but from trauma. Injuries that happen while they are on the job as Government employees.

Thus, we remove from consideration the contagious or infectious disease; matters requiring surgical attention such as appendicitis or what-have-you; matters that are clearly relievable or subject to treatment only by the use of drugs or by the use of the knife.

We remove all of those things from consideration and deal with the physical structure of the body and the injuries that it might sustain on the job.

We can remove from that category of injury those which are of the type requiring surgical care such as fractures and those requiring repair of serious tearing of the physical structures.

Senator Burdick's bill, I think, gets right to the point. The majority-I should not say the majority, but a substantial number, approximately 50 percent of Federal injuries are of the sprain or strain variety, and that is the kind of condition for which the chiropractic profession is particularly well qualified and with which it is particularly concerned.

Those are rather large terms in the sense that they include a variety of conditions that might not be considered sprains or strains, but they do involve structural distortion and the functional integrity of the human body which is the chiropractor's real and fundamental concern.

There is an overall limitation in the present law which I think provides a safeguard that should not be overlooked. I think the Bureau or the Secretary need not pay for care, need not provide care unless it is likely to cure or relieve, and since that discretion is the Secretary's or the Bureau's, if the Bureau feels that a certain kind of care will not provide relief or will not provide a cure, if it will not reduce the period of disability, if it will not lessen the amount of monthly compensation, then the Bureau is presently under no obligation to provide or pay for any kind of care whatever.

I think the addition of the doctor of chiropractic to those practitioners whose services are available is certainly subject to the same limitation, would be under either bill, and I think the limitation would be very effective in controlling any abuses that might be imagined now in advance or that might produce themselves as reality if the bill is passed.

The most important objective of either bill is to prevent harm done to the Federal employee. The Federal employees have taken action through their representative organizations in asking that their unions, if you wish, do something to correct an inequity of this type. Since they are patients of chiropractors I think they have looked to the chiropractic profession also to do what it can, and I think the chiropractic profession should certainly be considered here not necessarily in the altruistic sense of trying to do something for the public or its patients, bur really that is the sum and substance of it. Because the financial benefit to the profession is very limited, it is not anything great, but the benefit to the patient, the Federal employee, would be outstanding.

When a Federal employee in complete good faith seeks relief from a practititioner who is fully qualified and authorized by State law to provide it, only to find subsequently that he must pay for that care himself, regardless of the result, it is a disservice not only to the employee but probably to his employer, the U.S. Government.

In the less altruistic sense, there is a resulting embarrassment to the doctor of chiropractic and, of course, that is why we are pressured to take whatever action we can to correct it.

The letter which is a form letter from the Bureau informing the employee that chiropractic services are not covered by the law, certainly is in derogation of the acknowledged professional status of the doctor of chiropractic. Certainly that was not intended by the law, but it is enescapable in the administration of its present pro

visions.

Interestingly, opposition to this bill evidences a kind of running battle between various schools of the healing arts. It is acknowledged, there is no need to hide it, we acknowledge the fact that organized medicine is irrevocably, unalterably opposed to chiropractic care of any kind being afforded to any person anywhere in the world. They have made that crystal clear, so we acknowledge that fact.

Senator METCALF. That statement would be your response to the paragraph from the Secretary of Labor's letter that I read earlier? Mr. BUNKER. I think perhaps in a general way it would, Senator Metcalf. I think in a more specific sense, I might suggest that the information supplied to your committee, supposedly objective, bears a very strange relationship to the same selfish views and the same selfish expressions of the organized medical people. I say organized medicine advisedly, because it is organized medicine that expresses itself so categorically and so unobjectively. The individual medical physician does not so express himself and the relationship, very strangely, between the doctor of medicine and the doctor of chiropractic is one which is frequently much warmer than the public would ever realize.

I think there is a problem in that publicly and to the public eye the medical physician is constrained by organized medicine's ethical standards, the code of ethics, which prohibits him from associating with practitioners of what they call the fringe fields.

Now, I might say that if this were the proper forum we certainly could present adverse comment regarding our friends in the medical field. This is neither the time nor the place, nor is it relevant to these proceedings. But I think that it must be recognized that in the field of medicine itself, which they proclaim to embrace all forms of healing, regardless of what they are, the very field of medicine itself contains a segment that is referred to a manipulative therapy, physical medicine, which is closely related to the interests of the chiropractic profession.

So, on the one hand they have attempted to advance a specialty which I believe they call physiatry which involves all of the physical procedures, all of the manual dealings with the patient, and a specialty which significantly has been highly unpopular among the practitioners. It is popular in the orthopedic sense, but unpopular in the sense that it involves actual manual treatment of human beings. Why that is, I do not know.

I could philosophize, perhaps, as to the question of dignity, laying on of the hands by a doctor is perhaps sometimes considered to be beneath him. It might be preferable for him to write a prescription. to prescribe hospital accommodation and treatment by technicians or subordinates rather than to have him deal with the patient himself, personally, in that close relationship of the manual aspect.

The medical profession has been inconsistent from time to time in its views regarding manipulative therapy. It has suggested, for example, as recently as the 1930's, that there is no such thing as a subluxation. I think Dr. Goldstein could describe better what it means, but it describes the kind of position of the spinal column with which the chiropractic profession is concerned. It was denied by the medical profession and today it is admitted. The osteopath, as Mr. Badger pointed out, was in a similar position in 1938 when its practitioners were admitted to recognition and coverage by the act. The osteopath in California who was denounced as being a cultist subsequently was authorized by paying a simple fee to become a doctor of medicine as a matter of State certification.

Now, these things, I think, are significant, because you have a mixture of politics and medicine which frankly, I think are sometimes dangerous, but I think we should recognize in all of these that there is no absolutism-medicine is an art and science.

As such, I believe the scientific respect for new knowledge and new things to be learned, and new methods of applying the things that are learned as we proceed from time to time and, of course, developing these new items of knowledge the art itself must change and does; and I look quite frankly as a citizen, as an individual, and, of course, as a representative of the American Chiropractic Association, I look at the field of health care involving chemotherapy and I am quite frankly concerned, and I mention this quite casually, I am frankly concerned, but I am concerned as an individual when I read of incidents such as thalidimide, when I read of the fact that doctors are completely incapable of absorbing the knowledge, the meanings, the makeup, the effects, the side effects, of the myriad of drugs that are presented to them each day. Where in the world are they going in the field of chemotherapy?

Now, I do not decry it; I do not denounce it because I know as we all do that drug therapy is effective. It is not effective in all cases, and sometimes, unfortunately, the public is made a guinea pig, but these are things that are significant, and we think medicine should recognize those things and deal with them and not speak as Janus with one mouth about manipulative therapy when we practice it and manipulative therapy when they practice it, condemning the one and embracing the other.

My point in touching on those things is that we are here and we suffer from the opportunity of organized medicine to express itself through the Federal agencies in which it is represented to our complete disadvantage. We have not the opportunity to rebut in the sense that we can take them to task as they have taken us to task.

I think rather than linger on that subject I will say that our primary concern here is to have the bill amended to conform to what the Federal Government preaches and to correct an inequity that certainly was not intended but that has necessarily resulted from the administration of the present act.

I have a statistical report which I would like to leave with the committee having to do with the treatment of sprains and strains, and the relative cost of the various kinds of therapies with respect to it. It is an independent survey done in the State of Florida, and with the chairman's permission I will submit it for committee consideration.

Senator METCALF. It will be received and the staff will determine whether or not it goes in the record.

Mr. BUNKER. I might ask if I may, that Dr. Goldstein touch very briefly on the nature of the chiropractor's interest in, let us say, strain and sprain injuries, and the field of competency, that is the competency of the doctor of chiropractic to recognize a sprain or strain as opposed to another condition.

With your permission, I will ask Dr. Goldstein to do so.
Senator METCALF. Thank you. Go right ahead.

Dr. GOLDSTEIN. Thank you very much, Mr. Bunker.

Senators, gentlemen; I do not know if I can add too much to the testimony already given with the exception, perhaps, of realizing that chiropractic is a specialty; it is a specialty that perhaps arose somewhere as a protest movement insofar as various forms of the healing art were never developed by medicine generally-I think we can add dentistry, optometry, podiatry. And that the chiropractor, because of necessity, has become interested in the tissues of the body. We know muscles move bones and bones are put together at joints, so that the question of strain and sprain becomes the chiropractor's dish of tea.

As our present schools are set up, and we hope to continue to improve them, our students are prepared more and more to use diagnosis to be able to separate one condition from another, to be able to recognize and I am sure the committee will all agree that a doctor's office today, whether he be a chiropractor or anyone else, is sort of a clearinghouse for any conditions about which the patient may come to him the present student is able to separate a strain from a sprain, or a fracture, or whatever he might encounter in his day's practice. Thank you very much.

Mr. BUNKER. I think we are at the disposal of the committee if you have any questions of either Dr. Goldstein or myself.

Senator METCALF. I wanted to read to you, in view of the fact that you are suggesting that perhaps this Burdick bill was too limited in that it only provided for treatment of sprains and strains, a paragraph from a letter that the American Medical Association directed to Senator Burdick when he was chairman of this special subcommittee last year.

Chiropractic is a pseudoscience which is not based on scientific methods and therefore should be recognized as what it is-a theory of cultism. It is premised on the theory that human illness is all related to the spinal column, it holds that the nerves that emanate from the spinal cord become impinged or pinched by the vertebrae, therefore causing malfunction and diseases. As a result of this theory chiropractors claim that diseases and illness such as allergies, diabetes, heart trouble, and tonsilitis, to name a few, could be cured or adjusted by manipulating the spinal column. Such a theory, of course, runs counter to medical science. Now, I would like to have your comment.

Mr. BUNKER. Mr. Chairman, I might say, first of all, to answer that question, as it should be answered, would require much more time than I am certain we can devote to it here.

I think I could say as a lawyer that the statement-I can say this categorically-the statement is inaccurate and fallacious. It involves an assumption which has been presented by them and based on their assumption that leads to a conclusion which is in detraction of the chiropractic profession and its philosophy.

I am not qualified to speak about chiropractic philosophy, but Dr. Goldstein is. I think I might embarrass him somewhat, but he is the chairman of the Department of Diagnosis at the Chiropractic Institute of New York and he might be able to shed some light on the underlying fundamental, which, I think, you might be getting to.

Senator METCALF. I want Dr. Goldstein to answer, but before he answers, I want to read another statement from the Secretary of Labor's report. He says:

We call attention that certain ailments which are entirely unrelated to strains or sprains are sometimes first manifested by the same symptoms as they are, in such situations, we doubt that a person who is not a medical doctor would be the best qualified to correctly diagnose the illness or to prescribe treatment therefor. I am very interested in your comment on that, Dr. Goldstein, because of your official position as a diagnostician and chiropractor.

Dr. GOLDSTEIN. Thank you, Senator Metcalf. In answer to statement 1 relative to theory and practice, I think if one examined medical thinking, one would find that medicine wisely refrained from ever offering any theory. Medicine today has no theory as to how it gets results, it used very successfully the germ theory for many years and still does. Chiropractors, unfortunately, have had more theories than they have had facts, but I am sure the committee will readily feel that theories are there to be changed; if they are incorrect, let's change them. But certainly one cannot deny the facts that given numbers of patients come to our offices, very often after having not received any relief in orthodox physicians' offices, and I use the term "orthodox" in quotes, and receive relief at our hands so the question of theory, I think, should be, perhaps, put to rest.

We have not also been able to do as much research as we would like in some of these phases, because as you know, we have fought a long battle just to stay alive. We have had to try to concentrate on survival.

Frankly, I have forgotten the second half of the question.

Senator METCALF. The second half was that a medical doctor would be the best qualified to correctly diagnose the illness which might manifest itself as a symptom of strain or sprain.

Dr. GOLDSTEIN. Well, the question of differential diagnosis, Senator Metcalf, of course, is always a complex one. Under the best of conditions, diagnosticians could be wrong, but yet, we are training our students to take a decent history, examine the patient and if you will check the records very carefully you will find that the modern practitioner does a rather good job of deciding whether the case is in his field or not.

I have patients where a man thinks it is a pain in the shoulder and it turns out to be an acute myocardial infarction. Our trend is improving and I think that criticism is not completely in order. In fact, we have often been able to make a correct diagnosis where a miss diagnosis had been made in a physician's office relative to these conditions. Thank you.

Mr. BUNKER. I have one comment, Mr. Chairman, if I may. First of all, Dr. Goldstein, I might say, is an example of the practitioners throughout the country, licensed by the New Jersey State Board of Medical Examiners, characteristically he was examined in the field of diagnosis. The training we refer to is perhaps to be considered in two parts.