Chiropractic, Acupuncture, and Integrative Medicine: The Power and Politics of Healing

I have been in chiropractic practice for almost twenty five years. From the beginning, I have taken an integrative approach, working with a team of complementary practitioners—medical doctors, acupuncturists, physical, movement, and massage therapists, nurses, and osteopaths—all under one roof in my clinic, Chiromedica. There were not many practices like this back in the 1980’s. But in recent years there has been a proliferation of integrative health centers, many of them run by medical doctors. Major medical centers like California Pacific, UCSF, and Kaiser Permanente have set up “complementary and alternative medicine” clinics, yet chiropractic care is excluded in house, relegated (at best) to off site referral. Given chiropractic’s central role in the history and development of alternative and integrative healing, it is worth exploring why this might be the case.

Understanding the current state of American medicine requires a brief review of its history. In the mid to late nineteenth century, there was no professional monopoly on the delivery of health care. Allopathic (regular) doctors competed with homeopaths, eclectics (naturopaths), chiropractors, and osteopaths. Each discipline had something of value to offer, but none were sufficiently effective on their own to claim the cultural authority necessary to take control of the health care marketplace. By the early 20th century, however, regular medicine had gained this authority. In the throes of industrialization, America was enamored with all things scientific, and regular medicine was able to assert itself as the only healing discipline rooted in modern science. Armed with a foundational (germ) theory, a handful of effective drugs and surgical procedures, and political power consolidated through the formation of professional bodies like the American Medical Association and its Council on Medical Education, allopathic medicine finally cleared the field of competition.

Yet distant from the power centers of the new medical empire–New York, Boston, Baltimore, Chicago—which were anchored by university medical schools and their research hospitals, alternative practitioners continued to ply their trades. In poor rural areas there was no access to this “scientific” medicine and no money to seed its growth. It was the local chiropractors, osteopaths, and herbalists who remained. These practitioners were affordable, rooted in their local communities, and effectively treated a host of conditions that this new medicine could not.

Throughout the 20th century, changes took place rapidly. Allopathic medicine developed increasingly sophisticated methods of diagnosis and treatment. Osteopathy was folded into medicine in a deal struck with the AMA whereby parity was given in exchange for the abandonment of osteopathy’s primary focus on esoteric theories of illness and its practices of body manipulation. And many of the practices of the eclectics (naturopaths) were adopted (or co-opted) by regular medicine, leading to a withering of the schools of natural medicine. Chiropractic stood alone in its resistance to the new medical power, and suffered the consequences of its disobedience–outlawing of the profession, jailing of its practitioners, conspiracies to destroy it from within. But still the patients came. And as the science grew to support the ancient manipulative art, (see “Chiropractic and the East/West Dilemma). Chiropractic came to become a significant player at the table of American health care.

Traditional Chinese Medicine (TCM), which includes acupuncture and has a two thousand year old history, has arrived only recently in the United States. Although practiced throughout the historical period described above, it was found mainly within scattered Chinatown’s, invisible to most of the country. Sensationalized with Nixon’s opening to China when one member of the American entourage had an attack of appendicitis and was anesthetized using only acupuncture needles, this system came to the awareness of the American public. Thawed relations with China allowed increased flow of this knowledge and the beginning of  TCM’s utilization on a popular scale. At first the MD’s tried to prevent the use of this therapy, labeling it oriental mysticism, a primitive relic, without scientific basis. But patients discovered that this “new” practice could treat a host of conditions that stumped their regular MD’s. The next response by the MD’s was control, asserting that only MD’s could practice this new healing art. It was a public safety issue, they claimed. Patients needed to be protected from unqualified practitioners—charlatans who might take advantage of the innocent public. So an MD who took a 300 hour course in acupuncture in a conference room at a Marriot Hilton could practice, but someone who studied the ancient science for 4 years or longer in China was prohibited. After this failed to have an effect on public utilization, TCM gained a foothold in the health care market. Colleges of Traditional Chinese Medicine were established, licensing was instituted, and today, Licensed Acupuncturists (L.Ac.) and Oriental Medical Doctors (OMD) are recognized as primary providers, covered by many of today’s health insurance plans.

Now acupuncturists share space with M.D.’s. They are vital players on the integrative medical team. And while TCM is clearly a very powerful healing modality which stands up to scientific scrutiny when examined as an internally coherent system, the medical establishment seems to have shed many of the classical western scientific standards that it has applied so rigorously to other disciplines. It appears to accept that the body has an energetic system yet to be understood. That there are channels through which this energy flows that cannot be dissected out in the anatomy lab. That one can have a diagnosis of “windy liver” and proceed to treat this condition by putting needles into invisible points and prescribing teas and medicines made of (laboratory untested) herbs. Yet chiropractic, which is firmly rooted in western knowledge of anatomy, physiology, and neurology, is refused inclusion, despite the mounting evidence to support it’s therapeutic efficacy, particularly in the realm of musculoskeletal dysfunction.

The conflict between chiropractic and regular medicine has always been, at its core, a battle over market share. Regular medicine has spent vast sums of time and money on the slandering and libel of chiropractic. This negative message has sunk deep into the American consciousness and it plays not only in the minds of patients, but also in those of their doctors. chiropractic has become the “anti-medicine”. Medicines shadow. Non-scientific. A relic of our quaint medical past. A villain in the glorious story of the rise of modern medicine. To accept chiropractic after this telling undermines the foundation myth of modern medicine. To challenge the “truth” of this story ultimately threatens medical power, and the money that flows through the channels carved by that power.

So why has TCM been brought into the medical fold? First, there has not been a protracted historical struggle between regular medicine and TCM. While the battles might have been intense, they were brief. There was not enough time to establish deep toxic memories. On the contrary, TCM was something that rode to America on the countercultural wave of the 1960’s and 70’s. Coming at a time when the American mind was wide open to the great traditions of the east—Hinduism, Buddhism, Taoism–it was embraced as an extension of these ancient wisdoms. And it did not challenge the new scientific medical paradigm since it existed in an alternate universe, internally consistent, yet impossible to validate using standard scientific protocols. Challenging the TCM paradigm did nothing to undermine the logic of allopathic medicine. The medical acceptance of TCM is the warm and fuzzy romantic embrace of an exotic new friend. In the classic Orientalist tradition, eastern medicine has satisfied the western desire for mystery. And as long as the “orientals” know their place as valued, but less than equal partners of allopathic medicine, the two professions could happily work together to develop the “new” integrative model.

Allopathic medicine has successfully asserted its power and claimed the mantle of cultural authority. It has become fully internalized in the American psyche. Throughout its history, this medicine has absorbed the techniques and practices of other healing systems, both to strengthen its own practice and to undermine its competition. In adopting TCM in toto, as part of the integrative medical model, allopathic medicine expands its reach through accommodation of the cultural demands for TCM and other complementary therapies. At the same time, it maintains control of the new system, expanding on its historic strategy to dominate the health care marketplace. And make no mistake. The MD’s are firmly in charge. Ask any Acupuncturist working in this setting and they will tell you. That is, unless the acupuncturist happens to be an MD as well!

Integrative healing has been at the core of chiropractic practice for decades, yet chiropractors remain shut out of the corridors of integrative medical power. However, paradigms are always in flux, pushed to change from the periphery, and we chiropractors, the perpetual outsiders, are still well positioned to broaden the scope and deepen the practice of integrative medicine. A true integrative model would be one that fully embraces the healing arts and sciences of allopathic, TCM, and chiropractic, with each profession contributing its valuable piece, equally, for the benefit of patients everywhere.