Quackery and determined that its first goal was to "contain and eliminate chiropractic."However, the Committee on Quackery publicly said its purpose was to eliminate charlatans and snake-oil salesmen who would prey upon the public for financial gain.

Shortly after the group was formed, Throckmorton brought in another Iowa attorney, Doyl Taylor, to head the campaign. Taylor's qualifications for the job included knowing absolutely nothing about chiropractic. "I didn't know a chiropractor from an antelope," he later confessed. But within weeks he was proclaiming that chiropractors were "the greatest hazard to public health."

Taylor was soon working full time alongside Throckmorton creating a climate of opinion hostile to chiropractors. In 1966, the AMA's House of Delegates officially adopted a position statement Taylor helped write: "It is the position of the medical profession that chiropractic is an unscientific cult whose practitioners...constitute a hazard to health care in the United States."

Soon, Taylor was contacting hundreds of medical groups and societies, encouraging them to deem it unethical for a physician to refer patients to chiropractors or to consult with chiropractors, professionally or personally. In order to further sabotage and undermine chiropractors activities, Taylor created a team of agents who took assumed names, pretended to be chiropractors, spied on chiropractic conventions and did what they could to generate divisiveness and dissension.

Meanwhile, the AMA purchased and distributed 10,000 copies of a savagely antichiropractic book called At Your Own Risk: The Case Against Chiropractic, by Ralph Smith. Repeatedly using words like fraud, hoax and cult, the book all but said that chiropractic was a form of organized crime. In a haunting and eerily reminiscent phrase, it announced that: "According to the unanimous voice of science, chiropractic theory has about the same medical validity as witchcraft."

THE CAMPAIGN CONTINUES

DESPITE THE AMA CAMPAIGN, however, chiropractic was becoming increasingly popular, and even Americans who knew little about chiropractic were becoming curious. In 1967, Congress instructed the Department of Health, Education and Welfare (HEW) to appoint a panel to study and make a recommendation on whether chiropractors should be reimbursed by Medicare. Knowing reimbursement would be a major blow to their campaign, the AMA immediately set about attempting to persuade the panel that it was critical to the health of the nation that chiropractic not be covered.

Some of the panelists, however, were offended by the pressure. One, John McMillan Mennell, M.D., from Jefferson Medical College in Philadelphia, complained of receiving phone calls "clearly inspired by the AMA, suggesting what the tenor of my paper should be." He said the AMA showed a "bitter bias" against chiropractic, which was completely uncalled for, because "there is substantial evidence that manipulative therapy brings relief to sufferers from [certain kinds] of pain."

After the vote went against providing Medicare coverage for chiropractic, the AMA took the campaign to a new level of intensity. The AMA's consumer magazines began printing articles that repeatedly called chiropractic "quackery," and greatly exaggerated its dangers. Caught up in the excitement, the officials of the Committee on Quackery went about the country making speeches about chiropractic that were increasingly malicious. The chairperson of the committee, Dr. Joseph A. Sabatier, told a gathering of medical society officials that "rabid dogs and chiropractors fit into the same category...chiropractors are nice [but] they kill people."

The chiropractors who were being subjected to these attacks were attempting to conduct a business and provide a healing service that was legal and licensed. They had undergone extensive training but now were beset by the officials of a highly esteemed organization who were calling them killers. One chiropractor described the experience: "The repeated attacks were like a hammer being pounded against all of us. You couldn't get away from it. As the attacks continued, I had to spend more and more of my time defending myself and my profession. It took a toll. Eventually, I had to close my practice. Such a waste. The AMA didn't care who they hurt."

The Committee on Quackery, however, was delighted with the way things were going. In 19 71, the committee wrote a memo to the AMA Board of Trustees, saying it was "moving toward the ultimate goal" of eliminating the chiropractic profession. The memo also explained that the committee did not usually submit reports on its activities and progress because, "to make public some of [our] activities would be unwise."

THE CAMPAIGN EXPLODES

MUCH TO the AMA's horror, someone eventually spilled the beans. In 1975, an anonymous individual who came to be called "Sore Throat" sent a draft of what he or she said were internal AMA documents to reporters at most of the major newspapers in the country as well as to congressional committees and consumer activist groups. These documents revealed postal and income tax abuses, unethical use of the AMA journal, AMA control of congressional leaders and the campaign to destroy chiropractic. Sore Throat claimed to be a disgruntled AMA staff member, seeking to expose the organization's seedy side so that reform could be brought. Headlines in major newspapers began appearing, such as "Secret Memos Show AMA Deeply Involved in Politics," "Drug Firms Gave AMA $851,000" and "Secret AMA Link to Nixon Disclosed."

While all this was happening, Chicago chiropractor Chester Wilk began to consider an antitrust suit against the AMA. Wilk had long sensed that the AMA was trying to destroy chiropractic and had written a book on the subject called Chiropractic Speaks Out: A Reply to Medical Propaganda, Bigotry and Ignorance. In his book and frequent public speeches, Wilk pleaded with the AMA to stop trying to destroy alternative healing systems and instead to join forces toward the common goal of helping patients.

An attorney named George McAndrews, the younger brother of the then vice president of the International Chiropractors Association, suggested to Wilk a long string of prominent law firms that specialized in antitrust suits, but when Wilk and the McAndrews brothers approached them, they declined. "Take on the AMA? You've got to be kidding! You'll get squashed like a bug." If the chiropractors were to file suit. the relatively inexperienced George McAndrews would have to take on the case himself.

On a historic day in October 1976, Chester Wilk and three other chiropractors filed suit against the AMA, naming 11 of the nation's other most prominent medical groups as codefendants. According to the suit, the American Hospital Association, the American College of Surgeons, the American College of Physicians, the American College of Orthopedic Surgeons, the American College of Radiology and the Joint Commission on Accreditation of Hospitals, among others, had all taken part, in various ways, in an illegal conspiracy to destroy chiropractic.

George McAndrews may not have had the type of prior experience as an attorney that would have been ideal, but he certainly had the will to persevere. In preparing for the trial, he visited 34 states and collected over a million pages and 164 depositions. And the more he learned, the more committed he became.

William S. HotchLiss, M.D., a member of the AMA ,Board who had also been a member of the Committee on Quackery, probably knew better than anyone how embarrassed the AMA would be if everything came out. He proposed buying off the chiropractors. "If we could settle it all for a...sum, this would not be surrender, but would represent good common sense." But McAndrews and Wilk refused to settle.

The AMA made further attempts to head off the lawsuit. The House of Delegates now eliminated the section from its ethical codes banning consultation with "unscientific practitioners," such as chiropractors. But the chiropractors had come too far and knew too much to stop now. In December 1980 the case went to trial. In one of the epic court battles in U.S. history, the adversaries fought bitterly in court for the next 10 years. There were verdicts and appeals, new trials and more verdicts and more appeals. When the trial ended, there were 3,624 pages of transcripts, 1,265 exhibits and 73 depositions.

On August 24, 1987, U.S. District Court Judge Susan Getzendanner ruled that the AMA and its officials were guilty of attempting to eliminate the chiropractic profession. This conduct, she said, "constituted a conspiracy among the AMA and its members...in violation of Section 1 of the Sherman Act." She ordered the AMA to admit the "lawlessness of its conduct," to change its course and to publish her entire order in The Journal of the American Medical Association.

The AMA appealed, but in February 1990, the Appellate Court upheld the ruling. And in November 1990 the U.S. Supreme Court let the ruling stand.

By this time, all the other codefendants had reached settlements with the chiropractors. But the AMA continued to bicker. Finally, in December 1991, 15 bitter years after Chester Wilk and the McAndrews brothers had filed suit, the AMA agreed to make a 53.5 million payment for the chiropractors' legal costs and to revise its position.

Things finally began to change. Mainstream medicine began to reluctantly acknowledge there actually might be something to chiropractic and other alternative methods of healing. Encouraging studies of chiropractic began to appear in prestigious American medical journals. In 1994, the federal Agency for Health Care Policy and Research declared that most conventional therapies, including prescription painkillers and surgery, were rarely helpful for back pain. Instead, the agency recommended simple, over-the-counter anti-inflammatory medications and chiropractic. It was quite a switch from the days when chiropractic was constantly flogged as quackery.

At about the same time, chiropractors were made eligible to become commissioned health-care officers in the U.S. Armed Forces. And a military advisory panel, the Chiropractic Care Demonstration Project, was formed to implement chiropractic health care for military personnel.

By 1995, chiropractors had gained hospital privileges at more than 100 hospitals. Nearly 20 million Americans were visiting chiropractors annually, and many of their visits were being paid for by state, federal and private insurance sources.

THE BATTLE FOR HEALTH FREEDOM

IN THE SUMMER of 1995, Senator Thomas A. Daschle (D-S.D.) and Representative Peter DeFazio (D-Ore.) introduced the Access to Medical Treatment Act to the U.S. Congress (S1035/HR 2019). With an identical number of Republican and Democrats as original cosponsors, this landmark bill seeks to allow practitioners to use alternative therapies that have not been federally licensed but do not pose a health threat.

A consistent and unusual feature of this and other such health-freedom legislative efforts is that they almost invariably receive bipartisan support. For liberals, the issue is often seen as a matter of civil liberties and consumers' rights. For conservatives, the issue is individual freedom and the creation of a more open medical marketplace with greater competition between health and medical professionals.

But the AMA continues to stand in the way of alternative medicine. In 1993, the AMA published a book titled Altemative Health Methods, which none too open-mindedly characterized holistic medicine as "a melange of banalities, truisms, exaggerations and falsehoods, overlaid with disparagement of logical reasoning itself." The AMA touted it as an authoritative source of information on "unproven, disproven, controversial, fraudulent, and/or otherwise questionable approaches (such as) acupuncture, faith healing, biofeedback, homeopathy, naturopathy, colonic irrigation and more!

Although it is still true that no other group in health care can come close to matching the AMA in terms of its economic clout or political influence, increasing numbers of U.S. doctors are speaking out against the AMA's self-serving performance. They are tired of watching the AMA squelch alternatives. The number of American doctors who pay full dues to the AMA has been shrinking rapidly and is now less than half of what it was 20 years ago.

Across the country, not only doctors but also legislators and thousands of other citizens are realizing the most prominent voice in medicine has not lived up to its social responsibility. The greed and patriarchal closed-mindedness that have tainted medicine are coming under public scrutiny. They know the American people place a sacred trust in their physicians and deserve better.

At the same time, the American people are becoming increasingly dissatisfied with the care they receive from physicians who know little about prevention and who rely primarily on expensive medical technology and prescriptions for drugs. Many doctors, in turn, are becoming equally frustrated because that's all they have been trained to do, and in many cases that's about all they are allowed to do according to the strict "standards of care" that have been established by state medical boards.

The level of indignation in America is surging. With each passing month, the campaign for self-determination in health care continues to awaken the conscience of more Americans. The public is growing rapidly less comfortable with the idea of the doctor as dictator. They are calling for a new role--the doctor as collaborator.

There is still an awfully long way to go, but as the value of alternatives is becoming increasingly recognized, the holistic health explosion is coming to represent one of the most powerful grass roots movements in American history.

John Robbins is the Pulitzer Prize-nominated author of DIET FOR A NEW AMERICA and a board member of VEGETARIAN TIMES. In RECLAIMING OUR HEALTH: EXPLODING THE MEDICAL MYTH AND EMBRACING THE SOURCE OF TRUE HEALING (H.J. Kramer), Robbins explores the current crisis in our medical system and postulates that it will prove to he a turning point, leading to a new model of care that treats lifestyle and emotions as an integral part of health.

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