Chiropractic - History

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Historical overview

D.D. Palmer

Chiropractic (also known as Chiropractic Medicine) was founded in the 1890s by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. Palmer and his son B.J. Palmer later wrote that the elder Palmer gave the first chiropractic adjustment to a deaf man, Harvey Lillard, on September 18, 1895, restoring the man's hearing.[1] Lillard's daughter disputed the account, saying that Palmer had merely slapped Lillard on the back after hearing a joke.[2] Investigator Cyrus Lerner found in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. had concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the Tales of the Arabian Nights.[3] Palmer hypothesized that manual manipulation of the spine could result in improved neurological function and health. Friend and Rev. Samuel Weed suggested combining the words cheiros and praktikos (meaning "done by hand") and chiropractic was born.[4]

Philosophical contribution

Two chiropractic belief system constructs
THE TESTABLE PRINCIPLE   THE UNTESTABLE METAPHOR
Chiropractic Adjustment Universal Intelligence
↓ ↓
Restoration of Structural Integrity Innate Intelligence
↓ ↓
Improvement of Health Status Body Physiology
 
MATERIALISTIC:     VITALISTIC:
— operational definitions possible — origin of holism in chiropractic
— lends itself to scientific inquiry — cannot be proven or disproven
taken from Mootz & Phillips 1997[5]

Traditional and evidence-based chiropractic belief systems vary along a philosophical spectrum ranging from vitalism to materialism. These opposing philosophies have been a source of debate since the time of Aristotle and Plato. Vitalism, the belief that living things contain an element that cannot be explained through matter, was responsible for legally and philosophically differentiating chiropractic from conventional medicine and thereby helping ensure professional autonomy.[6] Chiropractic also retains elements of materialism, the belief that all things have explanations, which forms the basis of science. Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining.[5]

The chiropractor's purpose is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being of the person as a whole.[5] Principles such as holism, naturalism, therapeutic conservatism, critical rationalism, and thoughts from the phenomenological and humanistic paradigms form an important part of the philosophy of chiropractic."[7]

Chiropractors can adopt or share vitalist, naturalist, or materialist viewpoints and emphasize a holistic, patient-centered approach that appreciates the multifactorial nature of influences (i.e. structural, chemical, and psychological) on the functioning of the body in health and disease and recognizes the dynamics and interplay between lifestyle, environment, and health. This holistic paradigm is also blended with a biopsychosocial approach, which is also emphasized in chiropractic care. In addition, chiropractors also retain naturopathic and naturalist principles that suggest decreased "host resistance" of the body facilitates the disease process and that natural interventions are preferable towards strengthening the host in its effort to optimize function and return to homeostasis.[5] Chiropractic care primarily emphasizes manipulation and other manual therapies as an alternative than medications and surgery.[8]

Chiropractors also commonly use nutrition, exercise, patient education, health promotion and lifestyle counseling as part of their holistic outlook towards preventive health care.[9] Chiropractic's claim to improve health by improving biomechanical and neural function by the manual correction of joint and soft tissue dysfunctions of the neuromusculoskeletal system differentiates it from mainstream medicine and other complementary and alternative medicine (CAM) disciplines, but is also rooted, in part, in osteopathy and eastern medicine interventions.[7] All chiropractic paradigms emphasize the spine as their focus, but their rationales for treatment vary depending on their particular belief system.

The philosophy of chiropractic also stresses the importance of prevention and primarily utilizes a pro-active approach and a wellness model to achieve this goal.[10] For some, prevention includes a concept of "maintenance care" that attempts to "detect and correct" structural imbalances of the neuromusculoskeletal system while in its primary, or functional state.[11] The objective is early identification of mechanical dysfunctions to prevent or delay permanent pathological changes.[12]

In summary, the major premises regarding the philosophy of chiropractic include:[5]

  • Holism
  • non-invasive, emphasizes patient's inherent recuperative abilities
  • recognizes dynamics between lifestyle, environment, and health
  • spine and health are related in an important and fundamental way, and this relationship is mediated through the nervous system.[6]
  • recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body
  • appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
  • Conservatism
  • balances the benefits against the risks of clinical interventions
  • emphasizes non-invasive treatments to minimize risk with a preference to avoid surgery and medication
  • recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
  • prevents unnecessary barriers in the doctor-patient encounter
  • Manual and biopsychosocial approaches
  • strives toward early intervention, emphasizing timely diagnosis and treatment of reversible conditions before loss of functionality
  • emphasizes a patient-centered model in which the patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health[6]
  • approach of improving health through influencing function through structure primarily via manual therapies

Schools of thought and practice styles

Range of belief perspectives in chiropractic
perspective attribute potential belief endpoints
scope of practice: narrow ("straight") ← → broad ("mixer")
diagnostic approach: intuitive ← → analytical
philosophic orientation: vitalistic ← → materialistic
scientific orientation: descriptive ← → experimental
process orientation: implicit ← → explicit
practice attitude: doctor/model-centered ← → patient/situation-centered
professional integration: separate and distinct ← → integrated into mainstream
taken from Mootz & Phillips 1997[5]

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.[13] Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.[14]

Straight chiropractors are the oldest, and today the smallest faction; representing perhaps less than 10% of the profession in the US.[15] They adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an Innate intelligence within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies.[16] Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.

The Mainstream of Chiropractic, which was pejoratively called "Mixer's" by the so-called "Straight" chiropractors are an early offshoot of the straight movement. This branch "mixes" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of the many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad treatments including joint and soft tissue manipulation, electromodalities, physical therapy, exercise-rehabilitation and other complementary and alternative approaches such as acupuncture. Mixers tend to be open to mainstream medicine.[17] Mixers are the majority group.[18]

Historical term, "Vertebral subluxation"

Main article: Vertebral subluxation

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself.[19] D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[20] This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."[21]

The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.[22] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.[22] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer College of Chiropractic[23]) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College[24]) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.[25][26] A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%.[27] In 2005, subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.… This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies."[28]


Medical opposition

In 1899, a medical doctor in Davenport, USA, named Heinrich Matthey started a campaign against drugless practitioners.[3][29] D.D. Palmer insisted that his techniques did not need the same courses or license as medical doctors, as his graduates did not prescribe drugs, perform surgery or evaluate laboratory diagnostics. However, in 1906, D.D. Palmer was convicted for practicing medicine without a license. In response, B.J. created the Universal Chiropractic Association (UCA) for the purpose of protecting its members by covering their legal expenses should they get arrested for practicing medicine.[30]

BJ Palmer, Developer of Chiropractic, 1882-1961

Its first case came in 1907, when Shegataro Morikubo, DC was charged with unlicensed practice of osteopathic medicine in Wisconsin. Morikubo was freed using the defense that chiropractic philosophy was different from osteopathic philosophy. The victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy.[3] This began a longstanding feud between chiropractors and medical doctors that would culminate in the mid 1980's in a landmark case, Wilk et al. vs American Medical Association (AMA). Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult."[31] In 1984, Joseph Janse, DC, ND, attempted to describe the divide in chiropractic and medical philosophy regarding prevention and patient care:

"Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [medical doctors] it does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from the physiological normal were of little consequence, until they were replaced by pathological changes…"[32]

Legal battles

In 1992, the AMA stated "It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic."[33] In 1997, the following literature was adopted as policy of the AMA after a report on a number of alternative therapies. The report said (about chiropractic care): "Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."[34]

The British Medical Association (BMA) notes that "There is also no problem with GPs referring patients to practitioners in osteopathy and chiropractic who are registered with the relevant statutory regulatory bodies, as a similar means of redress is available to the patient."[35] In 1997, the BMA identified chiropractic health care as having "the potential for greatest use alongside orthodox medical care."[36]

Internal conflicts

So-called "straights" and the mainstream have had conflicts that continue to this day.[37] Objective Straight chiropractors, who were an off-shoot of straights, only focused on the correction of chiropractic vertebral subluxations while traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases.[38] Reform chiropractors were an evidence-based off-shoot of mixers who rejected traditional Palmer philosophy and tended not to use alternative medicine methods.[39] There is disagreement over what does innate and subluxation mean to chiropractic.[17] Some chiropractors believe in Innate intelligence, an untestable faith-based belief, not of science, which has been a source of derision for chiropractors.[40] In Wisconsin, US, there was local chiropractic support to offset a chiropractic anti-fluoridation campaign.[41]

Wilk et al. vs. American Medical Association

Chester A. Wilk, DC from Chicago initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk et al. vs AMA et al.[42] The landmark lawsuit ended in 1987 when the US District Court found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the American College of Physicians were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this could not have been achieved in a manner less restrictive of competition, for instance by public education campaigns.[43] A summary of the court's opinion concluded:

"Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country."[43]

On February 7, 1990, the AMA lost its appeal,[44] and could no longer prevent medical physicians from collaborating with chiropractors.[43]

Movement toward science

In the first 50 years of chiropractic, there was a lack of research. The terms science and research were often used as marketing tools. Several decades would pass before research and an interest in science became evident in chiropractic.[45] In 1975, chiropractors joined medical and scientific attendees in a workshop sponsored by the National Institutes of Health on the research status of spinal manipulation. In 1978, the Journal of Manipulative & Physiological Therapeutics (JMPT) was launched.[46] In 1983 the JMPT published an article advocating "a scientific institution with some capability for research" and was considered the beginning of the scientific chiropractic movement.[47] Robert S. Francis, DC, states that "Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s."[48] Various chiropractic groups distributed patient brochures with unsubstantiated claims.[49] In the early 1990s there was little scientific research into chiropractic. In 1993, the Manga report funded by the Ministry of Health strongly supported chiropractic care for lower back pain.[46] At the time, the Manga report "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment."[50] A 2001 study says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established."[49] In 1998, historian Joseph Keating Jr wrote that "substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from non-chiropractors, contributions from non-chiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."[51] A 2002 study states "Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems."[52] Chiropractic began a century ago in simplistic terms but as the profession developed it is now well established with many chiropractic colleges worldwide.[53] There are barriers between primary care physicians and chiropractors for having positive referral relationships.[54] Despite internal debate and external opposition, its unified profession suggests it will endure as a relevant component of health care.[17]

The Present Day

Today, the chiropractic profession generally divides itself into "mainstream" and, "traditional" a/k/a, "straight" Chiropractic. Historically the terms "straights" and "mixers," were applied by Palmer to distinguish those who rigorously followed his teachings from those who incorporated Physiotherapy, nutrition and or other methods to treat patients. Although both groups have had off-shoots. [17][19] Significant differences regarding scope of practice, claims made about spinal manipulation, and beliefs regarding professional integration, differentiated the various schools of thought and practice styles held within the profession.[14] Naturally, the various State's scope of practice legislation and CCE (Council on Chiropractic Education) accreditation rules have been a unifying force, between traditional and evidence-based chiropractic beliefs which ranged range from vitalism to materialism.[6]

References

  1. ↑ Palmer DD, Palmer BJ (1906). The science of chiropractic: its principles and adjustments. Davenport, IA: Palmer School of Chiropractic. OCLC 36930079.
  2. ↑ Westbrooks B (1982). "The troubled legacy of Harvey Lillard: the black experience in chiropractic". Chiropr Hist. 2 (1): 47–53. PMID 11611211.
  3. ↑ 3.0 3.1 3.2 Template:Cite paper
  4. ↑ Martin SC (1993). "Chiropractic and the social context of medical technology, 1895-1925". Technol Cult. 34 (4): 808–34. PMID 11623404.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11.
  6. ↑ 6.0 6.1 6.2 6.3 Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1.
  7. ↑ 7.0 7.1 Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1.
  8. ↑ Hansen DT, Mootz RD (1999). "Formal processes in health care technology assessment: a primer for the chiropractic profession". In Mootz RD, Hansen DT. Chiropractic technologies. Jones & Bartlett. pp. 3–17. ISBN 0834213737.
  9. ↑ Rupert RL (2000). "A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors, maintenance care: part I". J Manipulative Physiol Ther. 23 (1): 1–9. doi:10.1016/S0161-4754(00)90107-6. PMID 10658870.
  10. ↑ Rupert RL, Manello D, Sandefur R (2000). "Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II". J Manipulative Physiol Ther. 23 (1): 10–9. doi:10.1016/S0161-4754(00)90108-8. PMID 10658871.
  11. ↑ Canadian Chiropractic Association (1996). "Glenerin guidelines: preventive maintenance care". Retrieved 2008-02-26.
  12. ↑ Vear HJ (1992). "Scope of chiropractic practice". In Vear HJ (ed.). Chiropractic Standards of Practice and Quality of Care. Gaithersburg, MD: Aspen. pp. 49–68. OCLC 23972994.
  13. ↑ Keating J Jr. (2003). "Surveys now and then". Dyn Chiropr. 21 (19). Retrieved 2008-03-24.
  14. ↑ 14.0 14.1 Healey JW (1990). "It's where you put the period". Dyn Chiropr. 8 (21).
  15. ↑ Saul F. Rosenthal (1987). A Sociology of Chiropractic. Edwin Mellen Pr.
  16. ↑ Keating, Joseph C. (2004). Chiropractic History: a Primer (PDF). Association For The History Of Chiropractic. Unknown parameter |coauthors= ignored (help)
  17. ↑ 17.0 17.1 17.2 17.3 Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801.
  18. ↑ Coulehan JL (1985). "Adjustment, the hands and healing". Cult Med Psychiatry. 9 (4): 353–82. PMID 2934224.
  19. ↑ 19.0 19.1 Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 23–64. ISBN 0-07-137534-1.
  20. ↑ Keating JC Jr (1995). "D.D. Palmer's forgotten theories of chiropractic" (PDF). Association for the History of Chiropractic. Retrieved 2008-05-14.
  21. ↑ Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743.
  22. ↑ 22.0 22.1 Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17.
  23. ↑ "Palmer College of Chiropractic, General Information". Retrieved 2008-03-24.
  24. ↑ "Undergraduate and graduate programs 2006–2007" (PDF). Canadian Memorial Chiropractic College. 2006.
  25. ↑ Kevin A. Rose, Alan Adams (2000). "A Survey of the Use of Evidence-Based Health Care in Chiropractic College Clinics" (PDF). The Journal of Chiropractic Education. 14 (2): 71–7.
  26. ↑ Samuel Homola (2006). "Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor" (PDF). The Journal of Manual & Manipulative Therapy. 14 (2): E14–E18.
  27. ↑
  28. ↑ Template:Cite paper
  29. ↑ Keating J Jr (2001). "Chiropractic at the turn of the century". Dyn Chiropr. 18 (6).
  30. ↑ Keating JC Jr (1999). "Tom Moore, defender of chiropractic, part 1". Dyn Chiropr. 17 (25).
  31. ↑ Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. PMID 2817179.
  32. ↑ Janse J, quoted in: Strang VV (1984). Essential Principles of Chiropractic. Davenport, IA: Palmer College of Chiropractic. pp. p. 26. OCLC 12102972.
  33. ↑ "E-3.041 Chiropractic". American Medical Association. Retrieved 2008-03-24.
  34. ↑ "Report 12 of the Council on Scientific Affairs (A-97) Full Text". American Medical Association. Retrieved 2008-03-24.
  35. ↑ "Referrals to complementary therapists". British Medical Association. Retrieved 2008-05-25.
  36. ↑ Chapman-Smith DA (1997). "Legislative approaches to the regulation of the chiropractic profession". Med Law. 16 (3): 437–49. PMID 9409129.
  37. ↑
  38. ↑ "Position Paper One — What is Objective Straight Chiropractic?". Foundation for the Advancement of Chiropractic Education (F.A.C.E.). Retrieved 2008-03-24.
  39. ↑
  40. ↑ Joseph C. Keating, Jr (2002). "The Meanings of Innate" (PDF). J Can Chiropr Assoc. 46 (1): 10.
  41. ↑ Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success". Am J Public Health. 79 (10): 1405–8. PMID 2782512.
  42. ↑ Robbins, John (1996). "Medical monopoly: the game nobody wins - excerpt from 'Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing'". CNET Networks. Vegetarian Times.
  43. ↑ 43.0 43.1 43.2 "The Wilk case" (PDF). The Chiropractic Resource Organization. Retrieved 2008-05-12.
  44. ↑ Wilk v. AMA, 895 F.2d 352 (7th Cir. 1990).
  45. ↑ Keating JC Jr, Green BN, Johnson CD (1995). ""Research" and "science" in the first half of the chiropractic century". J Manipulative Physiol Ther. 18 (6): 357–78. PMID 7595110.
  46. ↑ 46.0 46.1 Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43. Retrieved 2008-05-10.
  47. ↑ DeBoer KF (1983). "Notes from the (chiropractic college's) underground". J Manipulative Physiol Ther. 6 (3): 147–50. PMID 6655376.
  48. ↑ "International MUA Academy of Physicians - Historical Considerations". Retrieved 2008-03-24.
  49. ↑ 49.0 49.1 Grod JP, Sikorski D, Keating JC Jr (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551.
  50. ↑ "Canada Celebrates 100 Years of Chiropractic". Dynamic Chiropractic. July 17, 1995. Retrieved 2008-05-01.
  51. ↑ Keating J; et al. (1998). "A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996". J Manip Physiol Ther. 21: 539–52. PMID 9798183 PMID 9798183 Check |pmid= value (help).
  52. ↑
  53. ↑
  54. ↑ Allareddy V, Greene BR, Smith M, Haas M, Liao J (2007). "Facilitators and barriers to improving interprofessional referral relationships between primary care physicians and chiropractors". J Ambul Care Manage. 30 (4): 347–54. doi:10.1097/01.JAC.0000290404.96907.e3. PMID 17873667.
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