Dear Editor:

You asked for responses to the question of "should we teach MDs to manipulate?" This is a key issue at the level of the WFC and seriously affects the potential of our association in Russia, so I have endeavored to respond.

The question of whether DCs should be in the business of teaching organized medicine to manipulate, a la chiropractic, requires answers which are not as simple as yea or nay. Answers cannot be as forthcoming as a knee-jerk reflex. The issues are far reaching, and, frankly, most Americans are unaware of most of those. One cannot expect anyone practicing in a country in which every state licenses the profession, to be particularly sensitive to the plight of those DCs whose careers, income, safety, and perhaps even lives depend on the vagaries of their political systems.

One can begin to comprehend only when one realizes the enormity of the problem in light of the major political situations we face around the world. There are, for prime examples, the cases of France, Latin America (Mexico, in particular), Israel, Japan, and my association, Russia.

In France and Belgium, due to their Code Napoleon, a system of law which the US only sees in token form, and only in Louisiana, deals with our profession as one outlawed. This system has the opposite premise of our British Common Law-based legal structure: Anything not specifically made legal, is automatically illegal. And since there is no specific statute on the books to allow the practice of chiropractic, therefore, like prostitution, it remains an outlaw practice. Furthermore, there are specific laws which allow only an MD to use the title, chiropractor. And our brave tenacious colleagues are paying huge fines, which go to the patriotic MD who turns them in to the authorities for the damages to the MD's practice.

There are schools in France teaching manipulation to MDs so they can call themselves chiropracteurs. The chilling effect on the practice of orthodox chiropractic with the proliferation of large numbers of MDs trained in real chiropractic, where our own cannot operate, should be obvious.

In Mexico, the problem is in some ways worse. Despite enjoying the recent fruits of legislation creating a Collegio de Professionistas (licensing authority) for chiropractic, and the presumed protection of the Code Napoleon which this would seem to afford (making it actually therefore illegal to practice without this license), there remain several thousand barefoot practitioners, knows as brujos, all of whom would jump at the opportunity to call themselves quiropracticos. There is also the medical profession itself which has essentially embraced our profession, which would probably love to learn our methods with a gratuitous weekend course, so they, like their brethren in France can make believe they are qualified to practice chiropractic.

In Russia, as in the other 14 former Soviet Republics, called "newly independent states," there is a very popular medical specialty called manualnaya meditsina. This was officially recognized only about 12 years ago while still under the Soviet system, and so exists now in all the 14 new countries' laws.

There are thousands of physicians practicing this system, which is probably very close to ours. These people, whose degrees are not really of MDs per se, but something akin to "general physician," could easily become general physicians (medicine), or general physicians (chiropractic). They are more like our "straight" practitioners than we would like to admit, and many, perhaps a majority, could easily be qualified to receive a DC degree with less than the WFC mandated two years of additional training.

But, and this is a big but, what of the emigres from our system who go to places like Israel, or the U.S.? In the U.S. there is no problem for the chiropractic profession, but in Israel where there is no law to protect the practice of chiropractic, the medical practitioners are all coming in, mostly from Russia, to say they are xeiropraktors, because they can practice that without passing the state medical boards. Another nightmare this creates for the real DCs practicing there is that since many of the xeiropraktors are really not trained at all, and are getting their chiropractic from books they study themselves, they give real DCs an undeserved bad name.

Realize that in organizing the WFC, it was crucial that some unity be brought to Japan's multiple associations. In their system, much akin to ours of 50 years ago, with a proliferation of proprietary colleges, each with their own requirements, there was a majority of the profession practicing with a degree called "CC" or Certified Chiropractor. These ranged from one to three years of training, and are now grandfathered into the profession by way of accords between the several associations. This creates a unified front which is sure to make significant political gains in the future.

What of the CCs? Well, there won't be any more of them, and the associations and colleges have agreed to develop programs to encourage those still practicing to upgrade to DC. Therefore, in their cultures the profession will evolve, but at its own pace.

We are becoming very popular around the world, and everyone with the opportunity to do so will jump on the bandwagon! The need for regulatory legislation is critical in these places, but like in the early days here, the medical machine rolls over our colleagues where and whenever it can.

One must also understand that each culture has a right to its own developmental stage, at its own pace, and in its own way. The rest of us have no right to order that other countries jump into chiropractic fully grown with our US model of practice. It may not fit. And it will certainly cause anti-American feelings towards an American profession.

What to do? The answers are even more difficult and perhaps unpleasant for some of our colleagues in some of the nations I have discussed.

For years we have been beating our heads against this stone wall called "medicine" and fighting an uphill fight. Perhaps the time has come to open our doors to some extent and let them join us! I know this could still be disastrous for us in France and perhaps in Belgium. But I hope that there the situation will change with the EEC's unification treaties and the acceptance of chiropractic as a profession legally elsewhere in Europe.

Perhaps if we create a serious system for MDs, or general physicians with manualnaya meditsina diplomas (or the equal elsewhere) to actually get a recognized DC diploma they can be proud of, with a realistic amount of postgraduate education (in some cases at least, two additional years is perhaps too much commitment to demand), then we will have chiropractors, graduates of accredited programs practicing our system. Perhaps they will participate with us to fight within their own political jurisdictions to get what we as outsiders can only dream of.

At least when such truly trained people emigrate to places like Israel, France, or even Mexico, they will be by then converts to our system: real DCs who could be part of our own associations, and help us fight the good fight.

Think about it. Does having association members with MD, DC after their lend greater or lesser credibility to your national associations? Does having Scott Haldeman, DC, MD, PhD, as our colleague help us or hurt us? Is the reason for our opposition to allowing those from the medical ranks who want to cross over the old political lines legitimate concern, or really just anti-competitive protectionism tinged with professional insecurity? Sorry, someone had to say this.

It must be understood that despite all of our responses to the editor's query, the WFC has already spoken on this issue. There is a firm policy in place, passed at the London meeting, that MDs can become DCs only if the program is no less than two years long. It will be considered unethical for DCs to teach programs to MDs which are less than two years for the receipt of a legitimate DC degree.

Having said all of this, I want it very clear that as a representative of Russia to the World Federation of Chiropractic, the Russian Chiropractic Association will uphold the policies of our world governing agency (WFC). But I want to stimulate thought along these lines, because we could easily have several thousand members in our Russian Association if we were to assist in creating a realistic educational system for these people. The ripple effect on the rest of the world could be significant. Would it be for the better?

Stephen J. Press, DC, PhD, CCSP, FACSM, FICC
Englewood, New Jersey

Dear Editor,

Writing in the July 29, 1996 issue of Dynamic Chiropractic (pp. 6), my friend and critic, Rolf E. Peters, DC, co-editor of the Chiropractic Journal of Australia, correctly points out that my recent column in DC, "The Original Theories of Chiropractic," did not lay out all the details bearing on my belief that the first adjustment was not delivered on September 18, 1895. Since the topic of this particular column was Palmer's first theories, I "hit the high spots" so far as the chronological details were concerned. However, I would note that I have several times previously (Keating, 1991, 1992) given reasons for doubting that seemingly sacred date (9/18/95).

Dr. Peters is correct in asserting that D. D. Palmer did later give September 18, 1895 as the precise date of the first adjustment, but I had found no examples of this precision when I wrote my column in 1993. At that time I had encountered Old Dad Chiro stating only that the first adjustment was administered in September, 1895; I also found numerous examples of BJ giving the more precise 9/18/95.

I give greater weight to the earliest known published account of the Harvey Lillard case than to either Palmer's later, retrospective date. This earliest known published testimonial account of the Lillard episode appeared in the January, 1897 issue of The Chiropractic, an advertiser published by DD to build his practice and attract students to his school of magnetic healing. Dr. Peters is correct in pointing out that there seems to be a missing issue of the advertiser: #15 was the January, 1896 issue of The Magnetic Cure, and #17 was the January, 1897 issue of the renamed The Chiropractic. We don't know what DD might have published in the missing issue #16.

To the best of my knowledge, Palmer's earliest use of the 9/18/95 date did not appear until the December, 1904 premier issue of The Chiropractor, published by the Palmer's school. Here's what DD said more than eight years after the fact:

On September 18, 1895 Harvey Lillard called upon Dr. Palmer. The doctor asked him how long he had been deaf. He answered, "Seventeen years." He was so deaf that he could not hear the rumbling of a wagon on the street...Upon examination there was found a displaced vertebra, a spine that was not in line. Dr. Palmer informed Mr. Lillard that he thought he could be cured of deafness by fixing his back. He consented to have it fixed; we now say adjusted ...

There is an issue of primacy here. Should we put greater credence in a report by the patient published by Dr. Palmer and created within the near time frame of the event, or to a much later account of the date (for which there may have been additional motives...more about this later)? Harvey Lillard tells us (January, 1897) that he learned about Dr. Palmer's new method (chiropractic), "Last January ..." Could Lillard have been referring to some January in some year previous to 1896? I don't see how, notwithstanding the missing issue #16, unless we're considering that the "discovery" of chiropractic occurred in January, 1895 or January, 1894 or earlier. Either way (i.e., whichever year), Lillard's account still rebuts the September, 1895 date. So I deduce that either Harvey Lillard was not the first patient to be adjusted by Palmer, or the first adjustment must have been administered sometime during or after January, 1896.

I cannot take credit for being the first person to doubt the 9/18/95 date. Cyrus Lerner, an attorney and journalist hired by the Foundation for Health Research, Inc., of New York, a chiropractic advocacy group, suggested the following in his lengthy report on early chiropractic history:

It has made me wonder, as I studied the historical record, what a strange coincidence it is that B.J.'s expulsion from high school in September, 1895 occurred at about the very same time that the first chiropractic adjustment was supposed to have been given to Harvey Lillard on September 18, 1895.

We will see that it was B.J. who fixed the date of the first chiropractic adjustment, when he had taken on a new pose at the age of about 20.

The boy of 14, who had been expelled from high school in September, 1895 had returned to the field of education in May, 1902.

We shall see shortly how D.D. got himself into a situation, never before reported in the historical accounts, which caused him to leave Davenport and abandon his management of the school.

We shall see how B.J. at the age of 20 re-opened the school; how he advertised the "new management"; how he announced to the people of Davenport -- his friends and neighbors -- that now he was a "teacher" -- more than that, the "adjuster in chief" of the school, yes, its "schoolmaster."

He was prepared to show the people of Davenport---and especially the educated men of medicine--that his lack of formal education meant nothing.

His father had "discovered" the science of chiropractic in September, 1895. His father had no formal education either.

That date in September, 1895, he probably thought should stand out in history as proof, that being expelled from school should deter no one who seeks to learn by himself (Lerner, 1954, pp. 52-4).

Lerner is speculating, to be sure, but there's a ring of truth to what follows:

Unfamiliar as a young man in matters pertaining to legal rights and working without benefit of counsel to guide him, we shall see shortly how B.J. conceived the idea that it was necessary to establish a "legal priority" for the discovery of chiropractic. How, acting under that erroneous and mistaken impression, which first originated with the osteopaths, who did the same thing -- B. J. began "developing" chiropractic as if he were promoting an "invention" -- instead of promoting the cause of knowledge -- an unpatentable item -- as I have shown you (Lerner, 1954, pp. 179)..

and:

To prepare a "defense" to the threatening attitude of the osteopath, the idea was conceived that something had to be done to establish a similar "priority" for chiropractic.

And so we find that the date was fixed first for the discovery of chiropractic. Later, they went one step further and included the account of the Harvey Lillard incident to try and establish the "body" -- as it were -- the concrete evidence and the concrete proof to definitely establish that the "discovery of chiropractic" had actually occurred under circumstances which Palmer, they said, really remembered, in fact, that it occurred exactly on September 18, 1895 -- at the very moment and the very instant that he took one look at Harvey Lillard's back.

Is it any wonder, then, that the earliest preparation of the "Case for Chiropractic" caused chaos, confusion, doubt and skepticism to haunt the profession all these years?

Is it any wonder that the story of Harvey Lillard has been looked upon as though it were one of the "Tales of the Arabian Nights"? (Lerner, 1954, pp. 181)

Although the issue Dr. Peters and I are debating (the date of the first adjustment) may be considered chirotrivia, I don't think it's fair to characterize my work as a "red herring," which suggests some disingenuousness on my part. I may be a gadfly, but I'd like to think I'm an honest gadfly.

I look forward to further frank and friendly discussion of these issues with Dr. Peters.

Joseph C. Keating, Jr., PhD
Professor, LACC

References

Keating, JC., The Embryology of Chiropractic Thought, European Journal of Chiropractic 1991 (Dec); 39 (3): pp 75-89

Keating JC., The Evolution of Palmer's Metaphors and Hypotheses. Philosophical Constructs for the Chiropractic Profession 1992 (Sum); 2(1): pp. 9-19

Lerner C., Report on the History of Chiropractic, 1954, unpublished manuscript in eight volumes (Lyndon E. Lee Papers, Palmer College Archives)