Looking back at the lawsuit that transformed the chiropractic profession part 1: Origins of the conflict

Objective This paper is the first in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of the AMA and the origins of chiropractic and to explore how the AMA began its monopoly of health care in the United States, possible reasons that organized medicine acted against chiropractic, and how these events influenced the chiropractic profession. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. We used primary and secondary data sources. The final narrative recount was developed into 8 papers that follow a successive time line. This paper is the first of the series and explores the origins of the aversion of organized American medicine to other health professions and the origins of the chiropractic profession. Results The AMA began in the mid-1800s to unify like-minded “regular” medical physicians who developed a code of ethics and promoted higher educational standards. Their efforts to unify had excluded other types of health care providers, which they called “irregular” practitioners. However, Americans were seeking more natural alternatives to the harsh methods that regular medical physicians offered at that time. Nearly 50 years after the AMA began, the chiropractic profession attempted to emerge during a time when many patients valued vitalism and their freedom to choose what health care provider they would access. Conclusion During the years that chiropractic developed as a healing profession, organized medicine was already well established and developing a monopoly in American health care. These events created the foundation on which the tensions between these professions were built and ultimately resulted in the Wilk v AMA lawsuit.

The progression of diversity: Black women in neurosurgery

While diversity in organized medicine has undoubtedly improved, a disparity remains in the racial and gender makeup of its constituents. This disparity is not distributed equally among all specialties of practice. The surgical subspecialties exemplify this phenomenon by having large gaps between the number of women and racial/ethnic minorities compared to their majority counterparts. Pertaining to neurosurgery in the US, this gap is substantial, with women reaching minority status only within the last 2 years. Among international women in neurosurgery, Black women are even further underrepresented despite efforts in recent years to close the gender gap. The reason for this disparity is likely multifactorial, as Black women demonstrate a unique intersectionality as a minority in regard to both race and gender. In this study, the authors provide historical context for the current state of diversity in neurosurgery and the global strides made by Black women within the field. The authors report recurrent themes in the experiences of Black female neurosurgery attendings and residents as revealed through personal interviews. Furthermore, they examine factors that contribute to the disproportionate representation of Black women in neurosurgery.

Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School’s Commitments to Newark

Many have referred to the coronavirus disease 2019 crisis and intertwined issues of structural racism as “twin pandemics”. As healthcare workers in Newark, New Jersey, a city heavily affected by the twin pandemics, we recognize that health workforce changes must be grounded in our community’s recent history. The objective of this essay is to briefly describe the relationship between organized medicine, state and local leaders, and the people of Newark. We begin with a discussion of Newark in the 1950s and 1960s: its people experienced poor socioeconomic conditions, terrible medical care, and the many sequelae of abhorrent racism. Plans to establish a New Jersey Medical School in Newark’s Central Ward also threatened to displace many residents from their homes. We then describe the Newark Agreements of 1968, which formalized a social contract between the state, business leaders, and people of Newark. In part, the Medical School committed to indefinitely promoting public health in Newark. We share progress towards this goal. Finally, we document key healthcare administrative decisions facing our community today. Stakeholder opinions are shared. We conclude that the Newark Agreements set an important standard for communities across the country. Creative solutions to healthcare policy may be realized through extensive community collaboration.

What Doctors Want: A Comment on the Financial Preferences of Organized Medicine

Organized medicine’s persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession’s longstanding preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This comment revisits classic comparative studies of organized medicine in the advanced democracies to highlight two underemphasized findings: (1) physicians’ financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today, as a discussion of contemporary American health politics illustrates.