by John Weeks
I have always viewed work in healthcare “integration” as deeply akin to the effort to racially integrate the culture we inhabit.
So I was riveted when Barack Obama addressed the nation with a speech which was, as the Daily Show’s Jon Stewart put it, the first time “a prominent politician spoke to Americans about race, as though they were adults.” I listened as a child of parents who took me on Open Housing marches in Seattle 45 years ago. I also listened from within my 25 years of involvement with thousands of you in the plodding advancement of the “integration” of health care disciplines and practices.
The parallels are profound. Between Western biomedicine and Asian medicine, between the dominant school of medicine and new paradigm world medicine or any healing-oriented, whole person approach, there exists a huge cultural and economic chasm.
The classic evidence of the reach of bias is the lambasting of alternative medicine as unscientific, throughout the 1960s, 1970s and 1980s. First, research funding was largely denied to the alternative fields in that period. More important, if the dominant school of medicine was a paragon of science, then why was the dominant school in need of an “evidence based medicine” revolution in the early 1990s?
Like the rights of non-Caucasians in such decisions as Brown versus the Board of Education or the resolution of the opening housing issue here in Seattle, the rights of non-dominant healthcare disciplines were opened by a major legal case. Wilk versus the American Medical Association (AMA) was a decade-long battle, 1977-1987, pitting chiropractors against the AMA [1] Yet while the plaintiffs represented chiropractic, their legal campaign – hard fought and grassroots fundraised like so much in civil rights – was a battle for all non-dominant, natural health care.
Look at some the elements of this case in the light of civil rights actions.
- Slurring, bigoted language The AMA, through its own media campaigns and those of its surrogates, routinely dismissed all alternatives as “quackery, as “fraud” and as “unscientific cults.” Routinely blasted were therapeutic nutrition, naturopathic medicine, acupuncture, holism, hypnotherapy, mind-body approaches, vitamins, and, of course, the favored target, and the most powerful “other” - chiropractic. It was not that there was no truth in the AMA claims. Rather, n-word labels were affixed to entire classes of professionals. Certainly the same level of slandering vigor was not directed by the AMA at exposing the much more costly – both in dollars and human health - unscientific practices in medicine’s dominant school.
- Institutional segregation The AMA, under its own principles in the early 1980s, forbade its members to maintain any relationship with any practitioners who did not “practice a method of healing founded on a scientific basis.” (Again, the issue is with prejudicial application of a principle: the subsequent development of “evidence-based medicine” raises the question about whether AMA members should have been in relationship to each other, or to themselves, for that matter, if they followed the tenet.)
- Red-lining This term is taken from civil rights work. It refers to the practice, by insurers, of not issuing homeowners or business insurance in certain neighborhoods, leading to their decline. Non-dominant healthcare disciplines and practices and those that are health-oriented, remain, to this day, largely redlined and uncovered by medical insurance.
- Lost economic opportunity Redlining is part of a broader exclusion of non-dominant practitioners from participation with the economic activity at the center of the now $2.1 trillion medical-industrial complex. This is both private sector and government sector. Federal programs to support healthcare education, research, and clinical services are typically either closed to non-dominant practitioners, institutions and professions or have only recently been barely wedged open.
As happened often in civil rights cases, the plaintiffs in Wilk did not immediately win. They had to re-file. But on September 25, 1987, the judge issued her opinion that the AMA had engaged in an unlawful conspiracy in restraint of trade "to contain and eliminate the chiropractic profession." The judge issued a permanent injunction against the AMA to prevent such future behavior. [2]
Colleagues have suggested to me that I draw the parallels between racial issues and healthcare integration issues too closely. I submit that, given the mixed cultural and economic forces which promote and uphold healthcare segregation in the United States, to understand our efforts in the context of civil rights and social justice campaigns is appropriate. Certainly there was no slavery, and forced immigration in our healthcare integration world. But there has been institutional apartheid – and even an effort at genocide against a profession, if the judge’s finding is correct. Yes, one cannot choose one’s race as one can a profession as one chooses a healthcare discipline. Yet once one hangs one’s initials behind one’s name, whether the initials be “DC” or “ND” or “MD” or “RYT” or “LAc,” a load of cultural baggage, bias and prejudice is immediately deposited on a practitioner, good and bad. One is often judged by the color of one’s degree, not by the skills and abilities. Opportunities are denied, or inappropriately preferred.
Obama spoke of race in the context of our 220 years of work, in the United States, to “form a more perfect union.” Our efforts to form a more perfect union of therapies, practices and practitioners in the service of the health of the people are barely 20 years old. Obama pointed out that one errs if one acts or speaks as though the United States is static, that there have been no positive changes. The error, rather, is to not admit the depth of the inequities and the troublesome nature of our history, so that our action can be fully informed by the past.
The same holds true for those of us in healthcare integration. The advances in our integration dialogue in hospitals, among employers, across disciplines, between academics, in research and in governmental programs have been nothing short of astonishing since the days of Wilk. At the same time, just yesterday I learned that yet another health system refused to allow either a chiropractor or a naturopathic physician to be a presenter in their continuing education program on complementary and alternative medicine topics. The exclusion was not based on merit. The message: MDs only beyond these gates.
Perhaps we are beginning now to have the strength to talk, as adults, about the depth of the prejudice, injustice and discrimination that continues to haunt our integration dialogue.
[1] Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987
[2] http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association
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