The medical monopoly

 

Wilks vs. AMA Antitrust Suit

A common misconception concerning chiropractic care is that medical doctors discourage their patients from visiting a chiropractor to take care of their musculoskeletal complaints. The basis of this misconception stems from a lawsuit filed by Chester A. Wilk D.C., a chiropractor, against the American Medical Association, AMA, for violation of the Sherman Antitrust Act. In most simple terms, the Sherman Antitrust Act sets rules to limit monopolies by companies.

The basis of Dr. Wilk’s argument was that the AMA planned, implemented, and conspired to eradicate the chiropractic profession. Until 1983, the AMA held the stance that it was unethical for medical doctors to associate with “unscientific health practices,” and at that time, it had labeled chiropractic as an “unscientific cult.” In addition to labeling chiropractic as an “unscientific cult,” the AMA established a special group, termed the “Committee on Quackery,” geared toward eliminating the AMA’s competition. In essence, the AMA was trying to establish guidelines so that a medical doctor and his/her patients were not allowed to associate with other healthcare providers, thus establishing a medical monopoly.

Following a several year lawsuit, on September 25, 1987, Judge Getzendanner issued her opinion that the AMA had violated Section 1, but not 2, of the Sherman Act, and that it had engaged in an unlawful conspiracy in restraint of trade “to contain and eliminate the chiropractic profession.” (Wilk v. American Medical Ass’n, 671 F. Supp. 1465, N.D. Ill. 1987). She further stated that the “AMA had entered into a long history of illegal behavior”. And, she then issued a permanent injunction against the AMA under Section 16 of the Clayton Act to prevent such future behavior.

Both sides cross-appealed, and the district court’s decision was affirmed by the U.S. Court of Appeals on February 7, 1990 (Wilk v. American Medical Ass’n,895 F.2d 352, 7th Cir. 1990). In their opinion, the Appellate Court wrote “The court found the AMA failed to establish that throughout the relevant period (1966-1980) their (the AMA’s) concern for scientific methods in patient care had been objectively reasonable”. The AMA petitioned the U.S. Supreme Court three times, but each time the Court denied appeal on all three occasions.

Following the case, Judge Getzendanner remarked, “The plaintiffs point out that the anecdotal evidence in the record favors chiropractors. The patients who testified were helped by chiropractors and not by medical physicians. Dr. Per Freitag, a medical physician who associates with chiropractors, has observed that patients in one hospital who receive chiropractic treatment are released sooner than patients in another hospital in which he is on staff which does not allow chiropractors. Dr. John McMillan Mennell, M.D. testified in favor of chiropractic. Even the defendants’ economic witness, Mr. Lynk, assumed that chiropractors outperformed medical physicians in the treatment of certain conditions and he believed that was a reasonable assumption.… I do not minimize the negative evidence. But most of the defense witnesses, surprisingly, appeared to be testifying for the plaintiffs. Taking into account all of the evidence, I conclude only that the AMA has failed to meet its burden on the issue of whether its concern for the scientific method in support of the boycott of the entire chiropractic profession was objectively reasonable throughout the entire period of the boycott. This finding is not and should not be construed as a judicial endorsement of chiropractic.”

Since the settlement of this lawsuit, there has been much more collaboration among chiropractors and medical doctors to achieve the greatest possible health objectives for their patients. In fact, many hospitals have a full-time chiropractor on staff, and many medical doctors will refer patients to chiropractors for certain conditions and vice versa. Like anywhere else, dogma and history are tough to change overnight, so there are some instances where some medical doctors hold animosity toward chiropractors, and vice versa, but much of this animosity stems from a plan by the American Medical Association to “contain and eliminate the chiropractic profession.”

The Wilk Case (pdf)