— Journalist Howard Wolinsky discusses his new book, “Contain and Eliminate”
by John Gever, Managing Editor, MedPage Today January 18, 2021
It’s no secret that allopathic physicians have long viewed chiropractors with suspicion. But the lengths to which the physicians’ biggest professional organization, the American Medical Association, once went to deprive chiropractors of their livelihoods and destroy the profession might surprise many today.
Until a group of chiropractors sued on antitrust grounds, finally winning their case in 1990, the AMA had spent decades enjoining its members from having anything to do with chiropractors. The group’s ethical principles stated that physicians should never refer patients to chiropractors, nor even see patients who were under a chiropractor’s care. Underpinning what became a dedicated office within the AMA was the belief that chiropractic was quackery, its practitioners charlatans — even though patients recognized that chiropractors could often relieve back pain and other conditions that still frustrate allopathic physicians.
Medical journalist and MedPage Today contributor Howard Wolinsky has now authored a book about the AMA’s long war on chiropractic and how a small group of DCs eventually prevailed. Wolinsky was contacted in 2018 by one of the chiropractors involved in the litigation, Louis Sportelli, who wanted the history of that effort written down. A surprising number of the principals were still alive and willing to talk.
Wolinsky agreed. In November, Contain and Eliminate: The American Medical Association’s Conspiracy to Destroy Chiropractic was published. I spoke with Wolinsky about his experiences — he’d followed the case almost from the beginning, initially (and ironically) as a writer for the AMA’s publication American Medical News (now defunct), then for the Chicago Sun-Times. Here’s our conversation, edited for brevity and clarity. (We’re also publishing an excerpt from the book, which introduces many of the story’s key figures.)
How and why did the chiropractors come to you with this project?
Forty years ago in December, I was a young reporter for American Medical News. The whole crew — except me as a newcomer — went to San Francisco to cover the AMA’s interim meeting. Suddenly, the managing editor called and said he needed me to cover an antitrust trial in which a Chicago chiropractor, Chester Wilk, et al. were suing the AMA.
I covered the trial in a straightforward fashion, writing several stories a week. Soon after the first trial ended [there would be a second], I moved over to the Chicago Sun-Times, where I was the medical writer for 26 years. I continued to cover the AMA from the outside. My stories on various financial and ethical scandals there led to two CEOs and seven other top execs, including the general counsel, being fired.
This led to my first book, co-authored with Tom Brune, The Serpent on the Staff: The Unhealthy Politics of the American Medical Association. One chapter in the book covered the Wilk antitrust suit. I spent some time with George McAndrews, the chiropractors’ lawyer, to look at exhibits and legal papers. He told me it was ironic, but he used to clip my articles from AMN to keep interested parties apprised of the Wilk trial.
The Serpent turned out to be a hit among chiropractors. Years passed, and McAndrews called me out of the blue and introduced me to Louis Sportelli, a prominent chiropractor, who wanted to publish an objective account of the Wilk case and its impact on chiropractic, while many of the parties involved were still alive, before it was forgotten. The book was published in November — delayed by COVID-19 issues as the printer was shut down until recently.
And why did they want to recapitulate that drama, now decades past? Is the hatchet still unburied between the House of Medicine and chiropractic?
I don’t think the idea is to reopen wounds. I think that the older generation of chiropractors wants to let the younger generation know about the battles fought on their behalf. The older chiropractors viewed the court case as a battle for their civil rights as a legal profession.
I was talking to a young chiropractor who had adjusted my wife. I asked him what he knew about the Wilk case. He had a blank expression. I prodded him. He yawned and said, “History.” He was discussing with my wife the option of getting X-rays at the hospital across the street. I told him that he probably wouldn’t be able to make that patient referral to the hospital had it not been for Wilk.
Is the hatchet unburied? Many hatchets have been buried. DCs and MDs can refer to each other. The young doctor doesn’t have to buy his own X-ray machine and can refer. The federal government has spent funding on chiropractic research. Medicare covers chiropractic care. DCs have published research in medical journals, including JAMA. A DC serves on the AMA’s CPT committee. Much has changed, at least in part because of the ruling of a judge who saw the “lingering” effects of a monopoly that would take generations to overcome. Some DCs teach in medical schools, and some MDs teach in chiropractic colleges. Still, some DCs encounter problems in making referrals. Plus, some older DCs want to remind the young DCs that chiropractors had to fight for their rights.
Also, Louis Sportelli felt that George McAndrews, the lawyer for the chiropractors, never got the credit he was due for sticking with the case and wanted McAndrews’s story told. McAndrews was the right lawyer at the right time. Other lawyers likely would have urged the chiropractors to accept a settlement offered by the AMA. But McAndrews had personal reasons for taking the case. He had seen the toll on his father, a chiropractor in rural Iowa, from being called a “quack” and a “fraud” by the local MDs. McAndrews was looking for revenge, not a big payday.
When you were covering this story in real time back then, how surprised were you at the revelations about the AMA’s behavior? I mean, you were something of an insider, working for an AMA publication.
I was a newbie and a bit of a skeptic about the AMA. I had an acupuncture chart on the bulletin board in my tiny, windowless office at the AMA. I knew the AMA was a powerhouse and a huge symbol of medicine. I knew some young MDs considered the AMA as a corrupt organization. I thought that working for their newspaper would be an education. It was.
Personally, I favored HMOs and even national health insurance. My beat included Canada (the AMN‘s only international correspondent) and the new Canadian national health plan. So I learned a lot.
I felt good about the paper. AMN was respected and not generally considered a mouthpiece for the AMA. I never felt like an insider. I knew little about chiropractic then. The revelations in court were just that to me, a revelation. The AMA’s abuse of power, as presented by McAndrews, was an eye-opener.
And in going back to these folks 40 years later, what surprised you, if anything? Did you learn anything new?
A big thing: I learned how and why the chiropractors’ lawyers changed their strategy after a jury, based on bad instructions from the judge, found for the AMA. It was supposed to be an antitrust trial based on whether the AMA created a monopoly. But the lawyers for the AMA argued the case as a First Amendment “patient safety” trial. They said it was within the AMA’s rights to say what they wanted about the chiropractors. The first judge bought it and gave the jury instructions to that effect.
An appeals court overturned the findings and ordered a second trial. This time, McAndrews and his colleagues opted for a bench trial, which took punitive damages out of the discussion. The new judge, Susan Getzendanner, said she was only interested in antitrust issues, not a patient-safety trial in which chiropractors were posed as a public health risk. I met her in her townhouse in Lincoln Park. She told me chiropractic was legal in all states, so on the face of it she considered it to be a safe modality.
The attorneys for the AMA and several other major medical groups were caught off guard and had to scramble. Of course, they lost in the end. Getzendanner’s finding that the AMA et al. had conspired to create a monopoly was upheld by the Court of Appeals. Ultimately, the U.S. Supreme Court let that finding stand in 1990.
I also learned more about the story behind the story of how the Wilk suit came to be, which involved another conspiracy — that of L. Ron Hubbard and his Church of Scientology against the AMA and other archenemies, including the IRS, CIA, DOJ, and almost any other organization on land and sea with a three-letter acronym.
That’s where the character dubbed “Sore Throat” came in.
On the heels of “Deep Throat” and Watergate came “Sore Throat,” who claimed to be an AMA whistleblower in 1975. “Dr. Throat,” as he liked to call himself, released piles of internal memos from the AMA to the press, IRS, U.S. Postal Service, and eventually the chiropractors. The media bit. Reporters were satisfied when the AMA authenticated the internal documents. But the media barely asked questions about who Sore Throat was. Back then, the AMA was on the brink of bankruptcy. It borrowed from banks to meet payroll. It held a “May Massacre,” laying off about 80 employees, including physician staffers. Sore Throat claimed to be one of them. He wasn’t. He was in fact a Scientologist carrying out L. Ron Hubbard’s vendetta dating back to the 1950s.
Research by an organization following ex-Scientologists led to some new findings. In effect there were two Dr. Throats. One managed infiltrations of the AMA and government agencies, as well as a break-in at the Chicago office of the AMA’s external counsel. The other was a shadowy PI, a high-level Scientology dirty trickster, who made contacts with the media, government, and the chiropractors, pretending to be a former AMA staffer.
This man, whose bio said he was, among other things, “an undercover agent,” infiltrated the AMA in the early 1970s in hopes of proving an AMA conspiracy against Scientology. He didn’t find that. Instead, he discovered the AMA’s plan to “contain and eliminate” chiropractic by a secretive AMA group known as the Committee on Quackery. These documents were delivered to the chiropractic world in a couple of different ways. Most chiropractors paid no attention to this information. But one who did was Dr. Chester Wilk.
One discovery I made was that the AMA’s general counsel, Robert Throckmorton, who cooked up the “contain and eliminate” plan, had some interesting “containment” experience in World War II. He was the legal architect of the U.S. government program to move Japanese Americans on the West Coast into internment camps during the war.
How surprised were you that so many of the principals were still alive?
Actually, many of the people involved died, including most of the plaintiffs. But the lead plaintiff, Chester Wilk, turned 90 last summer. Attorney McAndrews is 85. If they were alive and willing to talk, I would have liked to talk to H. Doyl Taylor, head of the AMA Office on Quackery, and Robert Throckmorton. But they were dead and likely wouldn’t have talked if they were still around. Fortunately, I had a searchable file of the trial motions, depositions, etc. So these people lived on in the trial record.
As it happens, I was once interviewed on video by a documentary maker who was doing something on the AMA’s war on chiropractors. He had taped interviews with several now-deceased characters in the story. He kindly gave me access to his interviews. So I was able to go beyond the public record.
Do you use chiropractic? Did your coverage of this story over the years affect your beliefs and attitudes toward chiropractic?
I have been a chiropractic patient on and off since the late 1980s. A chiropractor had an office upstairs at the Chicago Sun-Times who some colleagues were seeing. I had horrible neck pain dating back to when I was in my 20s and had a whiplash injury. I gave the chiropractor a try. I got relief. I got an “adjustment” but also had some treatments from a massage therapist on staff in the DC’s practice. I also have received acupuncture from a doctor trained in China. I do what I have to do to get help. I think covering this story opened my mind to chiropractors and other practitioners. I still see MDs as needed, of course. I mix and match.