INTRODUCTION

"Perhaps the greatest force promoting the integration of alternative and mainstream therapies is the growing crescendo of consumer demand. For the most part, consumers are not interested in validating a particular model of medicine. They only seek to get well, alleviate their symptoms, or stay as healthy as they can. “Does it work?” - not “Is it mainstream or alternative?”- is their concern’.1

If hegemony is the domination of 1 power, it is difficult to see the medical grasp on health care at all levels as anything other than a monopoly. The imposition and perpetuation of the medical model allows little room or opportunity for the emergence of alternative models of health care, especially the stimulation from competitive ones, but also collaboration.2–7

Some may have felt that an amalgamation might mean more of an absorption of chiropractic, and therefore its attenuation. Further, that it may have led to a loss of chiropractic as an separate entity and the possible diminution of spinal manipulation as had happened with the merger of osteopathy with medicine in California in 1961, and subsequently in other states.8

The medicalisation of osteopathy in the US is unique to that country. In the US, osteopathy is now essentially a parallel profession with medicine, as it includes such specialties as surgery, obstetrics and gynecology and the prescription of drugs.9

DISCUSSION

In view of published and verbal reports relating to a dialogue about a possible merger between the medical and chiropractic professions in the 1960’s, I looked to see if and in what form a proposal may have been made to members of the chiropractic profession. An offer was reported to substitute chiropractors’ registration to that of medical registration. McLeod and Sweaney both recall mention of the topic in discussion with previous generation chiropractors, and as reported by Wilk and Wardwell.10,11 (McLeod ME. Personal communication. February 2016; Sweaney JA. Personal communication. September 2015).

Such a move may tend to preserve the single-profession model in the domination of healthcare services. It effectively avoids the healthy stimulus of fair and open competition.12 Inglis asks, “Why should there not be two, three, or even more professions of medicine.”8(p260)

It is noted however, that drawn out but successful antitrust litigation against the AMA and others in 1976-1990 should have curtailed such restrictive trade practices.13,14 That does not appear to have happened.15–17

Over the years, there have been reports in the United States concerning offers from organised medicine to merge or absorb the chiropractic profession. Such a precedential concession has occurred in the past with other professions, such as eclectic medicine/naturopathy (‘Natural Medicine’)13(pp37-38) homeopathy13(pp25-29) and acupuncture.18 These moves seem not to have been based on scientific research, but more in order to obviate professional competition.19

While he did not put a timeframe on his 1992 prediction, Wardwell felt that chiropractic and medicine were drifting toward a merger. One suspects that any such process would have to overcome entrenched preconceived intransigence in both parties.13(p140)

The nature of this suggested union was not clearly defined by Wardwell. He suggested that rather than a complete fusion with medicine, chiropractic could eventually be associated in a similar manner to that of dentistry, optometry, psychology and podiatry.13(p275) Such a cooperative alliance would further develop the collaboration with chiropractors that is now well established in a number of jurisdictions, especially in Europe. There has also been integration of chiropractors in hospitals and armed forces in the US and Canada in particular.20–25 I suggest that eventually some form of universal accord will evolve.26

“No joint scientific investigation of the merits of chiropractic was ever undertaken.”13(p5)

The grounds for research into this topic were based on reports in the 1960’s that an offer from a medical organisation in California had been made ‘to chiropractic’ to amalgamate the 2 professions. At the time, these were verbal reports and searches were undertaken to discover firm evidence of such an offer.

Numerous avenues were pursued in order to obtain evidence which sought to clarify any reported offer to merge chiropractors with medical doctors - and osteopaths. At that time, negotiations between osteopathy and medicine were well underway.

I contacted a number of college sources and senior members of the chiropractic profession in order to determine what they recalled of such an offer. A senior Australian chiropractor who attended Palmer Chiropractic College in the 1950’s recalls BJ Palmer, who was regarded as a chiropractic leader at the time, waving a letter regarding an offer and being outspoken in rejecting such a proposal as a sell-out to medicine. Apart from the author, others’ colleagues recalled a chiropractic ‘pioneer,’ Dr HM Himes, informally discussing this offer. Holdway, McLeod and Sweaney all recall Himes recollection of circumstances surrounding such an offer. (Holdway KB. Personal communication. March 2016; McLeod ME, Personal communication. February 2016; Sweaney JA September 2015).

Dr Himes was a 1931 graduate from the Palmer college and would have known BJ well. For some years, he was head of the technique department at Palmer College; he also lectured throughout the US and Canada. In latter years, he became dean of the Canadian Memorial Chiropractic College until the mid-1960’s.27

There was apparently a degree of apprehension concerning the aspect that chiropractic would be absorbed in the way that osteopathy had been.9 The feeling was that if a merger took place, there would be a loss of identity and ultimately an absorption with eventually diminution of the profession and its perspective.8(p113)

The most promising sources regarding this 1960’s offer were in books on the chiropractic profession by Wilk and Wardwell.11,28 Although these volumes referred indirectly to an offer, neither provided hard evidence. Copies of “A history of Los Angeles Chiropractic College”29 and 'The Merger – M.D.s and D.O.s in California",9 were extensive histories of the professions in the state. Reference to such an offer to chiropractic could not be located in these editions.9,29

An online search was also conducted of 4 journals from that era. They were the Journal of the American Medical Association, the Western Journal of Medicine (California), the International Chiropractors Association Journal, and the Journal of the American Chiropractic Association. These were expected to provide evidence of such an offer, but again no such indications were revealed

One website alluded to such an offer, but again without noting any ‘hard’ evidence. Prescott stated that "… at least one of the early chiropractic colleges so that its graduates could elect to go on and acquire the broader license (California Chiropractic College)."30 Unfortunately, this website seems to have become defunct.

A further publication covering 120 years of the California Medical Registration Board was also obtained.31 Despite being a rather candid and extensive presentation, the text surprisingly did not allude to the topic of the medical-osteopathic integration in 1961, let alone an offer to the chiropractic profession.

“Early twentieth century medical science refused to investigate the embryonic neurobiological science of chiropractic care or recognise the value of the ageless art of manipulative therapy to help the pandemic of back pain.”17(p32)

During my time at chiropractic college in the latter half of the 1960’s, I and others mentioned earlier recall mention of an offer being made to chiropractors by organised medicine in California. We understood that the proposal was to merge registered chiropractors as registered medical practitioners - virtually a conversion of chiropractors’ registration licenses. No dated document or conditions of the offer could be located or identified.

It is likely that the purpose of such an offer was for the economic protection of medical practices - an antitrust or anti-competition matter. Such a notion tends to be supported by subsequent revelations through litigation exposed by Wilk-v-AMA and others court case.11,13,32–34

In researching the merger, I found that there had been previous moves to assimilate other health professions during the 1900’s.11(pp26-27) In 1903, the AMA (US) “even accepted homeopaths as members.”11(p29) Based on historical precedents with these other professions, the amalgamations with medicine appeared to be more a form of defending professional territory. Wardwell notes this as "Organised medicine (having) a long history of opposing types of healing that might encroach on its ‘turf’ "11(p161)

This chiropractic offer was apparently relayed to 1 of the prime leaders of the profession at the time, BJ Palmer, and presumably others. As recalled by McLeod, Palmer was reportedly adamant against the offer, preferring that the chiropractic profession not be contained under the medical umbrella. He purportedly felt that such an amalgamation would lead to the demise of the chiropractic profession as an independent healing science due to a dilution of its raison d’etre. Chiropractors from the time clearly recall BJ Palmer openly discussing the key terms in what could be interpreted as a compromising proposal. (McLeod M. Personal communication)

Following the 1961-62 absorption of osteopathic schools and practitioners into medicine in California, fears were expressed in that state’s chiropractic circles of a similar move that could ‘eliminate chiropractic.’32(p111)

It is not known if the 1960’s proposition to the chiropractic profession in California was verbal or in documented form. In any case, a computer-based search plus a number of inquiries could not locate any hard records of the offer. A direct inquiry to the Palmer College of Chiropractic, where BJ Palmer oversaw much of the profession’s activities, stated that it was unaware of any such document. But if spinal manipulation was to dissipate as feared, it could be said that allopathy had “turned its back on functional illness - leaving sufferers from headaches, if no organic cause could be found, with nothing better than aspirin.”8(pp115-116)

In the US, there had been an exodus of general medical practitioners into medical specialties. In 1930, 66% of medical doctors were in general practice. By 1963 this had dropped to 5%. This opened opportunities for chiropractors and osteopaths to establish successful general practice services at the primary contact level.8(p116)

In 1987, Baer recognised the growing accommodation of medicine and chiropractic, but acknowledged that unlike other ‘heterodox’ health professions, chiropractic had not been ‘absorbed’ by the dominant biomedical profession at this stage.35 The AMA had an established history of strongly opposing the existence of other health professions, only to subsequently absorb, embrace, or adopt them or many of their concepts.35

Merger Proposals

'Thus, while one segment of medicine castigates chiropractic as a worthless cult, the other is admitting its value and is negotiating with chiropractors to obtain ‘their useful manipulative skills.’10(p97)

Further evidence, but of a cursory nature, was provided by Wilk in his text, "Chiropractic Speaks Out." Wilk cites two references for this, but unfortunately it was not possible to retrieve these at this time.10,36,37 He noted that in "The November 15, 1971 issue of the American Medical News, a publication of the AMA, revealed a plan of absorbing chiropractors into medicine. In a two-page article largely devoted to chiropractic it stated how doctors of chiropractic had attended nine-month courses at Duke University, and became licensed ‘physician’s assistants.’ [He noted further that] …these doctors of chiropractic had to renounce their independence of medicine, reject their doctor’s title, and fall under the total domination of medical physicians."10

Claims have been made that he closest chiropractic came to assimilation with medicine was in the 1930’s in California.38 The profession there established the Physicians and Surgeons Post Graduate Course for chiropractors. Essentially, this would have positioned the chiropractic profession whereby it became more or less on a parallel path with allopathy (and osteopathy). The chiropractic profession debated the idea vigorously, but rejected it.10(pp96-98)

Wardwell was a Professor Emeritus in the Department of Sociology at the University of Connecticut. Although not a chiropractor, his reviews on the profession’s inter-professional relationships were rather comprehensive. He stated that there were "…proposals by California medical leaders to 'solve the problem of chiropractic’ (‘encroachment on medical turf’) by upgrading those already in practice and cutting off further licensing, as was done there with osteopathy in 1961, (and that) met with little favourable response from chiropractors.'11,39

Today in general practice, there is a palpable willingness toward inter-professional collaboration at an individual or on a personal inter-practitioner level. Professional co-operation also exists in research, at hospitals around the world, and with conference presentations.25,39 That trend continues with chiropractic college teaching and clinical positions held by medical doctors, as it has for over 100 years.40

Some 2 decades ago, Wardwell opined that chiropractic could become a “limited” (medical) profession, as had dentistry, podiatry, optometry and psychology. He noted that differences in these other health professions “did not challenge medicine’s fundamental principles.”13(pp43-44) They all appear to remain under a rather broad medical umbrella if not dominance, but at least collaborative and co-operative. Given the current but tardy trend, one could expect that Wardwell’s observations may well be fulfilled.

WHO Guidelines for MD’s Obtaining Chiropractic Qualifications

Based on the historical precedents of a number of medical doctors becoming chiropractors, it would seem natural that contemporary medical doctors would also show interest in attaining postgraduate chiropractic qualifications. In Australia and elsewhere, a number of chiropractic graduates have, or are currently undertaking, standard university courses to obtain medical registration.26

In 2005, the World Health Organisation recommended that medical doctors undergo a 3-year course “to attain minimal registrable requirements to practice safely and relatively effectively as chiropractors.”41 Chapman-Smith states that the 3-year course is also available for physiotherapists and notes that “…chiropractic education and skills development are significantly different from physiotherapy.”42

The WHO chiropractic guidelines also recognise the need to “appreciate the expertise and scope of chiropractic and other healthcare professionals in order to facilitate intra-disciplinary and inter-disciplinary cooperation and respect.”41,43

In contrast, the Duke University program-designed course was for chiropractors to become physician assistants in 2 years.10

In Australia, a weekend course was offered to teach medical doctors spinal manipulation.44,45 This is considerably shorter than some 120 hours in articular and soft tissue assessments and approximately 100 hours in technique application courses in an Australian chiropractic institution. (Ames R. Personal communication. October 18, 2019).

Course in Chiropractic for Medical Students

There is demonstrable interest from medical students in complementary and alternative medicine. The American Medical Students Association has established a curriculum to study chiropractic, osteopathy and other complementary and alternative models. In contrast to the WHO recommendations, this chiropractic component comprised a "Six-week elective mini-course (which) combines lecture and hands-on instructions in the diagnosis of musculoskeletal neck and back conditions commonly seen in the primary care setting. Non-pharmacological treatment options will be the focus. Course objectives include being able to identify structures/tissues via palpation, to discriminate between tender points and trigger points, to identify normal and abnormal spinal motion via palpation, and to determine the appropriate non-pharmacological treatment options." While the online listing seems to be no longer available, it is also posted on the website for Science-Based Medicine as ’ Manipulative Therapies: Chiropractic and Osteopathy’.46

Such a development would tend to prepare these graduates to appropriately identify and refer those patients experiencing biomechanical neurovertebral conditions and who would be best managed under manual care.

Medical Care Personnel Use CAM

As reported by Johnson et al. in 2011, the use of complementary and alternative medicine (CAM), including chiropractic, is highest among medical doctors compared to other professions. “U.S. health care workers, especially doctors and nurses, use complementary and alternative medicine (CAM) far more than do workers in other fields, according to a new study. CAM includes diverse therapies outside the realm of conventional medicine. Overall, 76 percent of health care workers report CAM usage, compared with 63 percent of the general working population.”47 A similar finding with nurses by Dawson, also appears to contradict critics of the CAM health professions.48 While in 2000, Eastwood noted the consumer demands was leading to medical practitioners adopting alternative concepts in their practices.49

COLLABORATION

There has been apparent medical interest in chiropractic since the early years of the chiropractic profession. Around the advent of chiropractic in 1895, open collaboration with allopathic doctors was relatively harmonious. Indeed, medical doctors comprised 33% - 5 of the 15 student members taught by DD Palmer. This was followed by medical doctors lecturing at Palmer’s college in 1905; one, Dr Alfred Hender, became dean of the college in 1912.11(pp134, 20, 38)

Surgeon Became Chiropractor

Baer noted that early in the 1900’s a member of the medical faculty at the University of Pennsylvania Dr A F Walters, an orthopaedic surgeon, became a chiropractor "who wrote and lectured extensively on his new profession."35

There appears to have been conflicting attitudes toward chiropractic between independent MDs and political medicine as many “chiropractors had some MDs as patients.”11(pp245-246) In 1952, Wardwell noted that “relations between physicians and chiropractors are often surprisingly close with inter-professional collaboration in spite of organised medicine’s taboo on cooperation with 'irregulars”.50 It was around this time that the AMA was particularly active in opposing chiropractic.8,10,11(pp161-178,13,18,32,51)

Wardwell cites Cherkin et al, who noted in 2 papers in 1988 and 1989 that in Washington State, 57% of general practitioners encouraged patients to see chiropractors. A Canadian survey reported in 1980 found that 84.5% of chiropractors had received referrals from medical practitioners. In addition, a 1990 Canadian medical study found that 62.6% of medical doctors referred patients to chiropractors. In 1980, that 96% of chiropractors had referred patients to medical doctors, and 49% of chiropractors had MDs as patients.11(pp245-246)

In 1980, Berliner and Salmon acknowledged the resurgence of patient interest in alternative care when they stated that demand for chiropractic “can be in part attributed to increasing consumer dissatisfaction with the present system of medical care delivery….” and further that there is an “assumption of hegemony by scientific medicine and its practitioners” which also appears to be a factor.51

In more recent developments, chiropractors are integrating practices with medical practices and multidisciplinary practices, hospitals, and the armed forces in the US and Canada.11(pp25-29, 53-61)

International Collaboration

Internationally, inter-professional relationships appear to be steadily strengthening between medical doctors and chiropractors. Visiting rights and use of chiropractic health services in hospitals are becoming standard practice, particularly in Europe, South Africa, Canada and the US.26

In a further sign of warming inter-professional associations, in 2011, a chiropractor, Dr Anthony Hamm, was elected to the position of co-chair of the American Medical Association’s Health Care Professionals Advisory Committee Review Board (HCPAC). In his role as HCPAC co-chair, Dr. Hamm also served on the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC makes annual recommendations on relative values regarding new and revised services to the Centers for Medicare and Medicaid Services (CMS), and performs broad reviews every five years of the Resource-Based Relative Value Scale (RBRVS), which determines Medicare provider reimbursement.52,53

As with examples in Switzerland, Denmark, South Africa, Canada and many other countries, healthcare in Russia is well on the way to incorporating chiropractic practices and models into standard health services. In 1991 the Russian medical school at the Pirogov Institute of Moscow announced the formation of a chiropractic faculty through the efforts of Dr Stephen Press, a chiropractor, and Dr A. Fedin, the chief neurologist. Shpilko confirmed the inclusion of chiropractic as 1 of 8 alternative therapies “officially recognised” by the Russian Ministry of Health, and stated that such health services reach 60% of the population.54,55

In 1994, Dr Andrei Pikalov, a Russian medical doctor, stated that “recognition of manual therapy (manipulation) in Russia started about 30 years ago” – circa 1965. There are now 6 institutes teaching such methods in Russia. He stated that it is practiced in all hospitals and outpatient clinics in Russia as the field of vertebroneurology. This term would seem a particularly relevant designation as it emphasises the neurological element in the chiropractic vertebral subluxation model.56

The restraint on chiropractic appears to be both inconsistent and incongruous, in view of the developments resulting from the 1979 NZ Inquiry of chiropractic and the 1990 US antitrust law suit against the AMA. The claims are further contradicted when:

  • The medical version of chiropractic, manipulative medicine, is a growing element in medicine,57

  • Manipulation under anaesthesia (MUA) in hospitals as conducted by chiropractors in conjunction with medical theatre staff is also in growing demand.58,59

  • The old medical claim that vertebrae cannot be manipulated is now superseded despite the claim.60–62

  • There is precedential evidence and recognition of the vertebral lesion - the vertebral subluxation complex (VSC) in the medical literature.63,64

  • Disturbed spinal mechanics have been shown to affect neural elements such as somato-autonomic reflexes, mechanoreceptors, nociceptors and other sensory receptors.65–73

  • There is ongoing independent and collaborative medical/chiropractic research, into the understanding of the neurobiological elements of the chiropractic model.74–77

  • There is a growing trend in collaborative care of patients.78

  • Authoritative chiropractic research is published in medical journals.79,80

  • Contemporary and historical chiropractic and osteopathic research papers with animal subjects have been published.81–84

  • There are papers on the chiropractic model of care of animals published in veterinary and chiropractic journals,85–92

  • Papers in medical journals report the manipulative management of visceral conditions.93–98

  • Papers in medical journals report on the spinal manipulative management of infants for a variety of childhood conditions.60,61,99,100

  • Chiropractic has been shown to be a particularly safe procedure.101–107

  • I am not aware of any formal scientific study which refutes or contradicts the basis for the chiropractic model – nor the vertebral subluxation premise.11(p162)

Despite the adoption of fundamental chiropractic concepts in medicine, there are still some who purport to reject these established facts, or just chose to ignore them. Overall however, developments would suggest a gradual blending and mutual recognition, with political rather than clinical or scientific aspects still being the primary hurdle.

Without the success in positive patient outcomes, patient demand, and the perseverance of chiropractors, neither medicine nor physiotherapy would have been interested in developing or adopting their version of manipulation.

Chiropractic is a health profession offering options for a range of conditions. It is not a synonym for manipulation, which can at times be a part of the chiropractic model of care.

The practice of health care is a human right. Every individual must have the possibility of accessing it, without discrimination of any kind and in a fair, balanced and true spirit, which requires mutual recognition with a spirit of friendship, solidarity and understanding all in the best interest of patient health and welfare.

CONCLUSION

“Inasmuch as medicine, in spite of its emphasis on objectivity and scientific research, is resistant to changing its basic formulations, chiropractic performs the important function of furnishing another channel of medical innovation…..and physicians know practically nothing about chiropractic.” Wardwell 195250

Given the degree of informal as well as formal interaction between medical doctors and chiropractors over many decades, there are reasonable grounds to expect that some form of an integration offer to the chiropractic profession may have been floated by organised medicine, at least in California. Although a few references alluded to such offers, I could locate no documentation that outlined terms conditions or formerly recognised any negotiations.

The relationship between the 2 professions in North America does appear to have improved in recent years. It took the US Court of Appeal’s decision in The Wilk Case to expedite this.108–110 Following the decision, 50,000 chiropractors obtained the formal ability to consult professionally with MDs, use hospital facilities and apply for hospital appointments, access co-admitting rights (similar to dentists and podiatrists in the US), administer treatments, and importantly, order diagnostic tests, offer dietary advice and recommend physiotherapy for their patients. By the early 1990’s after the court judgement, at least 60 hospitals or ambulatory centres employed chiropractors on staff.39 Given the patient demand for such services, it should not have taken a court decision to accomplish all this.

Varying degrees of interaction between chiropractors and medical doctors are quite commonplace throughout the world at the clinical level. Collaboration is also taking place at an organisational level involving hospitals, insurance companies, workers’ compensation, educational institutions, health funds, and in veteran affairs health services. Once initiated, this integration seems to be quite successful.

At the political-organisation-professional level in some countries, there still remains resistance to chiropractic. However, in others, there is open recognition of chiropractic as an independent yet affiliated health profession.

The merging of osteopathy in California, which spread to the rest of the US, was one of a series of amalgamations where medicine absorbed or integrated other health professions. Medicine has had a traditional record of taking over other health professions, and as such, that may have been a factor alerting chiropractors at the time of the osteopathic merger. Based on previous history, the concern held by many chiropractors is that merging could well lead to submerging and subsequent an abatement of the profession in a loss of identity.

Serious debate as to whether a monopolistic healthcare model is best for patients has yet to take place.14–17,111 However, as reflected in trade practices legislation, a dominant cabal-like cartel is discouraged in non-medical commercial areas as not being in the best interest of consumers, and the same could apply to health care.

“Faced with different, modalities of treatment, we choose medicine not necessarily because it is the best care, or even the logical choice, but because we have been programmed to think of health care as consisting of drugs and surgery.”

'Is there any reason why the same freedom should not exist in the field of health as exists in business or politics, or religion, or anything else? Is there any reason why one single approach to the problem of health, backed by powerful financial interests, should be given a complete monopoly?"10(p165)

Thee has traditionally been persistent resistance toward chiropractic at a political medicine level. This appears quite different at an individual and clinical level where collaboration and co-operation takes place. This dichotomy of medical attitudes tends to reflect a contradiction and inconsistency to the claims against chiropractic and supplies an element of support for the possibility of merger discussions taking place at some stage.

Despite indications, I found no evidence that could confirm any formal offer made to chiropractors in California or any other US state.

Efficacy and patient demand could be possible factors explaining any medical interest in engulfing chiropractic. By its continued existence and growth, chiropractic essentially challenges medicine as the ultimate authority on all health matters.

While the chiropractic profession is under sustained opposition from politico-medical quarters, this resistance is inconsistent with worldwide trends involving individual practitioners. Critics’ claims are hardly justified or supported by the published scientific evidence when key elements of chiropractic are adopted by these other once-critical professions. They are also effectively contradicted by the legal outcomes against political medicine under the findings in the 1990 US Supreme Court - the case of Wilk-v-AMA & others.15,108–110 All the fears of safety and unscientific claims about chiropractic seem to suddenly become acceptable to hospitals and health funders/insurers. This has made sceptical patients and independent minded allopaths open to reviewing the original source of their opinions.

Wolinsky and Brune state that “there have always been multiple schools of medical thought.”19(p122) These have essentially all remained within the medical empire. Such a blurring of realms may be a reason to retain optional care with a separate and distinct yet collaborative and cooperative profession, somewhat akin to the medical-dental relationship. It would seem however, that the terms of membership could be somewhat restrictive to any absorbed profession.

Should the preconceived notions against chiropractic dissipate in light of scientific research (as expected), the writer suggests that a form of inter-professional alliances and greater collaboration between established health professions would evolve.

However, like dentistry, chiropractic should and will remain an optional system of healthcare in its own right. Further, many in medicine would have difficulty in publicly accepting the findings that it has denied acknowledging the potential in the chiropractic model for so long, and fostered unsubstantiated claims against chiropractic. Wardwell sees chiropractic being a “limited” profession like dentists - limited by its own model of healthcare. He does not see chiropractic becoming an ancillary profession but that it remains more independent with close interprofessional collaboration.11(pp280-287)

In researching this topic of a possible merging of chiropractic with medicine in California, I felt that definite if informal overtures and discussions may well have taken place, despite the lack of available documented evidence.

No apparent reason could be found as to why there should be a limit on the number of health professions. It may be said that hegemony has effectively resulted in a cartel which dominates so much of this essential service. The gatekeeper model appears self-serving in that it actively discourages evolving and stimulating options and theories in healthcare.

In essence, patient preferences were suppressed by a hegemonic model in health care. Patient preferences challenge the dominant forces in healthcare, which in turn is decidedly slow in responding to patient demands. In addition, political response and change should be patient-driven, not a response to a dominant profession’s powerful position of influence.

Due to the basic philosophical tenets of each profession, the interprofessional relationship would best serve patients by remaining as a fully collaborative but independent and fully cooperative in a similar vein to that of dentistry,

I would be grateful if any reader had definitive documentation or further confirmation regarding any move concerning a merging of chiropractic and medicine. Please contact me at cadaps@bigpond.net.au

“The chiropractic profession is assuming its valuable and appropriate role in the health care system in this country (USA) and around the world. As this happens the professional battles of the past will fade and the patient at last will be the true winner.” Jonas W (MD) 2000112