This article is part of a series on Health Policy. See also:
- Ground Control to Major Reform
- Hospital Salaries Could Cut Care Costs
- The Appropriate Practice Scope of Chiropractic May Be a Political Question, Not a Scientific One
A Colorful History
At the turn of the 20th century, medicine was at a turning point. Unscientific practices like bloodletting, bonesetting, and magnetic healing still pervaded medical practice. On the other hand, trust in the scientific method was mounting. Darwin’s controversial Origin of Species, published several decades earlier, was gaining acceptance. Louis Pasteur proved that life, including bacteria, can’t generate itself spontaneously, and Robert Koch developed a testable set of postulates for determining whether a particular bacteria was the cause of an illness. A future of medicine could be envisioned in which medical intervention was chosen from the pages of science alone, rather than from the pages of history.
D.D. Palmer was, then, what one might call a conservative. He had opened a magnetic healing clinic 10 years earlier in his hometown of Davenport, Iowa. He believed that every human possessed a “vital source,” the integrity of which was crucial to one’s health. And, in 1895, he cured his first patient—a deaf man named Harvey Lillard—by manipulation of Lillard’s spine alone. The field of chiropractic was born.
According to the chiropractic doctrine, all human disease stems from a phenomenon called vertebral subluxation, a misalignment of the spine that interferes with the body’s innate intelligence, a vital energy source representing God’s presence in man . The only way to cure the ailment is to correct the subluxation by spinal manipulation.
Chiropractic was capable of working miracles. A deaf man could hear; soon after, Palmer cured another patient of heart trouble. Indeed, D.D. Palmer strongly considered establishing chiropractic as a religion—in part, actually, to gain legal protection under the Free Exercise clause of the First Amendment! He decided against it, though, largely to avoid confusion with Christian Science .
In the early 1900s, D.D. Palmer was jailed for practicing medicine without a license. Soon after, though, he was back, crusading for chiropractic, now with his charismatic son B.J. by his side. And their success was considerable. By 1925, more than 80 chiropractic institutions had been established in the United States. Many were “diploma mills” offering “an easy way to make money.”  Many were “at one another’s throats.”  Their core tenets remained consistent, though, and the chiropractic profession gained considerable influence.
Modern science kept making strides, but chiropractors stuck to the doctrine. The gap between conventional medicine and chiropractic had widened “from a fissure into a canyon.” .
In the 1930s, in a climate characterized by the increasing advancement of scientific medicine, chiropractic saw a split into two camps: the “straights” and the “mixers.” These terms originate from the days of B.J. Palmer, who deemed himself a “straight” chiropractor, and scorned those who “mixed” the use of other instruments and techniques into their trade.
Modern-day straights still prescribe by the original doctrine set forth by D.D. Palmer. All diseases are a result of vertebral subluxation, and thus spinal manipulation can cure all disease. Mixers, on the other hand, retain chiropractic spinal manipulation techniques—mainly for the treatment of lower back pain—but also use other techniques for the betterment of patients, including diet and lifestyle recommendations. Mixers tend to be receptive to advances in modern medicine, and often act broadly as primary care providers.
About 20% of chiropractors today are straights. But by portraying themselves as “purists” and “heirs of a storied lineage,” they achieve influence disproportionate to their numbers .
In 1963, the American Medical Association (AMA) established the “Committee on Quackery,” aimed at containing and eventually eliminating the field of chiropractic. The AMA deemed chiropractic an “unscientific cult” and urged its doctors not to associate with “unscientific practitioners.” 
The AMA’s boycott of chiropractic culminated in the landmark 1987 case Wilk v. AMA. Chester A. Wilk, Doctor of Chiropractic, and four co-plaintiffs, sued the AMA for anticompetitive behavior—and won! Judge Getzendanner noted that, while chiropractic isn’t supported by scientific evidence, it’s backed by plenty of anecdotal evidence. Interestingly, though, many reports of chiropractic’s success came from mixers, who, in effect, came to the rescue of the straights! This story evokes the memory of D.D. Palmer himself, who, in his legal defense, referenced the work of a mixer whom he had previously denounced. History really does repeat itself!
At any rate, the so-called Trial of the Century was a huge win for the field of chiropractic. Since then, chiropractic’s strength and political base has only grown. Nowadays, chiropractors enjoy coverage by many insurance policies, and even the occasional physician referral.
Still, though, scientific support remains limited. Chiropractic has proven effective, according to some studies, for the treatment of lower back pain, but has not been shown to be an effective treatment for any other disorder . From a scientific standpoint, it seems that mixers ought to have free reign to practice, but perhaps straights should be more strictly regulated. And, in fact, straight chiropractors aren’t able to gain licensure in many (but not all) states .
Towards Consumer Freedom
The real issue at play here, though, may not be does chiropractic work, but rather, should chiropractic be allowed even if it doesn’t work. After all, even straight chiropractic is generally considered safe when performed properly. There have been reports of adverse effects, including serious or fatal ones, but these are extremely rare . Generally, it seems that, though chiropractic may not be helpful, it’s not harmful either.
And the legal precedent seems to protect businesses with questionable scientific underpinnings, so long as they don’t particularly hurt the customer. Many attempts to ban palm-reading, fortunetelling and astrology have failed, with opponents claiming the right to free speech. Just a week ago, a ban on psychics in Deadwood, South Dakota was repealed . About a year ago, a similar ban was struck down in Louisiana . Fortunetelling may not be scientifically supportable, but that doesn’t mean that it necessarily ought to be banned. After all, plenty of people leave the psychic’s office feeling better. And the same is true of the chiropractor.
Of course, Ponzi schemes and con-artistry certainly aren’t legal. We must ask ourselves whether the benefits—even if these consist of nothing but the comfort of being listened to and the hope that things might get better—outweigh the costs. Straight chiropractic seems to fall on the good side of that line.
- Chiropractic: A Critical Evaluation from the Journal of Pain and Symptom Management
- Actual letter written by D.D. Palmer on chiropractic as a religion
- Chiropractic: Origins, Controversies, and Contributions from the Journal of the American Medical Association
- Chiropractic and Public Health: Current State and Future Vision from the Journal of Manipulative and Physiological Therapies
- Summary of The Wilk Case
- ADJUSTING THE ROLE OF CHIROPRACTORS IN THE UNITED STATES: WHY NARROWING CHIROPRACTOR SCOPE OF PRACTICE STATUTES WILL PROTECT PATIENTS
- Deadwood City Commission repeals ban on psychics
- Fed Judge Strikes Down LA Ban on…Fortunetelling, Palm Reading & Astrology