The Issue Of Consultation.

State legislatures were one battleground, and the sickroom and hospital ward were another. War was declared in that arena in 1847, with the founding of the American Medical Association and the Association's adoption of a code of ethics. Although most of the code was taken verbatim from a noted English publication of half a century earlier, an innovation was introduced in response to the emergence of alternative medicine during the interim. This consultation clause began by urging physicians to call in qualified colleagues when perplexed by a case. But it ended with the stricture that anyone “whose practice is based upon an exclusive dogma”—i.e., who is a sectarian, an irregular—could not be accepted as “a fit associate in consultation”.

In other words, it would be unethical, a threat to the patient's health and not just the doctor's sense of decorum, for an allopathic physician to consult or agree to be consulted by a homeopath or other alternative “dogmatist.” Thus, in one doctor's interpretation, one might ethically consult “with foreign physicians, doctresses [women physicians],” even “colored physicians ... provided they are regular practitioners.” But if the would-be consultant were a dogmatist, even a native-born white male one, “justly exclude him as unsuitable for fellowship with those who profess to love all truth.” It would be as suitable for “a Jewish rabbi ... to exchange pulpits with Christian ministers” as for allopathic doctors to consult with alternative ones (49). For the rest of the nineteenth century, the consultation clause would be used to oppose the admission of alternative practitioners to local and state medical societies, the staffs of public hospitals and the military medical corps, and the faculties of publicly funded medical schools. The original clause was dropped from the AMA code when it was revised in 1903, but the principles adopted in its stead maintained the understanding that ethical practitioners would not voluntarily associate with alternative healers; only in 1980 would the Association revise its ethical principles so as to remove all restrictions on consultation.

Official disdain for alternative medicine would only be intensified by the grand reformation of medical education that began in the later years of the nineteenth century, and culminated with the celebrated Flexner Report of 1910. That survey—rather exposé—of the miserable educational standards that prevailed at nearly all of America's medical schools was an acute embarrassment to the allopathic profession. But it catalyzed an educational housecleaning that drove many institutions out of business and forced the surviving ones to impose far more rigorous programs of training.

Flexner's report did not have so immediate an impact on alternative schools and practitioners. He did include homeopathic and osteopathic colleges in his survey, and had as scathing words for them as for any allopathic schools. The eight osteopathic educational facilities, for example, were condemned as “hopelessly meager,” “utterly wretched,” “intolerably foul”. Even Still's own college, osteopathy's flagship, was dismissed as “absurdly inadequate”. This ridicule solidified mainstream practitioners' conviction of the unscientific (and therefore unworthy) nature of alternative medicine, but it did not result in the wholesale closing of alternative medical schools. To be sure, the number of homeopathic colleges dropped precipitously, from a high of 22 in 1900 to only 2 by 1923; however, homeopathy was already weakened by internal dissension (54). Osteopathy, by contrast, lost only one school in the twenty years following the Flexner Report, and the number of chiropractic schools actually grew prolifically.

Thus, as late as the mid-1920s, a Philadelphia physician could determine that alternative medicine was still flourishing, at least in his region: one third of his patients admitted they had also put themselves under the care of an alternative practitioner of some sort within the three months preceding their visit to him. Eisenberg's 1993 survey found also that one third of Americans rely on unconventional therapies. Public respect for alternative healers was already being undermined, however, by the compelling image of scientific medicine, the term insisted upon by allopathic doctors to distinguish the new medicine derived from the germ theory and the Flexnerian reformation of education.

The scientist-physician in shining lab coat armor confidently predicted endless triumphs over disease with the weapons of modern medical research; to the dazzled public, alternative systems appeared static and impotent by comparison. Alternative medicine fell lower in the popular estimation when sulfa drugs appeared in the 1930s; then the introduction of antibiotics the following decade made good on the promises of scientific medicine and made healing alternatives seem less necessary. As early as the 1930s, a survey of America's “healing cults” concluded that “homeopathy is past and gone,” and that chiropractic was approaching its twilight, both because they could not compete with scientific medicine.

Characterization of alternative medicine as cultism continued into the second half of the twentieth century. Osteopathy was identified as “a cult practice of medicine” by the AMA until 1961, and “professional associations [with] doctors of osteopathy” were proscribed as “unethical” until that same year (60). For that reason, osteopaths were prevented from serving as medical officers during World War II; and although Congress authorized the appointment of osteopaths to military hospitals in 1956, it was to be a full decade before the first DO would actually be offered a position.

Similarly, the AMA long held it unethical to refer patients to chiropractors, and staunchly opposed the extension of hospital privileges to DCs. As late as 1966, the Association's House of Delegates adopted a resolution designating chiropractic “an unscientific cult.” Chiropractors fought back, in 1976 filing an antitrust suit against the AMA, the American Hospital Association, and several other medical organizations. A verdict would not be rendered until 1987, but it went against the defendants, the judge finding the AMA guilty of a “conspiracy against chiropractors ... intended to contain and eliminate the entire profession of chiropractic.” The AMA appealed, but the decision was upheld.

Osteopathic physicians were included in the Medicare reimbursement system when that act was passed in 1965, but chiropractors and naturopaths were denied participation. Chiropractic and naturopathic professional associations both appealed to Congress for reconsideration, but each was turned down in identical language: their “theory and practice are not based upon the body of basic knowledge related to health, disease, and health care which has been widely accepted by the scientific community” (65). Likewise, their programs of education “do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment” (65). Continuing pressure from the chiropractic community succeeded in winning inclusion of their practitioners under Medicare in 1974, but naturopaths remain outside as of this writing.