The following is an excerpt from journalist Howard Wolinsky's new book, . It's the story of how chiropractors, frustrated by a decades-long AMA campaign to deny them their livelihood, ultimately prevailed -- with help from an unexpected quarter. Read a Q&A with Wolinsky about his reporting for the book.
Methadone, Medical Monopoly, Antitrust, and Serendipity
During the 1960s and 1970s, America was at war on several fronts. Baby boomers, the hippies, were caught up in the culture wars, which included hard drug use resulting in heroin addiction. It was front-page news that other boomers, soldiers, were coming home from the Vietnam War addicted to heroin. In a speech in 1971, President Nixon declared drug addiction as "public enemy number one," foreshadowing today's opioid crisis.
Doctors struggled to find effective ways to deal with heroin addiction. Some experimented with methadone, a synthetic opioid that German scientists developed in World War II when morphine was in short supply. In 1971, Nixon pushed for federal research on methadone.
Jordan Scher, MD, a prominent Chicago psychiatrist and a professor at Northwestern University, was an early researcher of methadone and opened a methadone maintenance clinic where he treated hundreds of addicts. But he ran afoul of government regulations on methadone use. The U.S. Food and Drug Administration went after him and aimed to shut down Scher's clinic in 1973. At the same time, the Internal Revenue Service went after him for tax evasion. And various medical associations were trying to pull Scher's medical license.
Scher hired Gerald "Jerry" Hosier, a young Chicago attorney, to defend him. Hosier, who later became a nationally prominent patent lawyer, recalled, "There was an all-out government and professional attack on Scher. I managed to keep his clinic open."
As a result of his work on Scher's behalf, Hosier became an expert on the canons of medical ethics, the obscure codes governing the behavior of physicians.
The patent lawyer's expertise unexpectedly came into play in 1974 when he was invited to give a speech on a topic of his choosing at the National College of Chiropractic in the Chicago suburb of Lombard. Neil Aldridge, a long-time friend of Hosier's and a student at National, invited Hosier, his fraternity brother in their undergraduate years at Northwestern University in Evanston, Illinois.
Aldridge came from a wealthy North Shore Chicago family. He put himself through Northwestern, working as a flight instructor and a freight pilot. Tall and handsome, Aldridge had dated Ann-Margret Olsson before she left Northwestern for a Hollywood career as Ann-Margret. Aldridge, who died in 2003, enrolled in chiropractic school.
Hosier reviewed possible legal topics to discuss with the chiropractic students. He ruled out issues relating to opening practice and professional liability. Too blasé. He concluded that the most crucial topic was what he viewed as an AMA conspiracy against the chiropractic profession.
"It was simply a fortuitous coincidence of events that I was aware of the AMA's canons of medical ethics. It was instantly evident to me that the most important legal issue for the chiropractic profession as a whole was the medical profession's boycott enforced by the canons," Hosier said. "I recall telling students that the canons would have a profoundly negative impact on their professional lives unless something was done about them -- and that all other legal matters impacting their professional lives paled in comparison."
Hosier found that comparable ethical canons were in place throughout the medical world. "They defined it this way -- 'Thou shall not cavort with cultists,' and then they defined a chiropractor as a cultist, and therefore, any affiliation, association, cross-referral of patients, anything of that kind, would be a violation of the canons of professional ethics," Hosier said. "So, a medical doctor could not work with a chiropractor without violating his canons of ethics."
He said it was clear to him that the medical codes of ethics were part of a per se violation of the antitrust laws. "You can't just create a group boycott of another profession and exclude them from an opportunity to see patients when they are legally and lawfully licensed. And it just prevented any referrals between doctors and chiropractors even if the doctor wanted to," he said.
That might have been the end of it. But Hosier's speech moved Steven Lumsden, DC, one of Aldridge's classmates, who helped organize the seminar. He said Hosier's outline of a conspiracy by organized medicine against chiropractic jibed with the information about an AMA conspiracy contained in the 1973 underground book In the Public Interest that was making the rounds at the time.
"It was particularly cathartic to me as I'd run into barriers as a student trying to work with the American Cancer Society and with Chicago College of Osteopathic Medicine, and this explained my consternation when I went outside of my chiropractic studies and attempted to develop collegial communications," said Lumsden.
A supposed former AMA physician turned whistleblower had written the book. Chiropractor Jerry McAndrews, of the International Chiropractors Association and president of the Palmer College of Chiropractic, had bought the rights to In the Public Interest and distributed 15,000 copies to chiropractors.
Unknown to Jerry McAndrews, Joe Lisa, a high-level Church of Scientology spy who had infiltrated the AMA in the late 1960s and early 1970s, was the author, according to federal records. Lisa later was an unindicted co-conspirator in a federal trial against Scientology for breaking into federal agencies and stealing documents. Separately, Lisa and a confederate also had purloined the secret AMA documents from the AMA Committee on Quackery, the AMA committee that plotted to contain and eliminate chiropractic.
No one remembers for sure, but Lumsden suspects he informed Dr. Chester Wilk, a Chicago chiropractor widely known for promoting an antitrust suit against the AMA, of Hosier's speech. Lumsden, of course, joined Wilk to become plaintiffs in the 1976 antitrust lawsuit Wilk et al. v. AMA et al.
"At that time Dr. Wilk and I were on the same track," remembered Lumsden. "He, of course, was my elder colleague and had done more work than I. My experience was as a student wanting to get the best education that I could get. I loved the clinical and basic sciences. I studied medical texts as well as learned esoteric chiropractic procedures and clinical techniques from the best at the time. I was a student of the basic sciences as well as the clinical sciences. I even took a job as a masseur at the Chicago Health Club to get used to working with people -- to become a better doctor."
Chester Wilk grew up in an immigrant Polish family on Chicago's Northwest Side, an enclave for Polish- and German-American immigrants. His parents taught him the virtues of hard work and getting an education. He worked from the time he was small, stocking shelves in the family's mom-and-pop grocery.
But Wilk said a friend of the family, a mysterious woman known as "Mrs. Budek," whom the senior Wilks knew back in the "Old Country," Poland, started guiding Chet on his future when he was eight years old. Mrs. Budek was a psychic who dropped by the Wilk residence, situated behind their grocery store, a couple of times a year, Bible in hand, and offered advice to Chet.
Wilk said Mrs. Budek's visions led him to become a chiropractor and also to pick up the chiropractic banner to wage war with the AMA. To this day, now almost ninety years old, Wilk said he regularly still consults his guardian angel's prophecies.
Months after Hosier's speech at National, Wilk reached out to the attorney and asked him to begin exploring an antitrust suit. Hosier was impressed with the documents reproduced in In the Public Interest. "I had never seen a case where the defendants' own documents were so damning," he said. "It was the best plaintiffs' case I had ever seen. Usually, you need to rely on circumstantial evidence to infer wrongful intent -- the documents delivered wrongful intent in vivid language."
But Hosier told Wilk that the stolen AMA documents reproduced in In the Public Interest would not stand up as proof of a conspiracy in court. He said the records would have to be subpoenaed from the AMA and other sources and introduced as evidence in a private antitrust suit in a U.S. District Court.
Some chiropractors remained skeptical about suing the AMA. To address this, Hosier suggested that they hire an antitrust expert to write an opinion on the viability of success for an antitrust suit. Hosier, through a clerk he had hired at his firm, Bruce Sperling, met Paul Slater, Sperling's roommate at Northwestern University College of Law. Slater was teaching antitrust law at Northwestern and was about to launch a new firm with Sperling in Chicago.
Sperling & Slater opened on January 1, 1976. Their first client was the National Chiropractic Antitrust Committee, which Wilk organized to raise funds for an antitrust suit. Slater and Sperling were hired to write an opinion on the feasibility of an antitrust suit against the medical establishment.
Sperling read the documents from In the Public Interest and some other documents that Wilk provided them through Hosier. He then wrote the factual statement of the letter of opinion, which ran about fifty pages. Slater then wrote the portion of the letter of opinion that applied the legal precedent to the statement of facts -- adding another seventy pages or so. Slater recalls they were paid about $50 per hour ($238/hour in 2019). He thinks the final bill came to about $20,000, a windfall for the young lawyers.
Chiropractic was a house divided. Some chiropractors worried about the potentially huge financial costs a suit could incur, estimated at more than $1 million in the mid-1970s. Some others in chiropractic promoted a different $1 million idea -- spend the funds on a comprehensive public relations campaign -- which Wilk saw as a waste of money.
Wilk's plan for an antitrust suit had few supporters within chiropractic. The power and the seemingly deep pockets of the AMA cowed chiropractors.
It was not widely known at the time that the AMA was quite vulnerable. The association was going broke, as its membership had been shrinking since the AMA lost its all-out battle to stop Medicare. The AMA borrowed funds to meet payroll, and it had laid off about eighty employees, including medical doctors -- an austerity move dubbed as the May Day Massacre on May 1, 1975. A year earlier, the AMA had declared victory and shut down its Committee on Quackery, which had spearheaded the AMA plan to contain and eliminate chiropractic.
Wilk had earned a reputation as a street fighter. In 1974, he'd written a book of his own, Chiropractic Speaks Out: A Reply to Medical Propaganda, Bigotry, and Ignorance. In it, Wilk made a case for the validity of chiropractic based on scientific research, and he attacked the AMA for trying to stop chiropractic education and block insurance and Medicare reimbursement for chiropractic services. "Chiropractic is not a cure-all, but neither is medicine," Wilk said.
Wilk had experienced prejudice himself when he launched his practice and tried to print an ad in Polish in a parish newspaper. The pastor said he couldn't publish the chiropractor's ad, apparently for fear of running up against MD parishioners.
Wilk also had heard plenty of stories about chiropractors being unable to refer their patients to medical doctors or to receive referrals from medical doctors because the AMA's Code of Ethics prohibited this.
He had experienced this firsthand as well. Chiropractors had trouble persuading radiologists to take X-rays of their patients, so they missed out on this expertise and had to buy X-ray equipment for their offices.
Radiology's position came out of Principle III of the AMA's "Principles of Medical Ethics," adopted in 1957, prohibiting MDs from associating professionally with "unscientific practitioners." Principle III holds: "A physician should practice a method of healing founded on a scientific basis, and he should not voluntarily associate with anyone who violates this principle."
Wilk smelled a conspiracy. In his book, he called on chiropractors to unite and bust the AMA monopoly. He contacted Harry Rosenfield, attorney for the American Chiropractic Association. Wilk asked the lawyer about the idea of an antitrust suit, a gambit other chiropractors in the past considered, but one that was abandoned for legal and financial reasons.
Rosenfield opposed Wilk's plan because he felt he had the situation under control with the AMA and that he could achieve peaceful co-existence between the AMA's membership and chiropractic.
But there was change in the air. There had been legal barriers to suing the "learned professions," such as law and medicine, which were considered above the monopoly laws. But fate was smiling on Wilk. The U.S. Supreme Court opened the doors to such suits in the 1970s.
As Wilk toured the country to promote his book, many chiropractors told him if an antitrust suit were organized, they would support it. This gave him hope.
"They would say to me, 'You're meeting a lot of people, If you can rally enough support, count on me, I'd love to be a part of an antitrust suit. If you get enough support, let us know,'" Wilk recalled.
The stars began to align. The determined chiropractor organized a group of like-minded, pro-antitrust litigation chiropractors who felt it was time to fight the AMA monopoly. They were sick and tired of what they saw as abuse at the hands of medical doctors and were not going to take it anymore.
In 1974, five chiropractors from Chicago, North Carolina, South Dakota, California, and Michigan had formed a committee to explore the idea of bringing an antitrust action. The National Chiropractic Antitrust Committee had as its goal to advance the cause for chiropractic and to raise funds for an antitrust lawsuit against the AMA and other major medical groups.
Months after Hosier's speech at National, Wilk reached out to the attorney. They decided to try to build support by attempting to make their case to state associations of chiropractors and the attorneys representing these organizations. It was an end-run around Rosenfield and the calcified leadership of the American Chiropractic Association.
The Congress of Chiropractic State Associations held its meeting on October 25–26, 1975, in Rosemont, Illinois, near O'Hare International Airport. Wilk hoped to speak in forums at this meeting to gain support.
But it wasn't going to happen. Dr. F. Donnell Hart, chairman of the Congress, declined Wilk's request to schedule a time for him to speak. Hart was a known opponent to the suit. He said he couldn't grant the request by himself and asked Wilk to contact him the evening before the meeting started so Hart could consult with the executive committee.
When Wilk and his compatriots arrived in Rosemont, Congress officials informed them that because of a busy agenda, "[the Congress] could not give us any time whatsoever during the meetings -- not even five or ten minutes -- but they could give us time on Sunday afternoon after the meeting adjourned," Wilk said. "But by that time, the state presidents and any other representatives would have left to go home, and we would be speaking to the hotel's clean-up crew."
Wilk said he and his group found as they sat on the sidelines that there would have been plenty of time to give his committee ten minutes, but Rosenfield persuaded the association to blow off Wilk & Co.
A determined man and no shrinking violet, Wilk decided to crash a meeting of twenty-two lawyers representing state chiropractic associations. He had scheduled a time for his antitrust lawyer, Gerald Hosier, to meet with interested lawyers and explain the case. Transportation was arranged.
When the meeting broke up, Wilk made his pitch again, and all but one lawyer, representing the Indiana Chiropractic Physicians Association, ignored him and lost themselves in chit chat and cocktails.
"I was near tears with disgust at what I saw. It was bad enough that their conduct was indifferent toward our offering. Still, these lawyers were being paid by the state associations that retained them in good faith as representative counsel, and that had sent them here because they were supposed to advocate for the associations' interests," said Wilk. "To me, the lawyers were demonstrating an appalling breach of trust."
Hosier persuaded the single Indiana attorney of the merits of an antitrust suit, but that was all he accomplished.
"I was disgusted, outraged, and thoroughly frustrated," said Wilk. "It was the lowest point in my entire professional career."
But that was Sunday. On Monday, a new day was dawning for Wilk and his committee, thanks to the AMA mole who would become known as Sore Throat.