For years, they were derided as quacks. They've been called unscientific, uneducated, unproven and dangerous.
Organized medicine has tried to stamp them out.
But as their profession nears its 100th anniversary, chiropractors find themselves cast in more flattering light. They've become increasingly popular with patients and even gained a degree of acceptance from the medical establishment. But their fight for respect isn't over.
Chiropractic was devised 100 years ago in Davenport, Iowa, by a man named David Daniel Palmer. According to legend, Palmer found a bump on the back of Harvey Lillard, a janitor who worked in his office building. He surmised it was caused by vertebrae that had shifted out of alignment. Palmer applied a swift thrust to Lillard's neck -- bones clicked back into place, the bump disappeared, and Lillard, who up to that point had been deaf, could suddenly hear.
Today, chiropractic is the largest drug-free health-care profession in the country, with about 50,000 doctors of chiropractic (D.C.s) treating millions of patients in the United States. Chiropractic is non-surgical and based on the idea that the manipulation of spinal bones -- a process called an "adjustment" -- can relieve neck and lower back pain.
Despite its popularity, or perhaps because of it, chiropractic has had some powerful enemies over the years. In 1987, a judge in an antitrust suit ruled that the American Medical Association (AMA) had conspired to "contain and eliminate" chiropractic. Prior to the court's decision, the AMA had stated in its official guidelines that it was unethical for medical doctors to associate with chiropractors.
The judge's ruling required the AMA to change its guidelines, which now say, "It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interest of his or her patient."
The AMA at the time claimed its efforts to destroy chiropractic were based on concern for patients, rather than on economic gain. But many chiropractors still believe organized medicine was trying to smash the competition.
"If anything, we're an economic threat," says Dr. Richard Dietzen, a chiropractor in Chicago. "The AMA was pleased to try to distort the truth and make medical practitioners leery of us."
In 1990, 34 percent of the American public visited alternative health-care providers, and spent $13.7 billion -- $10.3 billion of which was paid of their own pockets, according to Dr. James Winterstein, president of the National College of Chiropractic in Lombard, Ill.
Chiropractic enjoyed an improved image after the trial, but the AMA's labeling was hard to wash away. "When we won the lawsuit, we stopped a lot of propaganda," says Dr. Chester Will, a Chicago chiropractor who was the plaintiff in the case. "But lingering effects of the boycott still exist."
The AMA has stopped formal efforts to eliminate chiropractic, but, "I think it's now an informal thing," says Winterstein, who testified in the trial as an expert witness on behalf of his profession. "Organized medicine in large measure continues to express a bias against chiropractic."
Chiropractors say their profession is still hounded by misconceptions. Among the most prevalent are the beliefs that chiropractors are unscientific and uneducated.
"We are accepted educationally and scientifically by the relevant communities," Winterstein says. "We are well-educated today and accredited."
Chiropractic doctors currently need at least seven years of post-high school training, but the minimum requirement will increase to nine years by the end of the decade, Winterstein says.
Medical doctors -- who are required to finish eight years of post-secondary training -- might be surprised to know that chiropractic students take many of the same undergraduate courses, including anatomy, physiology and pathology, Winterstein says. "The bottom line is that chiropractors are doctors by definition and degree."
But unlike medical students, those attending chiropractic schools are not required to have earned a bachelor's degree. By 1999, they'll need a bachelor's degree, even though more than half already have them. Winterstein says, "We're going to continue to increase the requirements for prerequisite education and clinical education."
Like medical doctors and dentists, chiropractors are licensed as physicians. The difference is that chiropractors aren't allowed to write prescriptions or perform surgery. But being non-surgical and drug-free is the whole idea behind chiropractic.
"It isn't for everybody," Dietzen says. "Some people are drug-oriented and want instant gratification. But others want to get away from drugs and their side effects."
Bad publicity has lingered in the wake of a handful of cases in which chiropractic patients suffered heart attacks or strokes during spinal manipulations. But according to Dietzen, such reports have been blown out of proportion and context.
"Statistically, the chiropractor has a better chance of keeling over dead during a manipulation than the patients does of being hurt," he says.