This

interim hearings and published reports of which I was one of the authors. proposal was the progenitor of the pioneer Warren health plan offered by then Governor, and now Chief Justice of the Supreme Court, Earl Warren. I cite this to indicate some 25 years of continuing interest in the subject of how to provide best for the people's health.

"As the executive director of the Public Affairs Institute since its founding in 1947, I have initiated, supervised, and edited, or written a number of research studies bearing directly on this subject, including:

"Pensions in Our Economy,' a study of old-age pension problems and proposals in relation to the general economy (Stephen Raushenbush), 1955. "How To Get Safe Drugs and Cut Their Cost' (David Cushman Coyle), 1960.

"Health Insurance for the Aged,' (F. J. Seidner), 1960.

""Health Service Is a Basic Right of All the People' (Dewey Anderson). "The last-mentioned study appeared in 1956, was written by me as a result of closely pacing President Truman's Commission on the Health Needs of the Nation. As it presents brief sketches of all the health professions and occupations, including chiropractic, I submit copies for the use of the committee.

"Study of the characteristics of occupations, including in some measure the training, licensure, practice, barriers to entrance and status of the healing professions, were part of the research and published books on occupations which my codirector, Prof. P. E. Davidson, and I released at Stanford University as products of the Institute for Occupational Research. So, in more than a cursory way, I have been identified with aspects of this subject for the past quarter of a century. "With specific reference to my acquaintance with manipulative therapy as exemplified in the practice of osteopathy and chiropractic, I cite the following. My brother holds an unlimited license to practice as a physician and surgeon in California. He graduated from the Los Angeles College of Osteopathic Physicians and Surgeons, which in the amalgamation now going on between the medical doctors and osteopaths has become the California College of Medicine. For more than a quarter of a century I have had the benefit of many discussions and experienced the diagnoses and treatments of a well-trained and skilled practitioner of manipulative therapy.

"Then, when I had written the 'Health Service' study, Dr. Emmett J. Murphy challenged me to make an examination of his profession, and the result was a brief pamphlet study, "The Present-Day Doctor of Chiropractic.' There followed a request of the National Chiropractic Association to be a consultant member along with Dr. Gregg Evans, longtime dean of sciences at Yankton College in South Dakota and a member of the State board of examiners, in making a 1961 survey of the seven accredited colleges of the National Chiropractic Association.

"With this background in the field under review, I proceed to certain specific questions raised by the proposed legislation.

"1. What does the legislation do?-It permits a person in Federal employ to seek the advice and treatment of a licensed doctor of chiropractic for which compensation will be paid from compensation funds on the same identical showing and basis as would the services of a doctor of medicine or osteopathy.

"2. What the legislation does not do.-It does not license or place its stamp of approval on any form of practice, on any kind of treatment, to the exclusion of any other legally recognized by a State as within the scope of practice as defined by the State law operative in the patient's resident State.

"3. What is the opposition to this legislation?-The opposition is identical both as to substance and source as it was some years ago when the law was amended to include the services of person licensed as osteopathic physicians. It is the same kind and source of opposition offered over the years to every other school of healing by the dominant school of medicine through its organized professional and political arm, the American Medical Association.

"Just as in each previous instance, that opposition has cited the conviction of the AMA that the form of healing attacked at the moment was a 'cult,' was without adequate scientific evidence and support of its theories and practice. So in this instance the medical fraternity and its medically trained and disciplined members in the Government apparatus seek to prevent the inclusion of licensed chiropractic physicians and their manipulative therapy in this law. If they run true to form, they will do so by parading again the body of outdated, unsubstantiated, and biased material which they would have you believe represents truly scientific evidence of the harmful or even dangerous character of chiropractic treatment.

"They have set themselves up in this respect as the sole defenders of the health and safety of the unsuspecting and unknowing public which they would have you believe are the easy prey of these untrained and even dangerous cultists. In doing so they have lost sight of the Bible's admonition about casting the first stone for they tend to forget the presence in their midst of M.D.'s who are qualified under this legislation to receive compensation for practice but for whose competency the AMA cannot vouch. Nor can their conformity be attested either, for the history of this century of medicine in this country is one of much diversity of belief and practice, of sharp differences between the exponents of one "school" or another, of fights to the finish between allopaths, homeopaths, and eclectics. "4. AMA opposition to both osteopaths and chiropractors persists.-Now comes the struggle of the AMA against the two schools of natural and manipulative therapy, osteopathy and chiropractic, which Hyde and Wolff in their brilliant and heavily documented Yale Law Journal study of the American Medical Association indicate may be tinged with 'an element of self-protection from this economic encroachment.' "With respect to osteopathy, which the AMA still officially regards as a 'cult,' the process of elimination by absorption is well underway. It started in California, where if the people vote to rescind their osteopathic licensure law next November the 'unification agreement' as it is called, between a group of California osteopaths and the California Medical Association will become effective. By its terms and the attendant features of the program, osteopaths holding degrees from the former Los Angeles College will pay some $65 in fees and find themselves renamed 'M.D.' instead of 'D.O.' Where the long continued and often vigorous if not vicious denunciation of osteopathy by leaders in the AMA went to in the process is not known.

"But osteopathy as an exponent of the efficacy of manipulative therapy remains the basic tenet of the practice of these osteopathic trained physicians no matter if their new M.D. title is bought and paid for and a new lettering has to be engraved to erase the old D.O. on their shingle. Yet the practice performed is in major degree akin to and closely approximates that of its first cousin, chiropractic. For both forms of healing center their attention on the musculo-skeletal system and believe its functions have a large bearing on the health or ill health of the patient.

"The attitude of the medical organization toward chiropractic continues antagonistic, in part at least because of an image in the minds of its medical doctors carried over from a past of poorly trained, 'quickie college' or diploma mill chiropractors advertising and hawking their cures in an unprofessional manner so offensive to the sensibilities of the serious medical profession. I submit that if there were grounds for such an image they are not now characteristic of the profession.

"It is well to recall that in 1910 when Abraham Flexner made his famous Carnegie survey of medical schools, over half of some 150 schools were found to be privately owned, operated for profit, possessed little in the way of curriculum, few trained instructors, gave short courses and a goodly number were outright 'diploms mills.' It took 10 years to close them out, reducing their number by the early 1920's to less than a hundred, and now down to 80. But there is little room for complacency on the part of the AMA, despite noticeable improvement, for its own educational survey made during the past 10 years showed that of a selected sample of 41 medical schools only half were doing what the surveyors termed 'a fair job,' only 3 measured up to their full potential, and the rest were not offering a 'satisfactory education' in training medical doctors. Of over 28,000 members of faculty teaching in U.S. medical schools, only 9 percent were on full time, while 75 percent were on a purely voluntary status. (Educational Number, J.A.M.A., September 1954. Later partial studies reach similar conclusions.)

"I am convinced from the recent inspection made of all National Chiropractic Association's seven colleges that the image which the AMA has or seeks to create in the public mind is not correct. For training and practice have come a long way in the 60 years of chiropractic's existence, and progress has been rapid in the past decade.

"Here is a seriously motivated profession, conscious of its responsibilities, and aware of its limitations. It knows, too, that despite all the harassment it has undergone, it is the second largest of the healing arts, and treats a significant number of patients. It devotes over 4,000 hours to lecture, laboratory, and clinical training in its 4-year course of study, half of it in the basic sciences the other half is applied subjects.

"Chiropractors are licensed by State law to practice in 46 States and the District of Columbia. The continuing improvement and enlarging status and acceptance

1

One State

of chiropractic is testified to by the trends in education and licensure. has a severely restricted definition of chiropractic, while another has a very broad one. But even in its most restricted form State license covers the types of injuries and illnesses which make up the bulk of compensation cases.

"Now, all but five jurisdictions permit the doctor of chiropractic to practice under workmen's compensation laws. Some 600 life and accident insurance companies accept chiropractors' certification of claims, professional athletic organizations and many industrial concerns have chiropractors on their staffs or make their services available to their people. Labor unions particularly favor this form of care. The Brotherhood of Railroad Trainmen is a conspicuous example, for its members are subject to many back and other injuries and strains for which chiropractic treatment has been found beneficial.

"A strong evidence of the seriousness of purpose of this profession is the continuing professional program of its National Chiropractic Association. This organization has its house of delegates, its accrediting body and educational council governing the policies and inspection of the programs of the colleges, holds regional professional seminars, and State and national conventions. It issues a monthly journal, the content and tone of which are soundly ethical and scientific. It has a national research committee engaged in controlled research work. By all the attributes and in all the ways we have of testing the worth of a profession, today's chiropractor is seeking to meet the public standard.

"5. What is the public interest? I am here testifying on these bills as a citizen concerned about the public welfare. I am not an advocate of any particular form of healing. I am convinced from experience that today's chiropractor is equipped by training in the sciences underlying health, and in forms of therapeutics which have beneficial results so that he is able to meet people's needs.

"It is my belief that the responsibility rests with the several States to require strict compliance with basic science and professional licensure laws, operating under professionally competent and impartial boards, and to insist on conduct of a high ethical character of all who practice any form of healing. That it is not the Federal Government's responsibility to attempt to lay down such strictures, nor to exclude any profession which is so treated by any sovereign State in the enactment of laws providing for compensatoin for attending any Federal employee.

"Therefore, in the public interest, and in keeping with the just division of powers and responsibilities between the two branches of government, Federal and State, I urge your favorable report and congressional passage of this amendment."

Mr. ANDERSON. The first section of this little statement deals with my personal qualifications to discuss the topic, the bills under consideration before this committee. I come before you as a private citizen, and in that capacity, I am a witness. I have some knowledge and a very considerable interest in the subject being examined. My training has been in biological and social sciences, and I graduated with the three degrees through the graduate degree at the University of Stanford in California.

Now as a member of the California Legislature and chairman of a committee comparable to this committee in the Senate, in 1937 I was the chairman of a group of the legislature that introduced the first inclusive prepayment health plan in California. There followed interim hearings in support of that legislation across the State, and reports were written by us.

This is a long time ago. The proposal was a pioneer proposal. It was shortly followed by the one which the then Governor of the State of California, Earl Warren, now the Chief Justice of the Supreme Court, introduced, and I cite this to indicate a long-time interest over a span of more than a quarter of a century in the problems of people's health and since being the executive director of the Public Affairs Institute, I have either initiated, written, or supervised the research that has resulted in publication of a whole series of reports, some of which I mention in this statement, bearing upon the health of the Nation.

One of those reports, which I have submitted to the committee, is "Health Service Is a Basic Right of All the People." It was published in 1956. It was written as a result of having closely paced President Truman's Commission on the Health Needs of the Nation. It presents brief sketches of all the health professions and occupations, including chiropractic.

This study, over a period of more than a year, when the manuscript was ready, was submitted by registered mail to all the official bodies governing the various professions in the health field, and time was allowed for correction or statement, and an indication was made that any thing that looked wrong would be corrected, and that counterstatements would be included in the record. None came of a serious nature, and the publication followed.

I have also had an opportunity over a long period of time to study as an experiment the field of occupations, among which have been these various health and healing arts; but with special reference to the field of inquiry this morning, my own relationship with a manipulative therapy, both osteopathy and chiropractic, has come about as a result of a family connection, and further study. My own brother holds an unlimited license as a physician and surgeon practicing osteopathy in the State of California. He graduated from the Los Angeles College of Osteopathic Physicians & Surgeons, which now in the amalgamation process going on between medical doctors and osteopaths has just been changed to become the California Medical College, a class A medical school, without one change being made in faculty or content, being moved over from the osteopathic column now into the medical column of training.

For more than a quarter of a century, I have had the experience with my brother of both manipulative care and treatment on both my person and my family, and I have had the benefit of numerous discussions with a man who is able and intelligent in his field.

Then when this health study that I referred to a moment ago was published, I was challenged by Dr. Emmett Murphy to make a more thorough inquiry into the field of chiropractic, and the result was a brief study which we published, "The Present Day Doctor of Chiropractic." In preparing that study, I was given the opportunity by the National Chiropractic Association to visit its schools, to visit its practitioners in various places, to submit myself to treatments and diagnoses, and to familiarize myself at firsthand with the practice of chiropractic.

Then last year, the National Chiropractic Association decided, as part of its accrediting procedure of its colleges, to have an independent survey made of those colleges. Now, I was asked, along with Dr. Gregg Evans, the longtime dean of sciences at Yankton College in South Dakota, a member and presently the secre tary of the State examining board, himself a well-known chemist, to participate in this firsthand inspection of the seven schools accredited under the National Chiropractic Association.

Now, with this background, I have had probably more opportunity, however well I may have availed myself of it, to know as a layman about this profession and what it can do, and its limitations, than most anybody you can mention, and I asked muself as one who has been long acquainted with the process of Government in the Senate and House of the U.S. Congress what I would do if I were sitting where you are sitting in determining the answer to this proposed legislation. What does the legislation do?

Well, it permits a person in Federal employ to seek the advice and treatment of a licensed doctor of chiropractic, for which compensation will be paid from compensation funds on the same identical showing and the same basis as would the services of a doctor of medicine or a doctor of osteopathy.

And what the lesiglation does not do: It does not license or place a stamp of approval on any form of practice, on any kind of treatment, to the exclusion of any other locally recognized by a State as within the scope of practice as defined by the State law operative in the patient's resident State.

Why, then, opposition to this legislation? Well, the opposition is identical, both as to substance and source, as it was some years ago, when the law was amended to include the services of persons licensed as osteopathic physicians.

It is the same kind and source of opposition offered over the years to every other school of healing by the dominant school of medicine through its organized professional and political arm, the American Medical Association.

Just as in each previous instance, that opposition has cited the conviction of the AMA that the form of healing attacked at the moment was a "cult," was without scientific evidence in support of its theories and practice. So in this instance, the medical fraternity and its medically trained and disciplined members in the Government apparatus seek to prevent the inclusion of licensed chiropractic physicians and their manipulative therapy in this law. If they do so, they will succeed again in parading the body of outdated, unsubstantiated for the most part, and sometimes biased material which they would have you believe represents truly scientific evidence of the harmful or even dangerous character of chiropractic treatment, for they have set themselves up in this respect as the sole defenders of the health and safety of the unsuspecting and unknowing public which they would have you believe are the easy prey of these untrained and even dangerous cultists.

In doing so, they have lost sight of the Bible's admonition about casting the first stone, for they tend to forget the presence in their midst of M.D.'s who are qualified under this legislation to receive compensation for practice, but for whose

competency the AMA cannot vouch. Nor can their conformity be attested either, for the history of this century of medicine in this country is one of much diversity of belief and practice, of sharp differences between exponents of one "school" or the other, of fights to the finish between allopaths, homeopaths, and

eclectics.

The AMA opposition to both osteopaths and chiropractors persists, because now comes the struggle of the AMA against two schools of natural and manipulative therapy, osteopathy and chiropractic, which Hyde and Wolff in their brilliant Yale Law Journal study indicate "may be tinged" and I quote--"with an element of self-protection from this economic encroachment."

With respect to osteopathy, which the AMA still officially regards as a "cult," the process of elimination by absorption is well underway. It started in California, where if the people vote to rescind their osteopathic licensure law next November, the "unification agreement," as it is called, between a group of California osteopaths and the California Medical Association will become effective. By its terms and the attendant features of the program, osteopaths holding degrees from the former Los Angeles college will pay some $65 in fees and find themselves renamed "M.D." instead of "D.O.' Where the long-continued and often vigorous, if not vicious, denunciation of osteopathy by leaders in the AMA went to in the process is not known.

But osteopathy as an exponent of the efficacy of manipulative therapy remains the basic tenet of the practice of these osteopathic-trained physicians no matter if their new M.D. title is bought and paid for and a new lettering has to be engraved to erase the old D.O. on their shingle. Yet the practice performed is in major degree akin to and closely approximates that of its first cousin, chiropractic. For both forms of healing center their attention'on the musculoskeletal system and believe its functions have a large bearing on the health or ill health of the patient.

The attitude of the medical organization toward chiropractic continues antagonistic, in part at least because of an image in the minds of its medical doctors carried over from a past of poorly trained, "quickie college" or diploma-mill chiropractors advertising and hawking their cures in an unprofessional manner so offensive to the sensibilities of the serious medical profession. I submit that if there were grounds for such an image they are not now characteristic of the profession.

It is well to recall that in 1910 when Abraham Flexner made his famous Carnegie survey of medical schools, over half of some 150 schools were found to be privately owned, operated for profit, possessed little in the way of curriculum, few trained instructors, gave short courses, and a goodly number were outright "diploma mills." It took 10 years more, into the 1920's, to close them out, reducing their number by the early 1920's to less than 100, and now down to 80, but there is little room for complacency even today on the part of the AMA. Despite this notable improvement, by its own editorial survey, surveys made during the past 10 years show that of a selected sample of 41 medical schools, only half-and there I am quoting the surveyers themselves only half were doing what the surveyers termed a "fair job." Only three measured up to their full potential, and the rest were not offering "a satisfactory education" in training medical doctors.

And of over 28,000 so-called members of faculty-these are people who are associated with training centers, as doctors on lists in hospitals, and so forthin U.S. medical schools, only 9 percent were in full time, while 75 percent were on a purely voluntary basis, and I give you the citation.

I am convinced from the recent inspection made of all National Chiropractic Association's seven colleges, that the image which the AMA has or seeks to create in the public mind is not correct. For training and practice have come a long way in the 60 years of chiropractic experience, and progress has been rapid, most particularly in the past decade. I believe this to be a seriously motivated profession, conscious of its responsibilities and aware of its limitations.

It knows, too, that despite all the harassment it has undergone, it is the second largest of the healing arts. It treats a significant number of patients. It devotes over 4,000 hours to lecture, laboratory and clinical training in its 4-year course of study, half of it in the basic sciences, the other half in applied subjects.

Chiropractors are licensed by State law to practice in 46 States and the District of Columbia. The continuing improvement and enlarging status and acceptance of chiropractic is testified to by the trends in education and licensure. One State has a severely restricted definition of chiropractic, while another may have a broad one, but even in its most restricted form, State licenses cover the types of injuries and illnesses which make up the bulk of compensation cases.