Soc Sci Med. 1986 ; 22(10): 1035-46.

Limits to medical dominance: the case of chiropractic.

Coburn D, Biggs CL.

This paper describes and analyzes the social history of chiropractic in Canada to partially test a thesis regarding changes in the dominance of the medical profession. We earlier sketched the rise of medicine to dominance by World War I, its consolidation until after World War II, and signs of the start of a decline in dominance signalled by the 1962 doctors' strike in Saskatchewan. One test of the historical sequence described, and particularly the recent signs of decline in medical power, is to examine one of orthodox medicine's major competitors, chiropractic. To what degree has medicine been successful in its opposition to chiropractic? The development of chiropractic in Canada shows its early survival and latterly, in the 1960s and 1970s its increasing popular use and official recognition. Particularly important in its recent success was the establishment of a college in Canada in 1945 and partial inclusion of chiropractic under government health insurance in the 1970s. While chiropractic has gained in acceptance and recognition it has sacrificed many of its earlier claims to be an alternative healing art and to some degree chiropractic has become 'medicalized'. But medicine has also been forced to make concessions. Despite total medical opposition, chiropractic survives. The recent successes of chiropractic tend to confirm our earlier thesis of the beginnings of the decline of medical dominance and to show that medicine, while dominant, was never hegemenous. However, chiropractic did not produce medicine's current difficulties. Rather medicine is being challenged directly by state power and pressures to rationalize health care and indirectly is affected by the class struggle. Chiropractic itself owes much of its own early success to support by the working class and working class organizations such as unions. In this sense both medicine and chiropractic can only be adequately viewed both in relationship to one another and as part of the changing Canadian social structure as a whole.