Antitrust vs. Sound Medicine

Some time ago, I pointed to an article debunking chiropractic. My post title was, "Chiropractic: Worse Than You Might Think."

Over the weekend, some reading caused me to learn why you might have a neutral, or even positive opinion of that belief system. Two passages from the book The Health Robbers: A Close Look at Quackery in America will do short work of this, given the context it or the article can provide about the supposed merits of chiropractic.

The first of these explains how chiropractors came to have medical licenses in the first place:

His license, like your money, is backed by the government. (Image by Austin Distel, via Unsplash, license.)

As competition among chiropractors grew, and as many were jailed for practicing medicine without a license, they began to pressure state legislators to license them. Responding to this pressure, perhaps with the hope that licensing would lead to higher standards of education and practice, states began to pass licensing laws. The first area to license chiropractors was the District of Columbia in 1896. Between 1913 and 1933, forty states passed licensing laws. The rest gradually followed suit,with Louisiana being the last to do so in 1974. Chiropractors may not prescribe drugs or perform surgery, but are permitted to "adjust" the spine. But for what? If all disease is caused by spines that need adjustment, can't chiropractors treat everything? (164)

Set aside for a moment the fact that licensing laws violate individual rights and so should not even be on the books. The fact that they were and are means that while they are, people will consider a license a credential and factor it in to their decision to judge the expertise of a medical professional.

That being the case, there is no excuse to, say, loosen up standards even for the alleged purpose of reforming an inherently corrupt, unscientific "profession."

The end result was exactly as was cynically hoped: Chiropractors had the state's imprimatur as legitimate physicians.

And this would, down the line, end up tag-teaming with another law that should have never been on the books, antitrust, to hobble the very (type of) organization that should have been (and was) trying to uphold standards for the medical profession:

The antitrust case was launched in 1976 when five chiropractors began a series of lawsuits against the AMA, other professional organizations, and several individual critics, charging that they had conspired to destroy chiropractic and to illegally deprive chiropractors of access to laboratory, x-ray, and hospital facilities. The suits were based on the theory that since chiropractors were licensed professionals, attempting to interfere with their activities violated antitrust laws.

During the 1960s and early 1970s, the AMA engaged in a wide variety of anti chiropractic activities. These activities were intended to protect the public from unscientific and unethical practices that were rampant during those years. Under antitrust law, however, good intentions may not be adequate justification for a boycott. Faced with an uncertain outcome and the prospect of great legal expense, most of the defendant groups settled their cases out-of-court by agreeing that their members were free to decide for themselves how to deal with chiropractors. The AMA adopted a similar policy, but chose to meet the chiropractors in court.

Following a jury trial (won by the AMA), an appeal to a higher court (won by the chiropractors), and an agreement to narrow the scope of the proceedings, the case was retried in front of a federal judge. In 1987, the judge ruled in favor of the chiropractors. Her lengthy opinion, however, was not complimentary to chiropractic. For example, she said that during the 1960s, "there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious." She noted that chiropractors still took too many x-rays. She concluded that the dominant reason for the AMA's antichiropractic campaign was the belief that chiropractic was not in the best interests of patients. But she ruled that good intentions did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. The AMA appealed the decision to higher courts, but was not successful.

Although chiropractors trumpet the antitrust ruling as an endorsement of their effectiveness, it was not. The outcome was based on narrow legal grounds and not the merits of chiropractic. (188-189) [bold added]

Good thing we have Big Brother around to keep us from being fooled by people wearing lab coats and calling themselves "doctor," and to save us from the inherently evil standards monopolies!

-- CAV