Chester Wilk Antitrust Lawsuit: Trials, 1987 Ruling, and Injunction

The Wilk v. AMA antitrust lawsuit was a federal case brought in 1976 by Chicago chiropractor Chester Wilk and four co-plaintiffs against the American Medical Association and other medical organizations, alleging an illegal conspiracy to eliminate the chiropractic profession in violation of the Sherman Antitrust Act. After a first trial ended in a defense verdict and was reversed on appeal, a 1987 bench ruling by Judge Susan Getzendanner found the AMA liable and issued a permanent injunction, which the Seventh Circuit affirmed in 1990 and the Supreme Court declined to review.

The Conduct at the Center of the Case

The plaintiffs’ claim was that organized medicine had run a coordinated boycott against chiropractors for decades. In 1963, the AMA created a Committee on Quackery (originally the Committee on Chiropractic) whose internal documents stated its mission as “the containment of chiropractic and, ultimately, the elimination of chiropractic.”¹

The mechanism was institutional. The AMA’s code of ethics barred physicians from professionally associating with chiropractors, meaning no referrals, no joint practice, and no teaching. Through its influence over the Joint Commission on Accreditation of Hospitals, the AMA supported “Standard X,” which effectively kept chiropractors off hospital staffs and blocked their patients from hospital diagnostic services.² The committee also discouraged high school counselors from steering students toward chiropractic careers, sent speakers to county medical societies, and ghostwrote anti-chiropractic content for outlets including television scripts and the Ann Landers advice column.³

Wilk’s own experience reflected the effect on the ground. He could not get hospitals to accept his patients for X-rays, and a referral arrangement he built with a local physician in the late 1960s collapsed once the physician learned the AMA’s ethical code forbade professional association with chiropractors.⁴

Who Sued, Who Was Sued, and Under What Law

The complaint was filed in 1976 in the U.S. District Court for the Northern District of Illinois. Five chiropractors signed on as plaintiffs: Chester Wilk, Patricia Arthur, James Bryden, Michael Pedigo, and Steven Lumsden, though Lumsden later withdrew.⁴

The defendants included the AMA, the American Hospital Association, the American College of Surgeons, the American College of Physicians, the Joint Commission on Accreditation of Hospitals, the American College of Radiology, the American Academy of Orthopaedic Surgeons, the American Osteopathic Association, the American Academy of Physical Medicine and Rehabilitation, the Illinois State Medical Society, the Chicago Medical Society, the Medical Society of Cook County, and four individual AMA officers: H. Doyl Taylor, Joseph A. Sabatier Jr., H. Thomas Ballantine, and James H. Sammons.⁵

The legal theory rested on Sections 1 and 2 of the Sherman Antitrust Act. The plaintiffs alleged a private conspiracy in restraint of trade: a group boycott, denial of hospital access, and systematic suppression of a competing licensed profession.²

Lead counsel was George P. McAndrews, a patent lawyer whose father had been a chiropractor and whose brother Jerry led the International Chiropractors Association. When the AMA failed to produce certain records in discovery, McAndrews subpoenaed state medical societies and gathered 26 boxes of internal correspondence, later observing that those state organizations “wrote everything down and never threw anything away.”⁶

The First Trial and Its Reversal

Trial began on December 9, 1980, before Judge Nicholas J. Bua and a twelve-person jury. The plaintiffs asked the court to treat the boycott as a per se antitrust violation, which would not have required proof of unreasonable market impact. Judge Bua refused and applied the “rule of reason” standard instead, putting a heavier burden on the plaintiffs.²

On January 30, 1981, the jury returned a verdict for the defendants.⁵ The AMA’s “patient care defense” carried the day: the organization framed its boycott as a good-faith effort to protect the public from what it called an unscientific practice. McAndrews appealed. On September 19, 1983, the Seventh Circuit remanded the case for a new trial.⁷

The litigation narrowed before the retrial. The American Hospital Association and the Illinois State Medical Society settled. The American College of Radiology was found to have participated in the conspiracy but settled before judgment. The Joint Commission on Accreditation of Hospitals and the American College of Physicians were dismissed after the court concluded they had acted independently of the AMA’s boycott, and charges against the American Academy of Orthopaedic Surgeons were also dismissed.⁸ The plaintiffs also dropped their claim for monetary damages and pursued only injunctive relief.⁹

Judge Getzendanner’s 1987 Ruling

The retrial was a bench trial before Judge Susan Getzendanner. On August 27, 1987, she issued a 101-page opinion finding that the AMA had violated Section 1 of the Sherman Antitrust Act.⁸ The opinion, reported at 671 F. Supp. 1465 (N.D. Ill. 1987), found that from at least September 1963 the AMA’s objective had been the “complete elimination of the chiropractic profession,” pursued through the Committee on Quackery and an ethics code that labeled chiropractic an “unscientific cult” and prohibited physicians from associating with, referring patients to, or teaching chiropractors.

The AMA again advanced its patient care defense. Judge Getzendanner rejected it, concluding that the AMA had “failed to carry its burden of persuasion” and had not shown its boycott was “objectively reasonable throughout the entire period.”⁸ Internal records undercut the AMA’s stated motives. A Board of Trustees member had acknowledged that restrictive policies were “hampering the AMA’s defense position in chiropractic lawsuits” and that the board had a “fiduciary responsibility” to change its principles to protect the AMA’s assets from potential bankruptcy, indicating that policy shifts were driven by legal exposure rather than patient safety.²

The court also found that the AMA had revised its Principles of Medical Ethics in 1980 to allow physicians to associate with chiropractors on paper, but had taken “no assertive actions” to inform its members or the public of the change, letting the exclusionary environment continue.²

The judge declined to rule on the scientific validity of chiropractic itself, writing that “the answer to that question can only be provided by a well designed, controlled, scientific study.”⁸

The Permanent Injunction

Judge Getzendanner entered a permanent injunction barring the AMA from restricting the freedom of any member or any hospital to associate with chiropractors or chiropractic institutions. The order required the AMA to publish the injunction in the Journal of the American Medical Association, which it did in the January 1, 1988, issue, and to send notice to every AMA member confirming that physicians could ethically associate with chiropractors when the physician believed doing so was in the patient’s best interest.⁸⁹

Appeal and Final Resolution

The AMA appealed. On February 7, 1990, the Seventh Circuit affirmed in a unanimous opinion by Circuit Judge Manion, joined by Circuit Judges Wood and Ripple. The panel upheld both the finding of an illegal boycott and the rejection of the patient care defense, agreeing that the AMA had not shown its concern for scientific methods was objectively reasonable or that a nationwide boycott was the least restrictive means available. The court also found that although the formal boycott had technically ended in 1980, its “lingering effects” continued to cause economic injury and reputational harm to chiropractors, justifying the injunction.¹⁰

The AMA petitioned the U.S. Supreme Court for certiorari. Review was denied in 1990 at 498 U.S. 982, and two additional AMA petitions that year were also denied, making the injunction final.¹¹

What the Ruling Changed

The decision dismantled the institutional structure that had kept chiropractors outside mainstream medicine. Pathways to hospital privileges, interprofessional referrals, and insurance reimbursement opened after decades of being closed. Lou Sportelli, a retired chiropractor who worked with Wilk, called it “one of the most important pieces of litigation that changed the trajectory of the advancement of the profession.”¹²

The victory was not total. Keith Overland, a former president of the American Chiropractic Association, said the AMA later shifted to more subtle strategies, including using “payment mechanisms to try and prevent patients from having equal access” to chiropractic care. Medicare, for instance, covers chiropractic services but restricts chiropractors to limited billing codes, often producing lower reimbursement than physician-level providers receive. In 2010, the AMA House of Delegates adopted a resolution to lobby for the repeal of Section 2706 of the Affordable Care Act, a provision that provides non-discrimination protections for healthcare providers including chiropractors.⁸

The case also mattered in antitrust law more broadly. Coming after the Supreme Court’s 1975 decision in Goldfarb v. Virginia State Bar, which eliminated the “learned profession” exemption from antitrust law, Wilk helped establish that professional associations are subject to antitrust scrutiny when their standards suppress competition from other licensed professions rather than genuinely advance public welfare.⁵

1
PMC (NIH). Historical Context of the AMA Campaign Against Chiropractic
2
PMC (NIH). Antitrust Claims in Wilk v AMA
3
AMA Journal of Ethics. Chiropractic’s Fight for Survival
4
PMC (NIH). The Untold Story of the AMA Conspiracy
5
Washington University Law Review. Wilk v AMA: Legal Analysis
6
Zasio. Contain and Eliminate: How Records Saved a Profession
7
CaseMine. Wilk v American Medical Association (7th Cir.)
8
Chiro.org. Wilk v AMA: 25 Years Later
9
Biotech Law (LSU). Wilk v American Medical Association, 895 F.2d 352
10
vLex. Wilk v American Medical Association, 895 F.2d 352
11
American Chiropractic Association. In Memoriam: Dr. Chester Wilk
12
Chicago Sun-Times. Chester Wilk Obituary